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F& E
fluid and electrolytes
| Question | Answer |
|---|---|
| Na+ Values | 135-145 mEq/L |
| Na+ Significance | Important for body volume regulation |
| Distinguishing Characteristics of Na+ | #1 extracellular cation; Inverse relationship with K+ and direct with Cl- |
| Abnormally low values of Na+ | Hyponatremia <135 mEq/L |
| Causes of Abnormally low values of Na+ | ↓ Na+ intake; Diuretics; GI suctioning; ↑sweating; ↓aldosterone; ↑ fluid intake; ↓excretion; Metabolic Alkalosis |
| Clinical Manifestations of Abnormally low values of Na+/Hyponatremia | Poor skin turgor; Dry mucosa; ↓ saliva; Ortho BP; Lethargy; Confusion; Seizures; Muscle cramps; Twitching |
| Treatment for Hyponatremia | Na+ replacement; Fluid restrictions; High Na+ foods; Seizure precautions |
| Nutritional Considerations(Foods with high content) of Na+ | Processed foods; Canned foods and vegetable juices;Convenience foods |
| Abnormally high values of Na+/ Hypernatremia | Hypernatremia > 145 mEq/L |
| Causes of Abnormally high values of Na+/ Hypernatremia | ↓ fluid intake; ↑ H20 loss; ↑Na+ intake; ↑ Na+ retention r/t ↑ aldosterone |
| Clinical Manifestations of Abnormally high values of Na+/ Hypernatremia | Restlessness; Weakness; Disorientation; Delusions; Hallucination; Thirst; Dry/swollen tongue; ↑ muscle tone/DTRs |
| Treatments for Abnormally high values of Na+/ Hypernatremia | Hypotonic IVFs; Na+ restriction; Prevent- hydration |
| K+ Values | 3.5-5.5 mEq/L |
| K+ Significance | Important for neuromuscular fx |
| Distinguishing Characteristics of K+ | #1 intracellular cation; Inverse relationship with Na+ |
| Abnormally low values of K+ | Hypokalemia < 3.5 mEq/L |
| Causes of Abnormally low values of K+ | ↓ K+ intake; GI suctioning; Vomiting; Diuretics; ↑ aldosterone; ECF K+ shifts to ICF caused by Alkalosis and Insulin; Digoxin toxicity |
| Clinical Manifestations of Abnormally low values of K+/Hypokalemia | Anorexia; N/V; Ileus; Muscle weakness; Paresthesias; Muscle cramps; Tachycardia; EKG changes; Dysrhythmias; Arrest |
| Treatments for Abnormally low values of K+/Hypokalemia | K+ replacement; High K+ foods; Salt substitutes; Hold Digoxin |
| Nutritional Considerations(Foods with high content) of K+ | Fruits (Raisins, Apricots,Bananas, Oranges); Vegetables (potatoes, tomatoes, green vegetables); Whole grains; Milk Meat; Fish |
| Abnormally high values of K+ | Hyperkalemia > 5.5 mEq/L |
| Causes of Abnormally high values of K+ | ↑intake; ↓ losses; K shift from ICF to ECF (hemolysis, tissue injury, acidosis) |
| Clinical Manifestations of Abnormally high values of K+ | N/V; Diarrhea; Abd. Cramps; Muscle weakness; ↓ DTR; Paresthesias; Paralysis; Acidosis; Insulin deficit; EKG changes; Dysrhythmias |
| Treatments for Abnormally high values of K+ | Redraw K+; K+ restriction; Cation exchange resins (kayexolate); IV Calcium Gluconate; IV NaHCO3-; IV insulin; B2 agonists; Dialysis |
| Ca++ Values | 8.5-10.5 mg/dL |
| Ca++ Significance | Important to muscle and vascular contraction; clotting; CNS fx and nerve transmission; Stored primarily in bones |
| Distinguishing Characteristics of Ca++ | Inverse relationship with P-; pH affects level; Affected by protein levels |
| Abnormally low values of Ca++ | Hypocalcemia < 8.5 mg/dL |
| Causes of Abnormally low values of Ca++ | ↓ Ca++ intake; Laxative abuse; Diarrhea; Malabsorption caused by ↓ Vit D; ↓ PTH, or ↑ P-; Diuresis; Pancreatitis; Alkalosis; ↓ protein (albumin) |
| Clinical Manifestations of Abnormally low values of Ca++ | Paresthesias; Tetany; Chovostek’s; Trousseau’s; ↑ DTRs; ↓ memory; Confusion; Delirium; Hallucination; Seizures; Laryngeal stridor; Irritability; Anxiety; ↓ clotting; ↑ HR; Dysrhythmias; Alkalosis |
| Treatments for Abnormally low values of Ca++ | Ca++ replacement; High Ca++ foods; Correct pH; Phosphate binders; Seizure precautions; Monitor airway |
| Nutritional Considerations (Foods with high content) of Ca++ | Dairy products; Green vegetables; Sardines |
| Abnormally high values of Ca++ | Hypercalcemia > 10.5 mg/dL |
| Causes of Abnormally high values of Ca++ | ↑ Ca++ release from bones; ↑ GI Ca++ absorption; ↓ excretion by kidneys; Acidosis; ↓ P- |
| Clinical Manifestations of Abnormally high values of Ca++ | Anorexia; N/V; Abdominal pain/cramping; Ileus; Constipation; Confusion; Lethargy; Coma; ↓ DTR; ↑ BP; Bone pain; ↓ urine output with thirst; ↓ P-; EKG changes; Muscle weakness/loss of tone; Risk of digoxin toxicity; Acidosis |
| Treatments for Abnormally high values of Ca++/Hypercalcemia | Hydration; Diuretics (no thiazides) Limit intake; Mobilization; Monitor constipation; Check digoxin level; Monitor cardiac status; Dialysis |
| Mg+ Values | 1.5-2.5 mEq/L |
| Mg+ Significance | Important in neuromuscular fx; Stored in bones and soft tissue |
| Distinguishing Characteristics of Mg+ | #2 intracellular cation; Needed for K+ absorption/utili-zation; Affected by protein levels |
| Abnormally low values of Mg+ | Hypomagnesemia < 1.5 mEq/L |
| Causes of Abnormally low values of Mg+ | ↓ Mg+ intake (malnutrition r/t alcoholism is most common cause); ↓ bowel absorption (Crohn’s); ↑ GI loss(diarrhea, vomiting); or renal loss (diuretics, diabetes, alcoholism) |
| Clinical Manifestations of Abnormally low values of Mg+ | Muscle weakness; Twitching; Tremors; Tetany; Dysphagia; Confusion; Hallucinations; Seizures; ↑ DTR; Chovostek’s; Trousseau’s; ↑ HR; EKG changes; ↓ K+; ↓ Ca++ |
| Treatments for Abnormally low values of Mg+ | Mg+ replacement; Monitor heart and airways; High Mg+ foods; Seizure precautions |
| Nutritional Considerations (Foods with high content)of Mg+ | vegetables; nuts; seeds; whole grains |
| Abnormally high values of Mg+ | Hypermagnesemia > 2.5 mEq/L |
| Causes of Abnormally high values/Hypermagnesemia | Renal failure; ↑ intake; Antacids with Mg+ (Maalox, Mylanta); Hemolysis; Hypothermia |
| Clinical Manifestations of Hypermagnesemia | N/V; Muscle weakness; Paralysis; ↓ DTR; Confusion; Lethargy; Coma; Respiratory depression; ↓HR; ↓BP |
| Treatments for Hypermagnesemia | Hydration; Diuretics; ↓ intake; Monitor neuro; resp and cardiac status; Dialysis |
| P- Values | 2.5-4.5 mg/dL |
| P- Significance | Important to ATP production; neuromuscular fx; oxygen release from Hgb; acid-base balance; Stored primarily in bones |
| Distinguishing Characteristics of P- | #1 intracellular anion; Inverse relationship with Ca++; Affected by protein levels |
| Abnormally low values of P- | Hypophosphotemia < 2.5 mg/dL |
| Causes of Abnormally low values of P-/Hypophosphotemia | ↓ P- intake or absorption r/t protein; malnutrition (anorexia, alcoholism); ↑ loss (renal, burns, DKA); ↑ metabolic P- use to produce ATP; Intracellular shift of P- caused by respiratory alkalosis |
| Clinical Manifestations of Abnormally low values of P-/Hypophosphotemia | Lethargy; Irritability; Apprehension; Confusion; Respiratory and Cardiac Muscle weakness; Ileus; Hyperglycemia; ↑ infection risk; ↑ bruise/bleed |
| Treatments for Abnormally low values of P-/Hypophosphotemia | P- replacement; High phosphorus foods; Check use of OTC antacids and laxatives |
| Nutritional Considerations (Foods with high content) of P- | Chocolate drinks; Dark colas; Canned ice teas; Milk products; Organ meats; Oysters; Sardines; Beans and peas; Whole grain products; Nuts; Seeds |
| Abnormally high values of P- | Hyperphosphatemia > 4.5 mg/dL |
| Causes of Abnormally high values of P- | Impaired P- excretion, ↑ P-intake, P- shift from ICF to ECF due to cell damage (chemo, muscle necrosis), ↓ Ca++; Acidosis |
| Clinical Manifestations of Abnormally high values of P- | Dry, itchy skin, Tetany, Anorexia, N/V, Muscle weakness, ↑ DTR, ↑ HR, ↓ Ca++ |
| Treatments for Abnormally high values of P- | Hydration, Diuresis, Phosphate binders, Limit intake |
| Cl- Values | 96-106 mEq/L |
| Cl- Significance | Important in acid-base balance |
| Distinguishing Characteristics of Cl- | Major extracelluar anion; Direct relationship with Na+ and Inverse with HCO3- |
| Abnormally low values of Cl- | Hypochloremia < 96 mEq/L |
| Causes of Abnormally low values of Cl- | ↓ Cl- intake, ↓ Na+ or K+ levels, Metabolic alkalosis, GI suctioning, Vomiting, Diarrhea, Excessive sweating, Diuretics |
| Clinical Manifestations of Abnormally low values of Cl- | Mental confusion, Slow breathing, Paralysis, Muscle tension or spasm |
| Treatments for Abnormally low values of Cl- | Cl- replacement |
| Nutritional Considerations(Foods with high content) of Cl- | Table salt (NaCl) and salt substitutes (KCl); Rye, Tomatoes, Milk, Lettuce, Celery, Olives |
| Abnormally high values of Cl- | Hyperchloridemia > 106 mEq/L |
| Causes of Abnormally high values of Cl- | Loss of HCO3 via kidneys or GI tract resulting in ↑ Na+ and Cl-;Acidosis |
| Clinical Manifestations for Abnormally high values of Cl- | Weakness, Headache, Nausea, Cardiac arrest |
| Treatments for Abnormally high values of Cl- | Lactated Ringers to ↑ HC03-,Diuretics to ↓ Cl- |
| Distinguishing Characteristics Value | 7.35-7.45 |
| Significance of pH (arterial) | Indicates H+ concentration |
| Distinguishing Characteristics of pH (arterial) | Reflects the acid or base levels of a fluid |
| Abnormally low values of pH (arterial) | Acidosis< 7.35 |
| Clinical Manifestations of Metabolic acidosis | HA, Confusion, Drowsy, Lethargic, Weakness, ↓ HR,Anorexia, N/V,Diarrhea,Kussmaul,↓ CO,Vasodilation,↑ K+ ↑ Ca++ |
| Clinical Manifestations of Respiratory acidosis | Hypoventilation, ↑ HR/BP, Mental cloudiness, ↑ ICP, ↑ K+, & Ca++ |
| Abnormally high values of pH (arterial) | Alkalosis > 7.45 |
| Clinical Manifestations of Abnormally high values of pH (arterial)/Metabolic Alkalosis | ↓ respirations, Numbness, Tingling, Tetany, Seizures, Confusion, Dizziness, ↑ HR, ↓ GI motility (ileus), ↓ Ca++, ↓ K+ |
| Clinical Manifestations of Abnormally high values of pH (arterial)/Respiratory Alkalosis | Light-headed, Palpitations, ↓ LOC, ↓ Ca++, ↓ K+ |
| HCO3- Values | 22-26 mEq/L |
| HCO3- Significance | Levels regulated by kidneys |
| Distinguishing Characteristics of HCO3- | Inverse relation-ship with Cl- |
| Abnormally low values of HCO3- Metabolic Acidosis | < 22 mEq/L |
| Causes of Abnormally low values of HCO3- | Diarrhea, Diuretics, Renal insuffi-ciency, ↑ Cl- administration, DKA, Lactic acidosis, uremia, ASA poisoning |
| Treatments for Abnormally low values of HCO3-/Metabolic Acidosis | Replace HCO3 if pH < 7.1 and HCO3 level <10; Dialysis; Monitor K+ & Ca++ |
| Abnormally high values of HCO3- in Metabolic Alkalosis | > 26 mEq/L |
| Causes of Abnormally high values of HCO3- | Loss of H+ ions (loss of gastric fluids via vomiting/suction, ↑ aldosterone level, ↑ HCO3- intake via antacids or IV NaHCO3 |
| Treatments for Metabolic Alkalosis | Treat GI cause to prevent loss of H+ |
| PaCO2 Values | 35-45 mmHG |
| PaCO2 Significance | Levels regulated by lungs |
| Abnormally low values PaCO2(Respiratory Alkalosis) | < 35 mmHG |
| Causes of Abnormally low PaCO2 values(Respiratory Alkalosis) | Hyperventilation caused by anxiety, hypoxia, ASA overdose, sepsis |
| Treatments for Abnormally low PaCO2 values(Respiratory Alkalosis) | Inhale via paper bag, Sedation, O2 if hypoxic |
| Abnormally high PaCO2 values(Respiratory Acidosis) | > 45 mmHg |
| Causes of Abnormally high PaCO2 values(Respiratory Acidosis) | Inadequate excretion of CO2, hypoventilation |
| Treatments for Abnormally high PaCO2 values(Respiratory Acidosis) | Improve ventilation with meds, pulm hygiene, or ventilator |
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