EXAM 3

affected by urea, creatine and uric acid

• Hypervolemia- excess fluid which can cause edema (water is pulled from cells) causing accumulation of fluids in interstitial spaces.
• may be caused by malfunctioning kidneys, failure of heart to pump
• cells shrink
• Edema can be around eyes, finers, ankles, sacral area and in or around organs

• More water than Na...
• 0.33% NaCl
• 0.45% NaCl (1/2 strength of NS)
• D5W hypotonic in BODY

WATER moves From lOw solute concentration to high solute concentration

• NEURO
• Caused by; GI losses, water intox. psychogenic polydipsia, hypoglycemia, SIADH, use of diuretics.
• S/S: coma, cerebral edema, muscle twiches, R & W
• TTT: Na replacement: water restriction, 0.9 NS LR ISO, lasix for SIADH.

Sodium & Water retention, K+ Loss

Secretes parathyroid hormone--> regulates Ca and Phosphorus

"PULLING force" back into capillaries

• HYPOvolemia
• Caused by: GI loss, decreased fluid intake. Risk factors; DI, adrenal insufficiency, hemorrhage, coma
• water out of cells, cells shrink
• osmolarity >300 mOsm/L

reflects the concentration of fluids that affects the movement of water between fluid compartments by osmosis

"pusHing force" out of capillaries into interstitial tissues.

Chloride, bicarb, phosphate, and sulfate

• 0.9% NaCl (NS)
• D5W (5% DEXTROSE IN WATER)
• LR

• Higher concentration of solutes.
• 5% Dextrose in .45% NaCl
• 10% Dextrose in water
• 5% dextrose in 0.9% NaCl (NS)

ONLY insulin you can give IV

• Antinausea
• Ex: ZOFRAN

Anti- fever

8.6-10.2 mg/dL

1.3-2.3 mEq/L

97-107 mEq/L

25-29 mEq/L

1.8-2.6 mEq/L

drugs ability to INITIATE BIOLOGIC ACTIVITY as a result of binding to receptor site.

combines with recpetors and initiates biochemical and physiologic changes.

Epi- stimulates alpha and beta-adrenergic receptors causing bronchial dilation and relieving congestion in bronchial mucosa and pulmonary vessels.

• Heparin
• Insulin

• decreased BVol & intracellular dehydration
• located in hypothalamus (makes ADH)

• Plasma-Interstital-Intracellular
• Na-142- 146- 15
• K- 5- 5- 150
• Ca- 5- 3- 27
• Mg- 2- 1- 27

• Caused by: excess water loss (water deprivation) or excess NA intake (hypertonic), DI, excess insensible water loss (heatstroke).
• S/S: NEURO, seizures, H/A, increased Temp & Thirst, r & w
• TTT: 0.3 NaCl, D5W

• Caused by: GI losses, starvation, DEcrease in Mg++, polyuria, Hyperaldosteronism, digoxin tox., use of diuretics.
• S/S: MUSCLE weakness/cramps, fatigue, dysrhythmias, DTRs.
• TTT: K replacement (IV PO), K diet: milk, eggs, grain, coffee, tea, fruits, veggies. Ca Gluconate (severe), monitor EKG & ABGs

• Caused by renal failure, hypoaldosteronism, Addisons Disease, Burns, meds such as K Cl-, ACE inhibitors, NSAIDs, K sparing diuretics. Pseudohyperkalemia, acidosis.
• S/S: muscle weakness and paralysis, dysrhythmias, anxiety
• occurs < hypokalemia, but this is more dangerous.
• TTT: Kayexalase, EKG, Dialysis, Limit K diet, IV Ca gluconate

• EFC < 8.6 mg/dL
• Caused by: Malabsorption, deficient Vit D, hypoparathyroidism, excess Ca loss, pancreatitis.
• S/S: NM. Numbness/tingling of fingers, mouth, feet. Trousseau & Chevosteks sign, seizures, mental changes, muscle cramps.
• TTT: Vit D, Ca Gluconate in D5W Bolus, weight bearing excerises.
• Severe is life threatning

• EFC >10.5 mg/dL
• Caused by: cancer and hyPERparathyroidism, bone loss due to immolbilization, Excess Vit D & Ca
• S/S: (NM) Cardiac arrest, muscle weakness, slurred speech/confusion, deep bone pain, polyuria, N & V
• TTT: 0.9 NaCl, Lasix, PO4++, encourage walking, 3-4 L/daily fluids, monitor EKG.

• < 1.5 mEq/L
• Caused by: GI losses, Chronic alcoholism, AMI, Decreased K and Ca, HYPER: parathyroidism & aldosteronism, malabsoption, diuretics
• S/S: NM irritability, muscle weakness, seizures, heart block, DTRs, resp paralysis, Trousseau & Chevostecks, Increased BP
• TTT: Diet high in Mg: green leafy veggies, nuts, grains, seafood.

• > 2.5 mEq/L
• Caused by: renal failure, excessive Mg intake, DKA, hypothyroidism, loss of DTRs
• S/S: NM. N&V, weakness, Dc BP, resp depression, coma, cardiac arrest. Flushed skin.
• TTT: Ca Gluconate, NaCl LR, Lasix

• < 1.8 mEq/L
• caused by: Decreased K, Mg, Vit D, hyperventilation, alcohol withdrawl, DKA, refeeding
• S/S: NM. Cardiomyopathy, resp failure, seizures, confusion, bone pain, muscle weakness
• TTT: Sodium Phosphase, potassium phosphate, milk

• > 2.6 meq/L
• Caused by: renal failure, excess Vit D & phosphate, chemotherapy
• S/S: tetany, muscle spasms/weakness, tachycardia
• TTT: Renegel (binds to phosphate to excrete it in GI), avoid laxatives and enemas.

• < 96 mEq/L
• Caused by: Addisons disease, Loss of Na & K cause Cl loss, diuretics
• S/S: NM, muscle cramps, tetany, seizures, coma, shallow resp
• TTT: 0.45 NS, avoid free water, Cl- diet

• > 108 mEq/L
• caused by: Ic Na (Cl- follows Na), Head injury, dehydration, diuretics
• S/S: NM, Dc cardiac output, tachycardia, coma, edema, dysrhythmias.
• TTT: diuretics (lower Na, lowers Cl), hypotonic IV LR, sodium bicarb

• NEVER GIVE K+ IV PUSH
• No more than 40 mEq/L peripherally
• No more than 60 mEq/L centrally
• Max 10 mEq/Hr peripherally
• Max 20 mEq/Hr centrally