Fluid & Electrolyte
Disorders
Disclaimer - Pocket Prof Apps has used
reasonable efforts to ensure that the
information provided is both accurate and
current. However, your education is
ultimately your responsibility, and Pocket
Prof Apps makes no guarantee to the
accuracy or applicability of any
information provided, and assumes no
liability for your reliance on any
information we provide. Further, the
information provided in resources
published by Pocket Prof Apps represents
the understanding and opinions of the
presenters and authors, and may or may
not be consistent with the opinions or
preferences of your own professors. We
therefore recommend that you use
information provided by Pocket Prof Apps
to supplement your other education
resources, and not replace your own
study, group discussions, and class
lectures.
©2013 www.pocketprofnursing.com
by Pocket Prof Apps
Fluid Volume Deficit
(No Water, No Salt, Or Both)
• No Water (hypertonic)
– Profuse sweating, hyperventilation, DKA, fevers,
diarrhea, renal failure, DI
• No Salt (hypotonic)
– Water intoxication, chronic illness, malnutrition,
renal failure
• Both (isotonic)
– NPO, poor intake, hemorrhage
Fluid Volume Deficit
•
•
•
•
•
•
Low BP, high HR
Dry mouth, thirst
Rapid weight loss
Low urine output
Confusion, lethargy
SG>1.030, high Hct, high
BUN, low Na, high osmo
 What
can you
do?
 What
are the
symptoms?
• Fluids (oral if alert)
• NS or LR (no potassium until
urine output is increased)
• Daily weight, strict I/Os
• May need antidiarrheals,
antiemetics, abx, antipyretics
Fluid Volume Excess
• Happens when there is increased sodium and
water
• Causes:
– Hypervolemia (isotonic)
• Too much IV fluid, kidney failure, corticosteroids
– Water intoxication (hypotonic)
• CHF, SIADH, IV fluids, psych problems, wound irrigation
– Too much sodium intake (hypertonic)
• Too much salt, 3% saline IV, too much NaHCO3
Fluid Volume Excess
•
•
•
•
•
•
•
Rapid weight gain
Edema
High BP, bounding pulses
May have  urine output
JVD, crackles, dyspnea
Decreased LOC
Low Hct, low BUN, high Na,
low osmo
 What
can you
do?
 What
are the
symptoms?
•
•
•
•
Diuretics
Fluid restriction (no IV fluids)
Sodium restriction
Daily weights, strict I/Os
Lab Normals
Electrolyte
Range
Magic 4
Potassium
3.5 – 5.5
4
Chloride
98 – 106
104
Sodium
135 - 145
140
pH
7.35 – 7.45
7.4
pCO2
35 – 45
40
HCO3
22 – 26
24
FYI – Hematocrit normal is 3 times the hemoglobin (10-14 is normal)
Sodium (135 – 145 mEq/L)
• Major cation of ECF
• Sodium level reflects the ratio of sodium to
water
• Regulated by kidneys, ADH, aldosterone
• GI tract absorbs sodium from food
• Imbalances are typically associated with fluid
volume problems
• Foods high in sodium – processed meats,
condiments, dairy
Hypernatremia ( Na)
• Water loss or excess
sodium
•  Na excretion – renal
failure, corticosteroids
•  Na intake – eating too
much salt, too much
sodium in IV fluids
•  water loss – fever,
infection,
hyperventilation,
sweating, diarrhea,
dehydration
F
R
I
E
D
“You Are Fried”
Fever (low grade,
flushed skin)
Restless (irritable)
Increased fluid
retention and  BP
Edema (peripheral
and pitting)
Decreased urine
output, dry mouth
Hypernatremia ( Na)
What can you
do?
Reduce
sodium
slowly!
• Treat the underlying
cause
• Diuretics
• Sodium restriction
• Seizure precautions
Hyponatremia ( Na)
•
• Water excess or loss of sodium




Dilution – polydipsia, freshwater drowning, SIADH, CHF
 excretion – sweating, diuretics, GI wound drainage,
renal disease
 intake – NPO, low salt diet, severe
vomiting/diarrhea
Symptoms:
 Confusion, headaches
 Seizures (can progress to coma)
 Abd cramps, n/v
Hyponatremia ( Na)
Replace
sodium
slowly!
 What
can you
do?
•
•
•
3% normal saline
If caused by fluid excess, will
need fluid restriction
Usu. can’t be fixed by adding
sodium to the diet
Potassium (3.5 - 5.0 mEq/L)
• Major cation of ICF
• Sodium-potassium pump is a major controller
• Moves into cells during formation of new
tissues and leaves the cell during tissue
breakdown
• Source of potassium – diet
• Primary route of loss - kidneys
• Foods – avacado, fish, banana, OJ, raisins,
dried fruits, meat, milk, fruits, veggies, salt
substitutes
Hyperkalemia ( K)


Causes – kidney failure
(most common), use of
salt or potassium
supplements, receiving
old blood, cell
destruction, acidosis,
hypoxia, exercise,
catabolic state, use of
potassium-sparing
diuretics
Can get false high results
if specimen not handled
properly
“MURDER”
M
U
R
D
E
R
Muscle weakness
Urine, oliguria, anuria
Respiratory distress
Decreased cardiac
contractility
ECG changes
Reflexes, hyperreflexia,
or areflexxia
Hyperkalemia ( K)
 What
can you
do?
• Cardiac monitor
• Kayexalate, calcium
gluconate, or glucose &
insulin IV
• Lasix if kidneys are
functioning
• Stop potassium in IV
fluids
• Have pt avoid foods high
in potassium
• Dialysis if severe
Hypokalemia ( K)
• Causes
– Vomiting, NG suction, diarrhea, medications (diuretics,
laxatives, insulin), metabolic alkalosis, rapid cell building
(ie. B12 or erythropoietin to increase RBCs)
• Signs/symptoms
– Dysrhythmias, weakness, n/v, paralytic ileus,
constipation, low BP, weak pulse, increased digoxin
toxicity, muscle weakness and paralysis, diuresis
Hypokalemia ( K)
can you
do?
Watch for
Digoxin
toxicity!
 What
Potassium Administration
•Must have urine output
•Never give IV push
•Must be on cardiac monitor
•Assess IV site often (prefer CVC)
•Always dilute and give no more
than 20 mEq, no faster than 1 hr
•Max concentration in IV fluids is
40 mEq/L
•
•
•
•
Cardiac monitor
Foods high in potassium
Watch for dig toxiciity
Potassium IV (only if
good urine output)
• Spirinolactone
• Treat constipation
• Keep pt safe from falls
Calcium (9.0 – 10.5 mg/dL)
• Primary source is bones
• Regulated by parathyroid hormone, calcitonin,
and vitamin D
• Affects transmission of nerve impulses, heart
and muscle contractions, blood clotting, and
forming of teeth and bone
Hypercalcemia ( Ca)
 What
are the
symptoms?
 What
causes
it?
 What
can you
do?
Hypocalcemia ( Ca)
C
A
T
S
“CATS
Convulsions
Arrhythmias
Tetany
Spasms and stridor
Phosphate Imbalances
• Hyperphosphatemia
– Cause - renal failure, tumor lysis syndrome
– S/S – calcium deposits in joints, skin, kidneys, eyes;
hypocalcemia, tetany, neuromuscular irritability
– Tx – fix hypocalcemia
• Hypophosphatemia
– Cause – malnutrition, malabsorption syndrome, alcohol
abuse, too many antacids
– S/S – CNS depression, confusion, muscle weakness,
dysrhythmias, fractures
– Tx – oral supplements (Neutra-Phos), decrease calcium
intake, IV phosphate (but this can cause sudden
hypocalcemia), stop anatacids and calcium supplements
Magnesium Imbalances
• Hypermagnesemia
– Cause – increased intake (ie. MOM, Maalox) with chronic
kidney disease
– S/S – lethargy, n/v, loss of DTRs, can have respiratory and
cardiac arrest
– Tx – avoid magnesium-containing drugs, increased fluid intake,
may need dialysis
• Hypomagnesemia
– Cause – prolonged fasting or starvation, chronic alcoholism,
diuretics
– S/S – confusion, hyperactive DTRs, tremors, seizures, cardiac
dysrhythmias
– Tx – oral supplements, increase green veggies, nuts, bananas,
oranges, peanut butter, chocolate; IV or IM magnesium (if
given too rapidly can cause cardiac or respiratory arrest)
Medications
• Loop diuretics
• Thiazide diuretics
• Potassium sparing diuretics
• Electrolytes
• Kayexalate
Don’t forget
rules for giving
potassium!
General Rules
• Don’t give at night
• Commonly given with
an
anti-hypertensive
• All but potassiumsparing will decrease
potassium levels
• Watch for more videos coming soon.
• Check out our website
(www.pocketprofnursing.com) for my
notes, videos, and games to test your
knowledge.
• Watch for more Med Surg videos and
app coming soon.
© 2013 www.pocketprofapps.com
Bringing practical nursing education to your mobile devices - teachers helping students.
• We welcome and ask for your feedback so we can
make improvements. Click below the video to
comment, suggest other video topics, and/or ask
questions.
• Please rate our videos by clicking “like” or “dislike”.
• Please “share” this video if it was helpful to you.
• Subscribe to our you tube channel so you will be the
first to see new videos.
• Thanks for watching!!!!
Image Attribution
• Slide 1 – Flickr by Randy Le'Moine Photography;
www.pixabay.com, no attribution required
• Slide 6 – Flickr by IvanWalsh.com
• Slide 19 - www.pixabay.com, no attribution required
• Much information on these slides (not images) was
utilized from Mosby’s Fluid & Electrolyte Memory
Notecards