Imbalance/ Lab values hypovolemia

Contributing factors Loss of water and lytes by any route

Signs and symptoms Same as signs for dehydration

treatment ORT Isotonic fluids to increase ECF

hypervolemia

Renal failure Heart failure Fluid shifts (tx of burns) Prolonged corticosteroid tx

Wt. gain Edema, ascites distended jugular veins Crackles, SOB, cough, RR BP

Fluid and Na restriction Diuretics Elevation of extremities Ted hose, possibly dialysis

Hyponatremia Na <135 specific gravity

dehydration

Na = neuro CNS stimulation (Sz, confusion, HA, twitching) BP, Wt gain, edema

Fluid restriction

Hypernatremia Na >145 specific gravity

Water deprivation/loss Diabetes insipidus Watery diarrhea, burns Excessive corticosteroid , NaHCO3, and NaCl

CNS depression Thirst/ very dehydrated BP, Pulse

Hypotonic IVF

Hypokalemia K<3.5 Flat T waves

(too much Lasix)= renal losses d/v/ gastric suction= abnormal GI losses hyperaldosteronism alkalosis

Ka = cardiac and GI disturbances CNS depression Hypoactive bowel Hypoactive reflexes

Encourage foods high in K Oral K IV K (never bolus, max rate is 5-10 mEq/hr)

Imbalance/Lab Hyperkalemia K>5.0 Tall tented T waves

Contributing Factors Renal failure uncontrolled DM = osmotic durisis NSAIDs acidosis

Signs & Symptoms CNS stimulation = irritability, anxiety tachycardia bradycardia hyperactive bowel hypotension flaccid muscles Ka = Cardic CNS stimulation Twitch, twitch Seize, Seize Chvosteks, Trousseaus Hyperactive bowel

Treatment K wasting diuretics Resin (kayexalate) Dialysis IV NaHCO3, IV insulin, glucose

Hypocalcemia Ca<4.5 Mg

Hypoparathyroidism Malabsorption alkalosis

Hypercalcemia Ca>5.5

Hyperparathyroidism Prolonged immobilization Digoxin toxicity Acidosis

CNS depression Hypoactive bowel

IV phosphate Calcitonin for pts with renal and heart failure

Hypomagnesaemia Mg<1.8

Chronic alcoholism DKA Chronic laxative use MI / K and Ca

Ma= muscle,( cardiac muscle) CNS stimulation Twitch, seize, chvotecks, Trousseaus

Hypermagnesaemia Mg>2.7

Renal Failure DKA

CNS depression

Imbalance/Lab Hypophosphatemia <2.5

Contributing Factors

Signs & Symptoms

Treatment

Hyperphosphatemia >4.5

Hypochloremia <96

Hyperchloremia >108