f&e disorders

7/23/2019 F&E Disorders

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Fluid & Electrolyte

Disorders

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Fluid )olume De*cit+,o (!ter' ,o -!lt' r /ot#

• ,o (!ter +#ypertonic

– Profuse swe!ting' #yper%entil!tion' D'

fe%ers' di!rr#e!' ren!l f!ilure' D• ,o -!lt +#ypotonic

– (!ter intoic!tion' c#ronic illness'

m!lnutrition' ren!l f!ilure• /ot# +isotonic

– ,P' poor int!ke' #emorr#!ge



Fluid )olume De*cit•

4ow /P' #ig# 5• Dry mout#' t#irst

• 5!pid weig#t loss

• 4ow urine output

• 6onfusion' let#!rgy• -781.030' #ig# ct'

#ig# /9,' low ,!'#ig# osmo • Fluids +or!l if !lert

•

,- or 45 +no pot!ssium untilurine output is incre!sed

• D!ily weig#t' strict :s

• ;!y need !ntidi!rr#e!ls'!ntiemetics' !b' !ntipyretics

(#!t c!nyou do<

(#!t !ret#e

symptoms<



Fluid )olume Ecess•

5!pid weig#t g!in• Edem!

• ig# /P' boundingpulses

•

;!y #!%e urineoutput

• A)D' cr!ckles' dyspne!

• Decre!sed 46

• 4ow ct' low /9,'#ig# ,!' low osmo • Diuretics

• Fluid restriction +no )?uids

•

-odium restriction•

(#!t c!n

you do<

(#!t !ret#e

symptoms<



4!b ,orm!ls

Electrolyte 5!nge ;!gic B

Pot!ssium 3.C C.C B

6#loride 10G 10B

-odium 13C " 1BC 1B0

p H.3C H.BC H.B

p62 3C BC B0

63 22 2G 2B

FI em!tocrit norm!l is 3 times t#e #emoglobin +10"1B is norm!l



-odium +13C 1BC mEJ:4

• ;!Kor c!tion of E6F

• -odium le%el re?ects t#e r!tio of sodiumto w!ter

• 5egul!ted by kidneys' D' !ldosterone

• 7 tr!ct !bsorbs sodium from food

• mb!l!nces !re typic!lly !ssoci!ted wit#

?uid %olume problems• Foods #ig# in sodium processed me!ts'

condiments' d!iry



ypern!tremi! + ,!

• (!ter loss or ecesssodium

• ,! ecretion ren!lf!ilure' corticosteroids

• ,! int!ke e!ting toomuc# s!lt' too muc#sodium in ) ?uids

• w!ter loss fe%er'

infection'#yper%entil!tion'swe!ting' di!rr#e!'de#ydr!tion

LIou re FriedMF Fe%er +low gr!de'?us#ed skin

5 5estless+irrit!ble

ncre!sed ?uidretention !nd

/P

E Edem!+perip#er!l

!nd pittingD Decre!sed urine

output' dry

mout#



ypern!tremi! + ,!

(#!t c!n

you do<• >re!t t#e underlying

c!use

• Diuretics

• -odium restriction

•

-eiNure prec!utions

5educesodiumslowlyO



ypon!tremi! + ,!

• • (!ter ecess or loss of sodium

Dilution polydipsi!' fres#w!ter drowning'-D' 6F

ecretion swe!ting' diuretics' 7 wounddr!in!ge' ren!l dise!se

int!ke ,P' low s!lt diet' se%ere%omiting:di!rr#e!

-ymptoms=

6onfusion' #e!d!c#es

-eiNures +c!n progress to com!



ypon!tremi! + ,!

(#!t c!n

you do<

• 3@ norm!l s!line

•

f c!used by ?uidecess' will need ?uidrestriction

• 9su. c!nt be *ed by!dding sodium to t#e

5epl!cesodiumslowlyO



Pot!ssium +3.C " C.0 mEJ:4

• ;!Kor c!tion of 6F

• -odium"pot!ssium pump is ! m!Kor controller

• ;o%es into cells during form!tion of new

tissues !nd le!%es t#e cell during tissuebre!kdown

• -ource of pot!ssium diet

• Prim!ry route of loss " kidneys

• Foods !%!c!do' *s#' b!n!n!' A' r!isins'dried fruits' me!t' milk' fruits' %eggies' s!ltsubstitutes



yperk!lemi! +

6!uses kidneyf!ilure +mostcommon' use of s!ltor pot!ssium

supplements'recei%ing old blood'cell destruction'!cidosis' #ypoi!'eercise' c!t!bolicst!te' use ofpot!ssium"sp!ringdiuretics

6!n get f!lse #ig#

L;95DE5M; ;uscle we!kness

9 9rine' oliguri!'

!nuri!5 5espir!tory

distressD Decre!sed c!rdi!c

contr!ctilityE E67 c#!nges5 5e?ees'

#yperre?ei!'

or !re?ei!



yperk!lemi! +

(#!t c!n

you do<

• 6!rdi!c monitor• !ye!l!te' c!lcium

glucon!te' orglucose & insulin )• 4!si if kidneys !re

functioning•

-top pot!ssium in )?uids• !%e pt !%oid foods

#ig# in pot!ssium•

Di!lysis if se%ere



ypok!lemi! +

• 6!uses

– )omiting' ,7 suction' di!rr#e!' medic!tions+diuretics' l!!ti%es' insulin' met!bolic!lk!losis' r!pid cell building +ie. /12 oreryt#ropoietin to incre!se 5/6s

• -igns:symptoms

– Dysr#yt#mi!s' we!kness' n:%' p!r!lytic ileus'constip!tion' low /P' we!k pulse' incre!seddigoin toicity' muscle we!kness !ndp!r!lysis' diuresis



ypok!lemi! +

(#!t c!n

you do< • 6!rdi!c monitor• Foods #ig# in

pot!ssium

• (!tc# for dig toiciity

• Pot!ssium ) +only ifgood urine output

• -pirinol!ctone

• >re!t constip!tion

• eep pt s!fe from f!lls

(!tc#for

DigointoicityO

Pot!ssium dministr!tion•;ust #!%e urine output•,e%er gi%e ) pus#•

;ust be on c!rdi!cmonitor•ssess ) site often +prefer6)6•lw!ys dilute !nd gi%e nomore t#!n 20 mEJ' no

f!ster t#!n 1 #r•;! concentr!tion in )



6!lcium +.0 10.C mg:d4

• Prim!ry source is bones

• 5egul!ted by p!r!t#yroid #ormone'c!lcitonin' !nd %it!min D

• $ects tr!nsmission of ner%eimpulses' #e!rt !nd musclecontr!ctions' blood clotting' !ndforming of teet# !nd bone



yperc!lcemi! + 6!

(#!t c!nyou do<

(#!t

c!uses it<

(#!t !ret#e

symptoms<



ypoc!lcemi! + 6!

L6>-6 6on%ulsions rr#yt#mi!s

> >et!ny- -p!sms !nd

stridor



P#osp#!te mb!l!nces

• yperp#osp#!temi! – 6!use " ren!l f!ilure' tumor lysis syndrome – -:- c!lcium deposits in Koints' skin' kidneys' eyesQ

#ypoc!lcemi!' tet!ny' neuromuscul!r irrit!bility –

> * #ypoc!lcemi!• ypop#osp#!temi!

– 6!use m!lnutrition' m!l!bsorption syndrome'!lco#ol !buse' too m!ny !nt!cids

– -:- 6,- depression' confusion' muscle we!kness'

dysr#yt#mi!s' fr!ctures – > or!l supplements +,eutr!"P#os' decre!se

c!lcium int!ke' ) p#osp#!te +but t#is c!n c!usesudden #ypoc!lcemi!' stop !n!t!cids !nd c!lciumsupplements



;!gnesium mb!l!nces

• yperm!gnesemi! – 6!use incre!sed int!ke +ie. ;;' ;!!lo wit#

c#ronic kidney dise!se – -:- let#!rgy' n:%' loss of D>5s' c!n #!%e

respir!tory !nd c!rdi!c !rrest – > !%oid m!gnesium"cont!ining drugs' incre!sed

?uid int!ke' m!y need di!lysis

• ypom!gnesemi! – 6!use prolonged f!sting or st!r%!tion' c#ronic

!lco#olism' diuretics – -:- confusion' #yper!cti%e D>5s' tremors'

seiNures' c!rdi!c dysr#yt#mi!s – > or!l supplements' incre!se green %eggies' nuts'

b!n!n!s' or!nges' pe!nut butter' c#ocol!teQ ) or ;

m!gnesium +if gi%en too r!pidly c!n c!use c!rdi!cor respir!tory !rrest



;edic!tions

• 4oop diuretics

• >#i!Nide diuretics

• Pot!ssium sp!ring diuretics

• Electrolytes

• !ye!l!te

General Rules

• Dont gi%e !t nig#t• 6ommonly gi%en

wit# !n!nti"#ypertensi%e

• ll but pot!ssium" sp!ring will decre!se

pot!ssium le%els

Dontforget

rules forgi%ing

pot!ssiumO



m!ge ttribution

• -lide 1 Flickr by 5!ndy 4eR;oineP#otogr!p#yQ www.pi!b!y.com' no!ttribution reJuired

•

-lide G Flickr by %!n(!ls#.com• -lide 1 " www.pi!b!y.com' no !ttribution

reJuired

• ;uc# inform!tion on t#ese slides +notim!ges w!s utiliNed from ;osbys Fluid &Electrolyte ;emory ,otec!rds

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