Fluid electrolytes and electrolyte imbalances

Sodium

135-145 mEq/L

Function: PULLS or Attracts WATER

Hyponatremia

Values:

< 130

Causes:

·         Excess sodium loss or weight gain

Signs and symptoms:

·         Hypotension

·         Confusion

·         Headache

·         Lethargy

·         Seizures

·         Decreased muscle tone

·         Muscle twitching and tremors

·         Vomiting

·         Diarrhea

·         Cramps

Treatment:

     Mild: Water restriction if water  retention problem;  

     Increase sodium if there is loss of Sodium

     Moderate:  IV 0.9% NS, 0.45% NS, LR

     Severe: 3% NS – short term Therapy in ICU setting

Hypernatremia

Values:

     Deprivation of water, hypertonic tube feedings     

     without food supplements, watery diarrhea, greatly

     increases insensible water loss, renal failure,

     inadequate blood circulation to kidneys, use of large

     doses of adrenal corticoids, excess sodium intake

Causes:

     Early:  generalized muscle weakness, faintness,

     muscle fatigue, HA

     Moderate:  Confusion, thirst

     Late:  Edema, restlessness, thirst, hyperreflexia,

     muscle twitching, irritability, seizures, possible coma

     Severe:  Permanent brain damage, HPN, tachycardia,

     N&V

Signs and symptoms:

·         Free water to replace ECF volume

·         Gradual lowering with hypotonic saline (decreased by no more than 2 meq/L/hr)

·         Offer fluids at regular interval

·         Supplement tube feedings with free water

·         Teach about foods, medications high in Sodium

·         Treat underlying problem

Treatment:

     Deprivation of water, hypertonic tube feedings

     without food supplements, watery diarrhea, greatly

     increases insensible water loss, renal failure,

     inadequate blood circulation to kidneys, use of large

     doses of adrenal corticoids, excess sodium intake

Potassium

3.5-5 mEq/L

Function:

major intracellular ion; influences muscle activity & pH regulation

Hypokalemia

Values:

      <3.5, Moderate: 2.5-3; severe <2.5

Causes:

·         Loss of GI secretions

·         Excessive renal excretion of K

·         Movement of K in cells (DKA)

·         Diuretics

Signs and symptoms:

·         Skeletal muscle weakness

·         ↓ smooth muscle function

·         ↓DTR’s

·         ↓ BP, EKG changes, possible cardiac arrest

·         N/V, paralytic ileus, diarrhea

·         Metabolic alkalosis

·         Mental depression and confusion

Treatment:

1.       Potassium supplements:

·          Oral replacement through high K diet

·         IV supplementation

No more than 10 mEq/hr; for child 2-4 mEq/kg/24hr

No more than 4 mEq/hr

2.       Hypertonic glucose solution

3.       Monitor:

·         I&O

·         Bowel sounds

·         VS, cardiac rythm

·         Muscle strength

·         Digoxin level if necessary

Hyperkalemia

Values:

       >5.3

Causes:

·         Excessive Potassium intake especially in patients with Renal failure

·         Tissue trauma

·         Acidosis

·         Catabolic state

Signs and symptoms:

·         ECG Changes

·         Tall, tented T-waves

·         Cardiac arrhythmias

·         Muscle weakness

·         Paralysis,

·          Paresthesia of tongue, face, hands and feet

·         N&V

·         Cramping

·         Diarrhea

·         Metabolic acidosis