Fluid & Electrolyte - Exam 1

What are some causes for hyponatremia r/t water increase?SIADH, water intoxication, freshwater drowning, fluid volume excess, hyperglycemia (causes the development of pseudohyponatremia (hyperglycemia causes hypertonic condition. Osmosis occurs and creates a dilution of the Na+)What are some causes for hypernatremia if the serum Na+ is within normal limits but the water decreases?Water loss, burns, fever, diuretics, decreased oral intake, diabetes insipidus, vomiting, diarrheaWhat are some causes for hypernatremia when the serum Na+ level increases?Excessive intake (oral or IV), concentrated TPN or infant formula, administration of a hypertonic solution, kidney injury, saltwater drowningWhat are the signs and symptoms of hyponatremia?Neurological changes such as irritability, headache, confusion, seizure potentialWhat are the signs and symptoms of hypernatremia?Neurological changes such as agitation, decreased LOC, coma, thirstWhat are the treatments for a patient who is hyponatremic r/t sodium loss?Replace sodium either orally or via hypertonic IV solution. Be sure to replace slowly over 48 hoursWhat is the treatment for a patient who is hyponatremic r/t water gain?Fluid restriction to concentrate solutes.What are the treatments for a patient who is hypernatremic r/t a decrease in water but sodium levels within normal limits?Increase fluid intake with plain water or through IV with an isotonic or hypotonic solution.What are the treatments for a patient who is hypernatremic r/t an increase in sodium but water is within normal limits?Decrease sodium intake either by reducing oral intake or by diluting serum sodium levels with a sodium-free IV liquid such as lactated ringers solution. Administer diuretics if fluid volume status is stableWhat dietary teaching should be done for a hyponatremic patient?Ingest drinks that contain electrolytesWhat dietary teaching should be done for a hypernatremic patient?Avoid foods high in sodium and follow a low sodium diet. Season foods with salt substitutes (high in potassium so may not be best option for all patients) or with lemon/herbs.What are examples of foods that are high in sodium?Canned soups and vegetables, cheese, ketchup, processed meats, table salt, salty snack foods, seafood, pickled foods, MSG/seasoned salt/soy sauce, baked goods with baking powder and baking soda.What is the function of chloride?Maintains water distribution between the ECF/ICFWhat is the relationship between sodium and chloride?Direct relationship with sodium; they're best friends; Chloride is anion and sodium is cation; when one goes up or down so does the other. Chloride just follows sodium. Chloride imbalance is never seen alone, always paired with sodium imbalance. Causes, assessment and treatment are identical to that of sodium.What is the function of potassium?Maintains neuromuscular function and acid-base balanceWhat are some causes of hypokalemia r/t potassium loss?Chronic diarrhea (ileostomy/IBS), prolonged GI suctioning, diaphoresis, dialysis, certain medications (loop/thiazide diuretics) decreased oral intake (anorexia or pts who have pica)What are some causes of hypokalemia r/t water gain?Any fluid volume excess scenario, CHF, excessive oral intake or IV hypotonic solutionWhat are some causes of hyperkalemia r/t potassium being within normal limits but a decrease in water?Metabolic acidosis, burns, trauma (excessive bleeding), vomiting, diarrheaWhat are some causes of hyperkalemai r/t a potassium increase with water levels within normal limits?renal dysfunction (chronic kidney disease/acute kidney injury), certain medications (ACE inhibitors, ARBs, NSAIDs), excessive intake (too much salt substitute), Addison's disease, potassium shift from ICF to ECF caused by cellular damage (rhabdomyolysis, crush injuries, tumor lysis)What are the symptoms of hypokalemia?Drowsy symptoms: muscle weakness, paralysis, flat/sleepy T-wave, possible U-wave, shallow respirations, respiratory distress, decreased motility, constipation, paralytic ileusWhat are the symptoms of hyperkalemia?Excitable symptoms: muscle twitching, wide QRS complex and tall/peaked T-waves or flat P-waves, abdominal cramping/diarrheaWhat are the treatments for hypokalemia?Oral potassium (liquid, tablet, or powder that you can dissolve in juice), IVHow should IV potassium be administered?never give as IV push!! This is what they give for euthanasia at animal hospitals. Rate should NEVER be given more than 20 mEq/hr. Pt should always be on telemetry to monitor for dysrhythmiasHow can you administer IV potassium?It is very irritating to the veins; you can use a large bore vein, but central line is preferred. Can be mixed with lidocaine to reduce irritationHow is hyperkalemia treated?Change diet; low potassum foods or discontinue oral potassium intake. K-cocktail; kidney excretion via loop or thiazide diuretics and dialysis in severe cases, GI excretion with kayexelate which is a GI resin to create loose stool diarrhea.What is a K-cocktail?It is used to quickly push potassium back into the cell in emergency situations. Consists of calcium gluconate and insulin (give glucose with this to avoid hypoglycemia), and beta agonist (albuterol is most common)What is some diet teaching you should do for a patient with hypokalemia?Eat foods high in potassium such as sweet potatoes, yogurts, bananas, orange juice, milk, dried fruit, melon, tomatoes, avocado, raw carrots, green leafy vegetables, most peas and beans.What is some diet teaching you should do for a patient with hyperkalemia?Avoid salt substitues, increase fluid intake, eat less red meat, eat more fish, follow a low potassium diet; eggs, apples, peas, peaches, cauliflower.What is the function of calcium?Facilitates blood clotting, is required for muscle contraction, needed for transmission of nerve impulses. Calcium creates stability in the synapse of the nerves. WIthout this, the threshold is decreased and nerve channels open very easily. In hypocalcemia, you get a very hyperactive nerve. In hypercalcemia, you get a very hypoactive nerve.What is bound calcium?40% is bound to protein, mainly albumin. The level of bound calcium is dependent on albumin levels and is useful when there is a normal serum albumin level.What is ionized calcium?Ionized is bound to nothing. It is dependent on hydration status. It is useful when patients have abnormal albumin levels.What is the role of calcitonin?Calcitonin "keeps" calcium in bones; When there is an increase in serum Ca+, calcitonin gets released and promotes deposition of Ca+ in the bone. This is a "negative feedback" system.What is the role parathyroid hormone (PTH)?When there is a decrease in serum Ca+, PTH gets secreted; Ca+ gets released from bones and is reabsorbed from the kidneys. Calcalcitrol (the active form of vitamin D) is also released and increases the calcium absorption in the GI tract. This is a "negative feedback" systemWhat are possible causes of hypercalcemia r/t calcium retention?Cancer (mostly bone cancers which cause a breakdown of bone and releases into the bloodstream). Excessive PTH which pulls Ca+ from the bonesWhat is the possible cause for hypercalcemia r/t excessive calcium intake?Excessive dietary intake or vitamin D/calcium supplementationWhat are the signs and symptoms of hypocalcemia?Numbness, tingling, tetany, seizure, Chvostek/Trousseau's, more prone to bleeding (Vitamin K and calcium work together for blood clotting), prolonged QT/ST segment, laryngeal spasm or contraction of diaphragm, hyperactive bowel sounds, diarrheaWhat are the signs and symptoms of hypercalcemia?Decreased reflexes and possible overall muscle weakness, increased blood clotting, shortened QT/ST segments, may experience respiratory depression or diaphragm paralysis, hypoactive bowel sounds and possible constipation.What are the treatments for hypocalcemia?Give oral supplements, increase dietary intake, give vitamin D supplements to increase GI absorption which can also be given IV calcium gluconate or calcium chlorideWhat are the treatments for hypercalcemia?Discontinue oral supplements, decrease dietary intake, promote renal excretion by increasing fluid intake to 3-4 L per day and administer loop diuretics. If patient is in renal failure, dialysis is indicated. Weight bearing exercises increase deposition of calcium back into the bone.What can you teach a patient with hypocalcemia about their diet?Consume foods high in calcium, how to take calcium supplement, how to prevent osteoporosis to avoid falls.What can you teach a patient with hypercalcemia about their diet?Avoid foods high in calcium, drink 3-4 liters of fluid per day to eliminate excess via the kidneys.What are some foods that are high in calcium?Yogurt, milk, cheese, salmon, tofu, rhubarb, sardines, collard greens, spinach, turnip greens, okra, white beans, baked beans, broccoli, peas, brussel sprouts, sesame seeds, bok choy, almonds.What is the function of magnesium?50% is found in the bones but it's primary location is in the ICF. Mg is required for muscle relaxation and supports immune function. It is also needed for absorption of calcium and vitamin B12What are some causes of hypomagnesemia?Shift from ICF to ECF (can be from burns, pancreatitis, or correction of acidosis). The most common cause is chronic alcoholism.What are some causes of hypermagnesemia?Excessive intake (most often r/t medical treatment; IV for pregnant women who are experiencing preeclampsia, also found in a lot of antacids, magnesium sulfate is a treatment for Torsades de Pointes). Increased absorption (r/t stagnant gut; postoperative, chronic constipation, paralytic ileus, decreased gastric motility r/t medications such as narcotics and anticholinergics) since everything sits in the gut longer, Mg is absorbed at a higher rate. Decreased excretion (chronic kidney disease and rhabdomyolysis)What are the signs and symptoms of hypomagnesemia?Excitable!! - tremors, seizures, muscle cramps, elevated heart rate and bloop pressure. Closely resembles potassium changes with a flat T wave and the development of a U wave.What are the signs and symptoms of hypermagnesemia?Drowsy...... - lethargic, decreased level of consciousness, decreased deep tendon reflex, decreased heart rate and blood pressure. Closely resembles potassium changes with a wide QRS complex and elevated T wave, development of Torsades de Pointes. Respiratory depression and hypoventilation.What are treatments for hypomagnesemia?Administer milk of magnesia and/or maalox. IV magnesium sulfate which is the most common treatment for uterine tetany related to preeclampsia in the OB unit; give very slowly and make sure you monitor respiratory status. IM magnesium sulfate is only used in emergency situations.What are treatments for hypermagnesemia?Discontinue all oral supplements. Remove the excess magnesium with dialysis; can give loop/thiazide diuretics, IV calcium gluconate will also promote renal excretion of Mg.What diet teaching can you do for patients with hypomagnesemia?Eat foods high in magnesium. Oral magnesium supplements are always to be taken with food. Don't take Mg supplements with iron because it will inhibit Mg absorption.What should you teach a patient with hypermagnesemia about their diet ?Avoid foods high in magnesium!What are examples of foods high in magnesium?Bananas, avocado, apricot, spinach, raisins, broccoli, lettuce, oatbran, walnuts, cashews, almonds, peanut, brazil nuts, pine nuts, black beans, white beans, lima beans, soy beans, almost all dairy products, pumpkin, cocoa, coffee, tap water, fish, tomato paste.Where is phosphorus located?80% is found in the bones/teeth and bound to calcium, the rest is in the ICF.What is phosphorus used for?Regulates calcium balance, is needed for muscle and nerve transmission, maintains acid-base balance, assists RBC to release oxygen bound to hemoglobin.What are some causes of hypophosphatemia?Phosphate loss (profuse vomiting/diarrhea, prolonged NG suction, excessive calcium supplements, or burns), inadequate intake (malnutrition), impaired absorption (celiac's or crohn's disease), increased excretion (from medications such as steroids, dexamethasone, loop/thiazide diuretics), shift from the ECF (burns/trauma, fluid volume excess, refeeding syndrome).What are some causes of hyperphosphatemia?Phosphate gain (from laxative use such as sodium phosphate), excessive intake (dietary; in infants who drink cows milk which they shouldn't have before 1 year), increased reabsorption (r/t hypoparathyroidism), decreased excretion (which is seen in chronic renal disease, glomerulonephritis, rhabdomyolysis), shift from ICF to ECF (such as from a crush injury, fluid volume deficit, cellular lysis, or rhabdomyolysis).What is the relationship between calcium and phosphorus?Rising calcium levels in the blood, correlates to a decrease in phosphorus levels. The thyroid produces calcitonin and that causes phosphorus retention by the kidneys. Decreasing calcium levels correlates to an increase in phosphorus secretion through the kidneys. In patients with chronic kidney disease this doesn't work; you can have all the PTH you want but it won't work the pt will still have elevated phosphorus levels and decreased calcium levels. This patient will need phosphate binder medications so it can be excreted through the feces.How does calcitonin effect phosphorus levels?When serum calcium levels rise in the blood, serum phosphorus declines, and the thyroid gland produces calcitonin. Phosphorus is retained by the kidneys, calcium is deposited in the bone (by inhibiting osteoclasts); blood calcium levels decline which cause an increase in serum phosphorus levels.How does parathyroid hormone effect phosphorus levels?When serum calcium levels fall, serum phosphorus levels increase and the parathyroid gland secretes parathyroid hormone. This release stored calcium from the bone (stimulation of osteoclasts more than osteoblasts), enhances reabsorption of calcium in the kidneys, and increases phosphorus excretion through the kidneys. The serum calcium level increases, causing a decrease serum phosphorus level.What are the signs and symptoms of phosphorus imbalance?Any s/sx that may present are actually related to the subsequent calcium imbalanceWhat are treatments for hypophosphatemia?Administer phosphorus suppplements and discontinue antacids. IV phosphorus may be indicated but is not to exceed 10 mEq/hr. Increase the dietary intake of phosphorusWhat are treatments for hyperphosphatemia?Discontinue phosphorus supplements. Administer phosphorus binders, decrease dietary intake and increase calcium intake.What diet teachings are indicated for a patient with hypophosphatemia?Eat foods high in phosphorusWhat diet teachings are indicated for a patient with hyperphosphatemia?Avoid foods high in phosphorus.What are examples of food that are high in phosphorus?Fish, nuts, seeds, dairy.