N200 electrolytes

42 % of total body weight-in tissue and red cells

17% total body weight

Compartments

• Interstitial
• Intravascular
• Transcellular

• lymphatic system
• **contains lymph, is the fluid between the cells and outside the blood vessels

• in the Plasma
• **fluid is blood plasma found in the vascular system.

• fluid is fluid separated from other fluids by a cellular barrier and consists of cerebrospinal, pleural, gastrointestinal (GI), intraocular, peritoneal, and synovial fluids
• ** Loss of transcellular fluid can produce fluid and electrolyte disturbance.

- pericardial fluid, pancreatic fluid, the eye, biliary fluid, paritineal space, synovial (joint) space

• 50-60% water
• 40-50% solids

• 45-55% water
• 45-55% solid

• 70-80% water
• 20-30% solid

involves the movement of a pure solvent such as water from an area of lesser concentration to an area of greater concentration.

the movement of a solute in a solution across a semipermeable membrane from an area of higher concentration to an area of lower concentration.

the process by which water and diffusable substances move together in response to fluid pressure.

requires requires metabolic activity and the expenditure of energy to move materials across cell membranes.

the kidneys, the skin, the lungs, and the gastrointestinal tract

with fever or burns.

• perspiration and can be perceived by the client or by the nurse through inspection
• ***Sensible loss is continuous when you sweat, because the patient can sense that it occur

5-600 mL of fluid via sensible and insensible in a day

isotonic and osmolar.

water and electrolytes are gained or lost in equal proportions.

are losses or excesses of only water so that the concentration of the serum is affected.

when we loss or gain water and fluid electrolytes from equal parts

• hyperosmotic state
• ***blood sugar gets so high that they are lossing water but no
• change in the amount of electrolytes.

135 - 145 mEq/L

3.5 – 5.0 mEq/L

8.5 – 10.5 mg/dL

1.5 – 2.5 mEq/L

one cation leaves the cell and is replaced by another. This occurs because cells tend to maintain electrical neutrality.

extracellular fluid (to maintain water balance)

blood cells

Sodium is the most abundant cation (90%) in ECF.

• **Maintains water balance through their effect on serum osmolality,
• nerve impulse transmission, regulation of acid-base balance, and participation
• in cellular chemical reactions.

• **Regulated by dietary intake and aldosterone
• secretion.

a lower-than-normal concentration of sodium in the blood

**Sodium less than 135

Sweating, intaking enough sodium, vomiting, GI fluids, diaretics, over drink water from iv fluids not just , head injuries, hypotonic tube feedings

- putting out extra fluids because you body is trying to even it out. Lower blood pressure, nausea and vomitting, may get confuesed, muscle twitching, headache, left untreated witll proceed to seziures and commas

diet high in sodium, salt tablets, decrease their fluid intake

a greater-than-normal concentration of sodium

give them more fluids, this patient is very dehydrated, dry and sticky mucous membranes, a red dry tongue, as progresses fatique and restlessness and change in level of conciousness, compulsions, (overexposure to elements, fever, diarehha, giving too much sodium in IV hypertonic solution, excesss sodium normal is (2 teaspons daily) we need iodine from table salt.

is give them water, monitor their I and O one we are restricting and the other we are encouraging

the major electrolyte and principle cation in the intracellular compartment.

Regulates many metabolic activities and is necessary for glycogen deposits in the liver and skeletal muscle, transmission and conduction of nerve impulses, normal cardiac conduction, and skeletal and smooth muscle contraction

intake and renal excretion.

urine output decreases the serum potassium concentration.(diaretics)

is one of the most common electrolyte imbalances, in which an inadequate amount of potassium circulates in ECF. When severe hypokalemia can affect cardiac conduction and function.

-Muscle cramps, charlley horse, anorexia, nausea vomiting, gastric suctioning , diahrra, poor intake of potassium, diaretic use, alcholism,

- eat their veggies, if it is given IV has to be given slowly, monitor their heart rate and rhythum, causias to the patient receiving digoxen

a greater-than-normal amount of potassium in the blood. Severe hyperkalemia produces marked cardiac conduction abnormalities.

gasterointestinal hyperactivity, cardiac dysrythmias or arrest, irregular pulse

give them kalexalte enema (bowel slides), potassium wasting diruretics , patient with renal failure might have to put them on dialysis, and monitor cardiac activity for cardiac arrest.

Cardiac conduction and postassium

Cardiac conduction

Calcium is necessary for bone and teeth formation, blood clotting, hormone secretion, cell membrane integrity, cardiac conduction, transmission of nerve impulses, and muscle contraction.

• Calcium is stored in bone, plasma, and body cells. Ninety-nine percent of
• calcium is located in bone.

Normal serum ionized calcium is 4 to 5 mEq/L. Normal total calcium is 8.5 to 10.5 mg/100ml.

can result from abnormalities of the thyroid and parathyroid glands.

Signs and symptoms can be related to a diminished function of the neuromuscular, cardiac, and renal systems

• **circome oral paraesthgia (numbness and tingling around mouth and fingers), muscle cramps, tremors, cardiac dysrythmias, decrease in cardaic output, positve troussau( blood pressure cuff on arm and the patient will experience
• tremors) or positive chvostek signs(tap on the facial nerve and the patient gets a twtch), can have confuesion, hyperactive deep tendon reflexes. Less calcium in blood and comes out of the bone

• Hypocarathyroidism, pancreatitus,thyroid cancer, hyperphosortemia (if calcium
• is low high phosphate), inadequate Vit.D intake (dietary, alcohol abuse)

calcium, Dairy products , Vegetables (dark leafy green), Salmon, Tums (antacids), Post menapausal women (give estrogen)

is frequently a symptom of an underlying disease resulting in excess bone resorption with release of calcium.

**molignancy, immobile (have higher calcium levels),

-lethargy and weakness, decrease in deep tendon reflexes, bone pain, constipation, flank pain (in the back kidney problems because kidney stones are made from them), dysrythmias (heart block)

phosphate (oral), immobile try and get them mobile, limit calcium high foods, give them water to dilute them, acid ash diet (cranberries, prun juice, counter acts does not allow the calcium to clump)

• Magnesium is essential for enzyme activities, neurochemical
• activities, and cardiac and skeletal muscle excitability. Approximately 50% - 60% of magnesium is maintained within the bone.

• Plasma concentrations of magnesium range from
• 1.5 to 2.5 mEq/L.

• Regulated by dietary intake, renal
• mechanisms, and actions of the parathyroid hormone.

can be the result of malnutrition, alcoholism, diarrhea, vomiting, fistula

• neuromuscluar irribillity with tremors, tachycardia, elevated blood pressure, vertigo
• (mesing with nerve conduction), confuesion,

mag supplement (epsin salts bathing salts), diet high in magnesium (greeen veggies, fish, legumes, nuts, dried fruits)

can be the result of renal failure, excessive oral intake of magnesium

**renal failure, excees oral intake of magnesium

vasodilation, nausea and vomitting, muscle weakness, low BP, HR slows down only for magnesium, respiratory depression, comma

- no legumes, dialysis (maybe) increase fluids, think safety (side rails up put on heart monitor no walking around the hallways),

Chloride (Cl-)

Bicarbonate (HCO3-)

Phosphate (PO4 3-)

Chloride is the major anion in ECF. The transport of chloride follows sodium. Normal concentrations of chloride range form 95 to 108 mEq/L.

Serum chloride is regulated by dietary intake and the kidneys.

vomiting or prolonged and excessive nasogastric or fistula drainage can result in because of the loss of hydrochloric acid

use of loop and thiazide diuretics also results in increased chloride loss as sodium is excreted.

• When serum chloride levels fall, the reabsorption of the bicarbonate ion occurs to maintain electrical neutrality
• ***may not be your patient that is dehydrated

usually occurs when the serum bicarbonate value falls or sodium level rises.

• Bicarbonate is the major chemical base buffer within the body. The bicarbonate
• ion is an essential component for acid-base balance.

• Phosphate is a buffer anion found primarily in ICF. It assists in acid-base
• regulation.

Calcium and phosphate are inversely proportional; if one rises, the other falls.

It is regulated by dietary intake, renal excretion, intestinal absorption, and PTH.

The normal serum level is 2.5 to 4.5 mg/100ml.

To raise phosphate- fish, pultry, dairy products, legumes

primarily in ICF. It assists in acid-base regulation

are inversely proportional; if one rises, the other falls.

It is regulated by dietary intake, renal excretion, intestinal absorption, and PTH.

The normal serum level is 2.5 to 4.5 mg/100ml.

Metabolic processes maintain a steady balance between acids and bases.

Arterial pH is an indirect measurement of hydrogen ion (H+) concentration.

The pH is also a reflection of the balance between:

**Carbon dioxide (CO2) regulated by the lungs

**Bicarbonate (HCO3-), a base regulated by kidneys.

7.35 to 7.45.

chemical, biological, and physiological buffering systems.

a substance that can absorb or release H+ to correct an acid-base imbalance.

the pH the PaCO2, PaO2, bicarb level, oxygen saturation, base excess level

**Arterial blood gas draw arterial blood to test pH

Worries: we don’t want to damage the artery and has an alternative blood flow . Do the Allens test to make sure the ulnar artery is functioning

• is the carbonic acid and bicarbonate buffer system. It’s the first buffering
• system to act.

Whenever carbon dioxide increases, there is an increase in hydrogen ions produced, and whenever hydrogen ions are produced, there is more carbon dioxide produced.

acidodic

alkaltic

• when hydrogen ions are absorbed or released by cells. It occurs after chemical
• buffering.

the lungs and the kidneys.


**When the concentration of hydrogen ions is altered, the lungs react to correct the imbalance by altering the rate and depth of respiration.

• **The kidneys take from a few hours to several days to regulate acid-base imbalance. They reabsorb bicarbonate in cases of acid excess and excrete it in
• cases of acid deficit.

Respitory system kicks in first to maintain the pH

Lungs kick in in the first 15 min.

• exercising we are decreasing CO2 and your breathing faster (compensation), so your exercising while sedated, they body will try to increase respiratory drive in
• an hour the kidneys will kick in

If the patient is dehydrated the lungs will still try to kick in first and then the kidneys will try and keep up after word. Kidneys take hours to days to kick in

the best way to evaluate acid-base balance. Measurement of ABGs involves analysis of six components.

These components are pH, PaCO2, PaO2, oxygen saturation, base excess, and HCO3-.

• pH measures hydrogen ion (H+) concentration in the body fluids. Even a slight
• change can be potentially life threatening.

An increase in concentration of H+ makes a solution more acidic

A decrease makes the solution more alkaline.

• Normal pH value is 7.35 to 7.45 (acidic is
• <7.35, and alkalotic is >7.45).

• PaCO2 is the partial pressure of carbon dioxide in arterial blood and is a reflection of the depth of pulmonary ventilation. The normal range is
• 35 to 45 mm Hg.

***The normal range is a Measurement of their pulmonary ventilation

Smoker will increase CO2 and O2 will be lower

COPD CO2 will go up 50-60 range and the O2 are in the same range

• PaO2 is the partial pressure of oxygen in arterial blood. It has no primary
• role in acid-base regulation if it is within normal limits.

Normal range is 80 to 100 mm Hg.

• Saturation is the point at which hemoglobin is saturated by oxygen (02). When a client is hypoxic and uses up readily available oxygen, the reserve oxygen (oxygen attached to hemoglobin) is drawn upon to provide oxygen to the
• tissues.

When the PaO2 falls below 60mm Hg, there is a large drop in saturation.

Normal range is 95% to 99%/

Base excess is the amount of blood buffer (hemoglobin and bicarbonate) that exists.

Serum bicarbonate (HCO3-) is the major renal component of acid-base balance and is excreted and reproduced by the kidneys to maintain a normal acid-base environment.

Respiratory acidosis

Respiratory alkalosis

Metabolic acidosis

Metabolic alkalosis

Respiratory acidosis is marked by an increased arterial carbon dioxide concentration (PaCO2) and decreased pH.

pH and CO2 in opposite directions

When co2 rises the pH drops

Patients with COPD, sedation

Signs and symptoms- confuesion, RR increase, warm flush skin, headache or weakness

Interventions-sit them up, cough, deep breathing exercises, Ches PT suctioning, artificial respirations, bronco dialator

is marked by a decreased PaCO2, and increased pH

CO2 below 35 and pH above 7.45

Patients that hyperventiating- anxiety attack, patients on ventilator, elevated body temperatures, brain stem injury

Signs and symptoms

Respiratory alkalosis- change in HR, SOB, light headedness, numbness and tingling in mouth and fingers, difficulty consentration give them a paper bag, relaxation activity, sedate them,

Metabolic acidosis is marked by a decreased HCO3 and a decreased pH

Bicarb that is changing

Diarrhea and renal failure (causes), diabetes, hypertonic IV solutions

• Signs and symptoms- kussmals respirations, nausea and vomitting, lethargy and
• confuesion, pH will be decreased and the bicarb

• For this patient we will give them bicarb and treat the underlying problem
• (ex renal failure to dialysis to blood sugar level)

Metabolic alkalosis is marked by an increased HCO3 and an increased pH

Gastric suctioning, vomiting, overuse of antacids, decer


Signs and symptoms- tenty (hypertonic muscles), dizziness, decrease RR and depth

What to do – monitor I and O stop the vomitting , administer IV fluids, threat underlying problem

Respiratory Opposite

**pH elevated PCO2 diminished=alkalosis (respiratory)

**pH diminished PCO2 elevated=acidosis (respiratory)

Metabolic Equal

**pH elevated HCO3 elevated=alkalosis (met)

**pH diminished HCO3 diminished=acidosis (met)

Resp Acid- ph down past 7.35, CO2 up 45

Resp Alk- pH up past 7.45, CO2 down 35

Metabloic acid- pH down no CO2 HCO3 down 22

Met alk- pH up , CO2 none, HCO3 up 26

• KNOW THIS
• Example- pH 7.48, CO2 35, HCO3 29 = met alk

7.32 pH, 48 CO2, HCO3 22= resp acid

• into the cells, causing them to enlarge.
• 0.45% NS

expands the body’s fluid volume. It has the same osmolarity as blood.

Lactated Ringer’s

0.9% NS

D5% /W – contains sodium and chloride*

pulls fluid from cells.

D5% / 0.9% NS

D5% / 0.45% NS

Hypothalamic regulation

Pituitary regualtion

Adrenal cortical regulation

Renal regulation

Cardiac regulation

Gastrointestinal regulation