Med Surg 1: fluid and electrolytes

• Cause: vomit, diarrhea, GI suction, low intake
•            ex. edema, ascites 

Sign:

• Increased:
• - urine osmolality, BUN, creatine, hemoglobin, hematocrit, pulse
• -fast weight loss, tented skin, oliguria

Manage:

• oral fluid
• isotonic ( .9NS, lactate ringer, D5W) 
• then hypotonic ( .45NS, D5 1/2W) 

monitor I+O, VS weak, orthostatic

Cause: heart failure, renal failure, cirrhosis, eat too much salt, hepatomeagly 

sign: edema, JVD, crackles, ascites, bp goes up, weight goes up, sob 

- hemoglobin, hematocrit goes down and so does urine osmolality 

• Manage: 
• fluid restriction
• Avoid Na+
• semi fowlers

1.3-2.3

2.5-4.5

3.5-5

8.6-10.2

• Ca goes up: phosphorus goes down 
• ca goes down: phosphorus goes up

97-107

135-145

cause: too much water, SIADH, too much D5W

signs: 

• - neurochanges, low bp, abdominal cramping, acute decrease= cerebral edema
•  
• management: give small amounts of hypertonic ( 3% saline, D10W, D20W) -- always on a pump NEVER by dial-aflow 

From SIADH: give lithium not a diuretic

cause: 

lose a lot of water , too much salt , admin hypertonic , diabetes inspidus 

sign: temperature goes up, neuro: twitching, swollen tongue, serum osmolarity goes up 

manage: give hypotonic (D1/2WNS, .45NS) or isotonic ( .9NS, lactate ringers, D5W) 

if its from diabetes inspidus: give desmopressin acetate 

- reduce na+ gradually

cause: GI loss, diuretics

sign: prominent u , dysrhythmia, parasthesia ( numb, tingling) , deep tendon reflexes decrease 

management: eat more K+ , EKG, ABG, IV pump K+ ( monitor I+O)

cause: KCL, heparin long time , impaired renal, acidosis

sign: dysrhythmia, muscle weakness, paresthesia Tall T , no P 

• management:
• -kayexalate( polystyrene sulfonate),
• -IV sodium bicarb ( moves K+ put temporarily)
• -IV calcium gluconate ( just helps T) 
• -Regular insulin + hypertonic ( D10, 3%) 
• -B2 agonist: albuterol 
• -Furosemide

• cause: hypoparathyroidsm
•           pancreatitis 
•           antiacid
•           Mg deficient , corticosteroids 

signs: Tetany ( muscle spasm)

hyperactive deep tendon

+ troussea, and chovesteck 

Management: 

• Vit D 1000-1500mg
• IV Ca+ gluconate 
• weight bearing excercises 

• - can cause orthostatic
• -extravasation

Cause: cancer, hyperparathyroidism, immobility

sign: muscle weakness , hypoactive deep tendon reflexes

lethal ventricular dysrhythmia ( heart block) 

Manage: 

• - furosemide
• -phosphate 
• -calcitonin ( unless allergic to salmon) IM

evaluate with albumin often accompanied with hypocalcemia 

cause: GI loss, diabetic ketoacidosis 


sign: neuromuscular irritability ( active and weak) -- slow involuntary twisting and writhing 

manage: assess swallowing 

magnesium sulfate IV ( dont vie more than 150mg/min)

cause: diabetic ketoacidosis 

• sign: acts like a sedative 
• resp center depressive, hypoactive reflex ( check deep tendon 

• management:
• IV calcium gluconate
• loop diuretics
• NS, LC ( if normal kidney)

cause: refeeding ( dumping syndrom), alcoholism, hyperparathyroid 

sign: weak muscle, tissue hypoxia 

• manage: 
• oral/iv phosphorus 
• prob: tetany from hypocalcemia can calcify tissue 
• - no faster than 10/hr 

watch for dumping synd

renal failure 

sign: soft tissue calcification, bad kidney

management: Ca acetate

excessive sweating, fever, addisons, too much bicarb 

hyperexcitability of muscle

• replace chloride ( IV NS, .45) 
• changes in loc and muscle strength reported
• avoid free water

• too much sodium chloride
• head injury

sign: tachypnea, lethargy


manage: LR, sodiumbicarb 

watch cognition