Fluid and Electrolyte Problems

Water is pulled out of vessels and into cells

Prevent and treat cellular dehydration

• D5W, 0.45 NS, 0.225 NS
• Glucose solutions are hypertonic in the bag, but have a hypotonic effect on the cells due to rapid metabolization of dextrose

Frequent monitoring of VS, LOC, and cirulation to detect depletion of vascular volume and cerebral cellular edema

• Very Rare
• Cause water to be pulled from cells and into the vessels

• Saline solutions greater than 0.9%
• Dextrose solutions (10 or 50%) used on a limited basis to treat pt with hypoglycemia

Serum Sodium is dangerously low (115 or less)

Monitor VS, neurological status, lung sounds, urine output, serum sodium levels to avoid hypernatremia and vasular volume overload

Synthesized by the hypothalmus and secreted by the pituitary gland

• Drop in BP or blood volume OR
• Rise in osmolality causing the kidneys to reabsorb more water

• A rise in BP or blood volume OR
• A drop in blood osmolality

Adrenal gland hormone that conserves sodium in the body by causing the kidneys to retain sodium and extrete potassium in its place

Drop in BP, blood volume, serum sodium, or a rise in serum potassium

Reabsorb more sodium into the blood increasing serum sodium levels, and water follows sodium to raise vascular

Rise in BP, blood volume, or sodium or a drop in potassium level

• Hormone produced and released by the adrenal gland when the body is stressed
• Promotes renal retention of sodium and water

• Cardiac hormone found in the atria
• Lowers blood volume and BP

Atria are stretched by high blood volume or high BP

• Cardiac hormone found within ventricles
• Decreases blood volume and pressure

Blood volume and pressure withing the ventricles are increased

• Fluid and solute are lost in proportional amounts so osmolality remains normal and no osmotic force is created
• Can lead quickly to shock

• Hemmorrhage (hypovolemia)
• GI losses
• Wound drainage or wound suctioning
• Fever
• Burns (#1 problem)
• Diuretics
• Third space fluid shifts

• Isotonic Solutions
• Blood Products
• Colloid volume expanders

• More water is lost than solute (primarily sodium)
• Serum osmolality is elevated, so fluid is pulled into vessels from cells causing cellular dehydration

• Inadequate fluid intake
• Prolonged isotonic fluid losses when body is no longer able to compensate
• Prolonged watery diarrhea
• Diabetes Insipidus
• Increased solute intake

• Injury or inflammation
• Malnutrition
• Liver dysfuntion
• High vascular hydrostatic pressure as seen in heart failure
• Renal failure

• Thirst
• Urine output less than 30 cc/hour
• Concentrated, dark urine with high specific gravity
• Dry skin with decreased turgor and elasticity; dry mucous membranes
• Dry tongue with longitudinal furrows
• Decreased tearing and dry conjunctiva
• Sunken eyeballs
• Flat neck veins and poor peripheral vein filling

• Normal or high HCT
• High urine specific gravity
• Serum osmolality elevated >300
• Hypernatremia

• Oral fluid volume replacement
• Avoid drinks with high sugar and salt content (hypertonic)
• Avoid caffeine (mild diuretic)
• Administer isotonic fluids
• Administer blood transfusions for hemorrhage

• Urine output and concentration >30 cc/hr
• Stable heart rate and blood pressure lying and standing
• Skin and mucous membranes moist with normal turgor and elasticity
• Normal mental status and behavior
• HCT, BUN, Serum osmolality, serum electrolytes return WNL within 48-72 hours

• Hematocrit and BUN decreased due to hemodilution
• Serum osmolality is low <275
• Serum sodium is low <125
• Chest x-ray may show plerual effusions