Fluids and Electrolytes

By: Keith Kainne “D” Garino, RN, LPT, MAEd

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 Body Fluid Compartments:

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 Body Fluid Transport:

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 IV FLUIDS

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 Hypertonic Isotonic Hypotonic

3% Saline 0.9% NaCl (Normal D5W (in the body)

5% Saline Saline) 2.5% Dextrose
10% Dextrose in Lactated Ringers 0.25% NaCl
Water (D10W) D5W (In the bag) 0.45% NaCl (half
5% Dextrose in normal saline)
0.9% Saline
5% Dextrose in
0.45% saline
5% Dextrose in
Lactated Ringer’s
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 • 3% Saline
• 2.5% Dextrose
• D5W (in the body)
• 10% Dextrose in Water (D10W)
• 5% Dextrose in 0.45% saline
• 0.25% NaCl
• 0.9% NaCl (Normal Saline)
• 5% Dextrose in 0.9% Saline
• D5W (In the bag)
• 5% Dextrose in Lactated Ringer’s
• Lactated Ringers
• 0.45% NaCl (half normal saline)
• 5% Saline
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 Fluid Volume Deficit
1. Isotonic
• Water loss ___ electrolyte loss
• IV fluids

2. Hypertonic
• Water loss ___ electrolyte loss
• IV fluids

3. Hypotonic
• Water loss ___ electrolyte loss
• IV fluids

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 Fluid Volume Excess
1. Isotonic
• Excess fluid in ____________
• DOC:

2. Hypertonic
• Na
• MGT:
• DOC:

3. Hypotonic
• Water intoxication
• MGT:
• DOC:

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 Assessment FVE FVD
Body Weight
Skin
Eyes
Neck vein
Lung sound
GIT
Muscle
LOC
Vital Signs
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 Assessment FVE FVD
Serum Osmolality (275-300 mOsm/kg)
Hematocrit (M:42%-52% ; F:35%-45%)
BUN (10-20 mg/dL)
Creatinine (0.6-1.2 mg/dL)
Serum Sodium (135-145 mEq/L)
urinary output
Urine Specific Gravity (1.010-1.025)
Central Venous Pressure (8-12 mmHg)
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 Intervention FVE FVD

Body weight

I &O

Fluid Intake

Diet

Medication
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 1. Hypertension
2. Decreased CVP
3. Flat neck veins
4. Crackles
5. Altered LOC
6. Edema
7. Poor skin turgor
8. Dry skin
9. Decreased osmolality
10. High HCT
11. Low USG
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 Potassium
• Normal value: 3.5-5 mEq/L
• Major intracellular cation.
• Increases musculoskeletal contraction.
• Abnormality can cause cardiovascular irregularity (decreased).

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 Cause Hypokalemia Hyperkalemia
Loop diuretics
Addison’s Disease
Diarrhea
Chronic Renal Failure
Metabolic Acidosis
Fasting
Burn Injury
Steroids
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Insulin
 Potassium
• Normal value: 3.5-5 mEq/L
• Major _______________ cation.
• ______________musculoskeletal contraction.
• Abnormality can cause ___________________(increased/decreased).
Assessment Hypokalemia Hyperkalemia
Heart Rate
Blood pressure
GIT

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 ECG Changes:
Hypokalemia Hyperkalemia
ST Depression Flat P wave
Flat T wave Wide QRS
U wave Prolonged PR interval
Tall T wave

“HypUkalemia ShuT Down FlaT” “Wide PRolonged Tall but Plat”

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 Interventions Hypokalemia Hyperkalemia

Diet

Priority V/S

Medication

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 1. Diarrhea 12. Caused by insulin
2. Hypotension 13. DOC – Loop diuretics
3. Flat P wave 14. DOC – KCl
4. Metabolic acidosis 15. DOC – salbutamol
5. U wave 16. Caused by Addison’s
6. Constipation 17. DOC – Spironolactone
7. Depressed ST 18. DOC – Ca Gluconate
8. Wide QRS 19. Caused by Burn
9. Flat T wave 20. Caused by Renal failure
10. Prolonged PR interval
11. Tall T wave

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 Sodium
• Normal value: 135-145 mEq/L
• Major Intravascular cation.
• Major determinant for concentration of blood.
• Regulates neuromuscular activity.
• Sodium and H2O are not mutual.

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 Cause Hyponatremia Hypernatremia
Loop Diuretics
Diarrhea
Chronic renal failure
Cushing’s Syndrome
Fasting
Fluid Loss
SIADH
Salty foods
Heart failure
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 Assessment Hyponatremia Hypernatremia

CNS

Renal

Skin

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 Interventions Hyponatremia Hypernatremia

Fluid Intake • FVE

• FVD

Medications • FVE • FVE

• FVD • FVD

Sodium Diet

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 Calcium
• Normal value: 9-10 mg/dL
• Major components of the bones.
• Musculoskeletal contraction.
• Cardiac muscle contraction.
• Abnormality can cause dysrhythmia.
• Excess in the kidneys can cause supersaturation and osmotic diuresis.

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 Cause Hypocalcemia Hypercalcemia
Lactose intolerance
Diarrhea
Thiazide diuretics
Vitamin D deficiency
Hyperparathyroidism
Immobility
Chronic Renal Failure
Dehydration
Acute pancreatitis
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 Assessment Hypocalcemia Hypercalcemia
Heart Rate
BP
Neuromuscular TwiTChing SpaSm
• T • W
• T • R
• C
• S
• S
GIT

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Renal
 Hypocalcemia Hypercalcemia
Prolonged ST Short ST
Prolonged QT Wide T

“Hypolonged ST QT” ShorT &

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 Intervention Hypocalcemia Hypercalcemia

Diet

Medication

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 1. Hypertension
2. Bradycardia
3. Polyuria
4. Diarrhea
5. Prolonged QT
6. Wide T wave
7. Short ST
8. Constipation
9. Vit D supplement
10. Renal calculi

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 Magnesium
• Normal value: 1.5-2.5 mEq/L
• Vasodilator
• Neuromuscular effects are similar to those of calcium.

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 Cause Hypomagnesemia Hypermagnesemia
Antacids
Fasting
Loop diuretics
Laxatives
Alcoholism
Magnesium Sulfate
Chronic Renal Failure

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Insulin
 Magnesium
• Normal value: 1.5-2.5 mEq/L
• Vasoconstrictor or Vasodilator
• Neuromuscular effects are similar to those of ______________.
Assessment Hypomagnesemia Hypermagnesemia

Heart

BP

Neuromuscular
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 Hypomagnesemia Hypermagnesemia

Tall T wave Prolonged PR

Depressed ST Wide QRS

“Tall but depreST” “HyPRolong and wide QRS”

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 Intervention Hypomagnesemia Hypermagnesemia

Diet

Medication

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 1. Hypotension
2. Flushed appearance
3. Twitching
4. Muscle weakness
5. Hyporeflexia
6. Spasm
7. Tachycardia
8. DOC: Ca Gluconate
9. Caused by alcoholism
10. Hypertension
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 Phosphorus
• Normal value: 2.5-4.5 mg/dL
• Inversely proportional to calcium.

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 Cause Hypophosphatemia Hyperphosphatemia

Antacids

Fasting

Hypoparathyroidism

Chronic Renal Failure

Respiratory Alkalosis

Tumor lysis syndrome

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 Assessment Hypophosphatemia Hyperphosphatemia

Refer to:

Intervention Hypophosphatemia Hyperphosphatemia

Diet

Medication
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 ABG Analysis
• To assess ventilation and acid-base balance.
• Blood withdrawal at the ___________artery.

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 ABG Analysis
• Blood pH – 7.35 - [7.40] - 7.45
• PaCO2 – 35-45 mmHg
• HCO3 – 22-26 meq/L
• PaO2 – 80-100 mmHg
• O2 saturation – 95-100%

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 Label: 1. HCO3 – 30
2. pH – 7.42
1. pH 3. pH – 7.5
• Above 7.4 – Alkalosis 4. pH – 7.39
• Below 7.4 – Acidosis 5. PCO2 - 49
2. HCO3 6. PCO2 – 30
• Above 26 – Alkalosis 7. HCO3 – 19
• Below 22 – Acidosis 8. PCO2 – 25
3. PCO2 9. pH – 7.2
• Above 45 – Acidosis 10. PCO2 – 50
• Below 35 - Alkalosis 11. HCO3 – 29
12. HCO3 – 17
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 Identify:
1. Respiratory: if pH and PCO2 have the same label.
2. Metabolic: if pH and HCO3 have the same label.
3. Mixed (respiratory and metabolic): ALL have the same label.
4. Normal: if ALL are within the normal range.

Ex.
• pH - 7.32 pH – 7. 48 pH - 7.2 pH – 7.5 pH – 7.38
• PCO2 – 30 PCO2 – 29 PCO2 - 60 PCO2 – 25 PCO2 - 37
• HCO3 - 19 HCO3 – 19 HCO3 – 16 HCO3 – 30 HCO3 - 24

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 Compensation:
1. Fully Compensated – if PCO2 & HCO3 are opposite and pH is
normal.
2. Partially Compensated – if PCO2 & HCO3 are opposite and pH is
abnormal.
3. Uncompensated – if PCO2 or HCO3 is within normal range.

Ex.
pH – 7.43, PCO2 - 49, HCO3 – 29 –
pH – 7.32, PCO2 – 36, HCO3 – 20 –
pH – 7.30, PCO2 - 48, HCO3 – 30 –
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 1.pH: 7.67, CO2: 20, HCO3: 24 6.pH: 7.11, CO2: 45, HCO3: 15

2.pH: 7.22, CO2: 26, HCO3: 13 7.pH: 7.38, CO2: 42, HCO3: 25

3.pH: 7.1, CO2: 28, HCO3: 18 8.pH: 7.39, CO2: 34, HCO3: 17

4.pH: 7.51, CO2: 35, HCO3: 36 9.pH: 7.43, CO2: 53, HCO3: 32

5.pH: 7.26, CO2: 38, HCO3: 17 10.pH: 7.44, CO2: 34, HCO3: 21

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 Acute & Chronic
Renal Failure
By: Keith Kainne “D” Garino, RN, LPT, MAEd

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 Acute Kidney Injury
• Sudden or Progressive loss of kidney function.
• Reversible or irreversible.

Causes:
1. Prerenal
2. Intrarenal/intrinsic
3. Postrenal
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 • Renal calculi
• Dehydration
• Bladder cancer
• Liver cirrhosis
• Antineoplastic medications
• Hemorrhage
• Heart failure
• Glomerulonephritis
• Burns
• Nephritis
• BPH
• Rhabdomyolysis

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 Phases of AKI:
1. Onset/Initiation
2. Oliguric phase (8-15 days)

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 Phases of AKI:
3. Diuretic phase (4-5L.day)

4. Recovery/Convalescent (1-2 years)

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 1. BUN – 30 9. Decreased body weight
2. GFR – 120 mL/min 10. Phosphate – 6
3. Potassium – 6 11. pH – 7.2
4. Dry skin 12. Sodium – 120
5. Creatinine - .9 13. Urine specific gravity – 1.020
6. Hypertension
7. Flat neck vein
8. Urine output – 20 ml/hr

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 Chronic Kidney Disease
• Sudden or progressive loss of function of the kidneys.
• Reversible or irreversible.
• GFR –
• Duration –
Stages Estimated GFR
Risk >90 mL/min
Mild CKD 60-90 mL/min
Moderate CKD 30-60 mL/min
Sever CKD 15-30 mL/min
ESRD <15 mL/min
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 Stages Estimated GFR
mL/min
mL/min
mL/min
mL/min
mL/min

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 Clinical Manifestations:

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 Management:
1. FVE
• Body weight
• I&O
• V/S
• Lung sounds
• Fluid intake
• Diet
• Meds

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 Management:
2. FVD
• Body weight
• I&O
• V/S
• Skin
•
•
• Fluid intake

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 Management:
3. Hyperkalemia
• V/S
• Diet
• Medication
•D
•I
•S
•C
•S

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 Management:
4. Hypermagnesemia
• V/S
• Monitor
• Diet
• Medications
•C
• Avoid
•D

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 Management:
4. Hyperphosphatemia
• Diet
• Medication

5. Hypocalcemia
• Diet
• Supplement

6. Metabolic Acidosis
• Medication

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 Management:
7. Anemia
• Laboratory
• Medication
• Supplements
• Procedure

8. Uremia and Azotemia

• Monitor
• Avoid
• Diet
• Activity

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