Fluids and Electrolytes

• 135-145 mEq/l
• Cation-in ECF and body secretions
• Regulated by renal system and aldosterone increases Na absorption
• Regulates water balance, maintains blood volume, transmits nerve impulses, and contracting muscles

• <135 serum, osmolality <280
• Causes: Na loss (gi, sweat, diuretics,) wound drainage, decreased aldosterone secretion, h2o gain, hypotonic tube feedings, decreased intake,
• S/Sx: Confusion, muscle twitching, ++DTR, hypotension, tachycardia, flat veins, N&V, headache, seizures and coma, cramps.
• Interventions: I&O, neuro checks, safety, encourage Na, limit water, oral care

• >145 serum, osmolality >300
• Causes: Na excess (renal failure, corticosteroids, Na intake), insensible fluid losses, diarrhea, normal saline infusions, tube feedings that are hypertonic without adequate water flushes, diabetes insipidus, heat strokes, drugs (kayexelate)
• S/Sx: Restless, seizures, coma, muscle twitch, thirst, red-swollen tongue, postural hypotension, decreased LOC.
• (SALT)
• Skin flushed
• Agitation
• Low grade fever
• Thirst
• Interventions: I/O, restrict Na, increase fluids, safety, reality orientation, seizure pre, daily weights, serum Na levels

True

3.5-5 mEq/l

• Muscle weakness, leg cramps, fatigue, N&V, decreased bowel sounds and motility, cardiac dysrhythmias, depressed dtrs, ABG alkalosis.
• (SUCTION)
• Skeletal muscle weakness
• U wave on EKG
• Constipation or ileus
• Toxicity of dig
• Irregular, weak pulse
• Orthostatic hypotension
• Numbness

GI hyperactivity, diarrhea, irritability, confusion, cardiac dysrhythmias, muscle weakness, no reflexes, paresthesias or numbness in extremeties

4.5-5.5 mEq/l

• Numbness, tingling of extremeties and around mouth, muscle tremors and cramps,
• Severe: tetany, seizures, cardiac dysrhythmias, confusion, Positive Trousseau's and Chvostek's signs

Lethargy, weakness, depressed dtrs, N&V, anorexia, constipation, polyuria, flank pain (kidney stones), dysrhythmias and heart blocks.

1.5-2.3 mEq/l

• Cardio: dysrhytmias, ekg changes, hypertension
• Neuro; twitch, cramps, chvostek & trousseaus, tetany, seizures
• Resp: hypoventilation due to muscle weakness
• CNS: agiatation, phsychosis, confusion, coma
• (STARVED)
• Seizures
• Tetany
• Anorexia and arrhythmias
• Rapid HR
• Vomiting
• Emotional lability
• Deep tendon reflexes increased

• Neuro: depressed dtr, resp depression, arrest
• Cardio: bradycardia and heart blocks
• Hypotension, flushing
• CNS: lethargy, confus, somnolen, coma
• Metabolic: hypocal, hyper k
• (RENAL)
• Reflexes decreased, plus weakness and paralysis
• Ecg changes
• Nausea & vomiting
• Appearance flushed
• Lethargy plus drowsy and coma

96-106 mEq/l

Agitation, irritable, hyper reflexes, Twitching, tetany, seizures, alkalosis

Weakness, lethargy, dysrhythmias, acidosis: deep rapid resp, tachypnea, edema, tachy, dyspnea, fluid retention

• 3-4.5 mEq/l
• Has inverse relationship with calcium

• Muscle weakness, malaise, anorexia, slurred speech, dysphagia, resp failure, rhabdomyolisis, patho fxs,
• CNS=confusion, paresthes, irritable
• Cardiac= decreased contractility, dec co, hypotension, cardiomegaly
• Low atp= suscept to infection, less oxygen to tissues, hemolytic anemia-rbc wbc

• Anorexia, dec mental staus, paresthesia, muscle weakness, cramps, n & v, popular eruptions, chvostek and trousseaus, tetany visual impairments
• Phos + calcium = deposits of calcium phosphate (heart, lungs, kidneys, cornea or soft tissue)