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    Describe Osmolality and Tonicity

    Discuss the iso-osmolality range for serum

    and isotonicity of intrav enous soluti ons.

    Describe the four c lassif ications of

    intrav enous fluids.Diff erentiate betwee n cations and an ions of

    electr oly tes.

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    Exp lain the m ajor f unction of cations.

    Discuss e xamp les of p otassium , calcium , and magnesium supp leme nts.

    Exp lain the meth ods use d to correct potassium , calcium , and magnesium e xcess.

    Describe se v eral signs and s y mp toms of h y p okalemia,

    h y p erkalemia, h y ponatremia, h y p ernatremia,h y p ocalcemia, h y p ercalcemia, h y p oc h loremia,h y p erc h loremia, h y p oph os ph atemia,h y p er ph os ph atemia.

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    Exp lain the pharm acok inetics and

    pharm acod y namics of oral and intrav enous

    potassium ch loride and calcium s alts.

    Describe the assessme nts , nsg. Inter v entions, and

    client te aching for fluid, potassium , sodium , calcium , and magnesium imb alances.

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    DISTRIBUTON OF BODY FLUIDS

    INTRACELLULAR FLUIDfound w it h in the ce lls of the b od y

    EXTRACELLULAR FLUIDfound outside the ce lls and counts about 1/3 of total body fluids.

    y Intravascu lar fluid or p lasmay

    Interstiti al fluidy Others c ompartme nts of ECF:

    y L y mphy Transcellular fluid

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    Is expresse d as osmoles or mi lliosmoles per kilogram

    (mOsm/ kg) of water.

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    :H as the s ame proportion of weight of partic les

    (Na, glucose, ure a, protein) and water.

    H as f ewer partic les th an water.

    H as more partic les th an water.

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    :

    1.

    2

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    Norm al Serum Osmolalit y 275-295 mOsm/ kg

    H y po-osmolarSerum Osmolalit y is less th an 275 mOsm/ kg

    Ma y be the resu lt of excess water i ntake or fluid o v erload (edem a).

    H y per- osmolar

    Serum Osmolalit y is greater th an 295 mOsm/ kgIt pulls the fluid right out the ce ll and deh y drates thepatient

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    mOsm/ kgD5W 250

    NSS or NaCl 310LR sol n 275R ingers s ol n 310

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    Sodium

    PotassiumCalciumMagnesiumCh loridePhosphorus

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    Maintaining fluid balance

    Contributi ng to acid-base re gulation

    Facilitating enz y me re actions

    Transmitti ng neur omuscu lar re actions

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    Sodium and Potassium

    Norm al le v el of NaECF = 135-145 mEq / L

    ICF = 3.5-5 mEq/ L

    Norm al le v el of KICF = 135-145 mEq/ L

    ECF = 3.5-5 mEq /L

    Na K pump

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    (Na 135 mEq/L)

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    (Na 145 mEq/L)

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    Peri odic table

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    (K 3.5mEq/L)

    Metabolic Alkalosis

    U OTissue tr aum a, injur y Vomiti ng (loos H ion)

    insu lin

    y Ectop ic be adsy

    Nausea and v omiti ngy A bdomina l diste ntion-droped perist alsisy Skeletal musc les

    weakness

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    V EGET ABLES FR U ITS B E V ER A GESy B aked potato B anana A pricot nectary A sparagus A pricot M ilky R a w carrot C an taloupe O range juicey R a w tomato O rangey S p inach D ried f ruits

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    (K 5.3 mEq/L)Causes : S/S:

    TxTx::

    Drugs:Drugs: Kayexalate

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    (8 .5 10.5 mEq/L)

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    (Ca 8 mg/dL)

    y Intake of Ca and

    v itamin Dy Lactose intolerancey Kidne y f ailurey CRF?y Diuretics

    y (+) Trosseau s signy (+) Ch v ostek s signy Irre gular pulsesy We akness

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    (Ca 10.5 mg/dL)

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    (1.5-2.5 mEq/L)

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    I V magnesium su lf ate

    Calcium glucona te

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    (1.7-2.6 mEq/L)

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