Fluid and electrolytes

• intracellular fluid
• 2/3 of water in an adult
• provides a medium for chemical functions
• major cation is is K

• extra cellular fluid
• comproses the other 1/3 of total body water
• consists of interstitial and intravascular fluid (plasma)provides a transport system to and from cells and maintains Blood volume
• major cation is Na, as well as Cl- and HCO3 (bicarb)

Increased osmolarity(resulting in concentrated HCT, HGB and BUN) will trigger the release of ADH. ADH will reduce urine output by kidneys, increasing permeability of H2O; osmolarity increases

Pressure exerted by an increased concentration of solutes in a compartment: water pulling pressure

the pressure blood exerts against vessels: water pushing pressure

• used to treat edema & 3rd spacing
• solutions are used to replace electrolytes and shift fluids from the ICF to the ECF
• cell decreases in size because salt sucks fluid out
• D10, D5NS, D5 1/2NS, D5RL

• used to treat burns and dehydration
• solutions cause fluid to shift from the ECF to the ICF
• more solutes inside the cell
• cell increases in size
• 1/2NS, 1/3NS, 1/4NS

• expands the colume of blood
• prevents osmolarity changes
• equal solutes on each side
• no cellular changes
• Osmolarity btwn 270-300
• D5W, D5WNS, LR (lactated ringers) are only solution that has electrolytes

• an increase in serum osmolality causing osmoreceptors to shrink
• 0.5% of body water has been lost

• isotonic loss of H2O and lytes
• Caused by: hemorrhage, N/V, diarrhea, burns and third spacing.
• S/S: dry lips & mucosa, fluid intake less than output, weak/rapid pulse, orthostatic hypotension

• Body retains both H2O and Na+
• Causes: intake of rapis NaCl infusion, excess Na+ in diet, CHF, Renal Failure
• S/S: JVD, rales, SOB, tachycardia, high BP, fluid intake greater than output, moist mucosa

• water is lost without change in electrolytes
• Na+ stays the same
• may increase serum osmolality

• water volume excess or water intoxication
• Cause: tap water enemas, wound irrigations, NG tube irrigations, SIADH
• S/S: mental status changes

135-145 mEq/L

• less than 135 mEq/L
• Causes: loop diuretic use, excessive water gain, GI fluid loss
• S/S: headache, lethargy, confusion, seizure, coma, abd. cramps

• greater than 145 mEq/L
• Causes: excessive water loss
• S/S: thirst, decreased urinary output, dry mucous membranes, postural hypotension, disorientation

• 3.5-5.0 mEq/L
• regulates smooth cardiac muscle conduction and the transmission and conduction of nerve impulses.

• less than 3.5 mEq/L
• Causes: dietary, loop diuretics
• S/S: Nausea and vomiting, decreased bowel sounds, muscle weakness, leg cramps, cardiac dysrythmias

• greater than 5.5 mEq/L
• Causes: decreased renal function
• S/S: GI hyperactivity, diarrhea, muscle weakness, numbness to extremities and EKG changes

9.0-10.5 gm/dl

• less then 9.0 gm/dl
• Causes: decreased absorption from intestine, ETOH abuse, acute pancreatitis
• S/S: Numbness and tingling of the mouth and extremities
• if severe: tetany, seizures, postive Trousseaus and Chvosteks signs

• greater than 10.5 gm/dl
• Causes: prolonged immobilization
• S/S: anorexia, nausea and vomiting, constipation, weakness, depressed DTRs, lethargy, polyuria, flank pain, renal calculi
• severe hypercal: slow HR and dysrythmias

1.8-2.7 mg/dl