Fluids and Electrolytes, Metabolism and Endocrine (NCM103) Patients With Fluids and Electrolytes (Renal) Alteration III
Electrolyte Imbalances
1. Sodium (Na + ) [Normal: 135 145 mEq/L] a. Hyponatremia Sodium Deficit Less than 135 mEq/L Water: Na
Causes: - Na Intake (Na is lost but more entry of Water) How is Na Lost? - Urine: Exemplified by patients with excessive urine output (DM, DI, Diuretics ) Excessive entry of water + Water Supplement D 5 W (Glucose 5% + Water) + Excessive Compulsive Intake of Water Manifestations: 1. Anorexia 2. N/V 3. Headache 4. Lethargic Looking
Diagnostic Findings - Level of Serum Na - Specific Gravity (N: 1.000 1.03) - Concentrated Urine
Management: - Na intake - Restrict fluid intake - Normal saline solution
b. Hypernatremia Sodium Excess More than 145 mEq/L Water: Na
Causes: (Similar to HYPOVOLEMIA) - Intake of water - Inadequate water supplement (Tube Feedings) - Diarrhea - Vomiting - Burns - Excessive diaphoresis
Manifestations: - Thirst Topics Discussed Here Are: 1. Electrolyte Imbalances a. Sodium Imbalances b. Potassium Imbalances c. Calcium Imbalances 2. Acid-Base Balance LOOKY HERE
jcmendiola_Achievers2013 - Body temperature - Pulse / BP
Diagnostic Findings: - Level of Na in blood (HIGH) - Level of Na in urine (LOW)
Management: Fluid intake (48 hours) If cannot take in fluid orally, use IV Fluid (D 5 W)
2. Potassium (K + ) [Normal: 3.5 5.0 mEq/L] K+ gets in the body though the food Gets out of the body by: GUT via Urine~ (90% of K+) GIT via Feces~ (10% of K+)
a. Hypokalemia Potassium Deficit Less than 3.5 mEq/L
Causes: - Intake of food HIGH in K+ o Patients with starvation diet Banana, Citrus Fruits, Green Leafy Veggies Potassium Content! Beef, Pork and Chicken Potassium Content! - Gastric suctioning - Vomiting (Hyperemesis Gravidarum) - Cushings Syndrome (Hyperaldosteronism K+ Excretion!)
Manifestations: 1. Easy Fatigability 2. Peristalsis of the stomach muscles (ANOREXIA) 3. Constipation 4. ECG Tracings: a. U-Wave~ + For children its normal = Extra excitability + Abnormal for adults b. Flattened T-Wave c. Depressed ST-Segment
Plan of Care: Food with HIGH Potassium Content! Augmenting of K+ Supplements o [Calcium Dural] per orem o Potassium Chloride (KCl) If cannot take orally, use IV form of KCl In the form of IV Drip! Assess the URINE OUTPUT! UO: NO K+
b. Hyperkalemia Potassium Excess More than 5.0 mEq/L
jcmendiola_Achievers2013 Causes: - Intake of food HIGH with Potassium - Disorders: o UO (Renal Failure) o Addisons Disease ( Aldosterone) K+ EXCRETION K+ RETENTION o Destruction of Cells (Escape of K+ from the cells) Burns Metastatic Cancer Large Bed Sore
Diagnostic Findings: - Serum Potassium is greater than 5 mEq/L - ECG o Affectation of T-Wave Tall T-wave Prolonged QRS Complex (QRS only occupies 2 small squares 0.08s) Prolonged PR Interval
Manifestations: Presence of muscle cramps Intestinal colic (Due to hypermotility) Muscular weakness
Plan of Care: - Intake of food HIGH in Potassium - Diuretics (K+ Wasting Diuretics) - The MD will order insulin o (Short-acting/Rapid Acting) Regular Insulin o Administer: IV not SQ o Insulin transports K+ back to the cell to decrease the K+ in the ECF o Administer with D 10 W / D 50 W - Give Cation-Exchange Resin (Kayexalate) o It is effective if there are 2 3 bowel movements during the day o Potassium is being excreted if more bowel movements
3. Calcium (Ca+) [Normal: 8.5 10.5 mg/dL] a. Hypocalcemia Calcium Deficit Less than 8.5 mg/dL How Does Potassium Perform Acid-Base Balance
Normal Balance: Under normal conditions, the K+ content in the ICF is greater than in the ECF. H+ Ions is low in both compartments
Acidosis: H+ Ions in the ECF increases due to some conditions, and the H+ ions move into the ICF. To have balance, K+ ions leave the cell and move into the ECF, causing HYPERKALEMIA
Alkalosis: More H+ ions are in the ICF than in the ECF. So, the H+ ions move out of the ICF and into the ECF, to have balance, the K+ in the ECF move into the ICF, causing HYPOKALEMIA
jcmendiola_Achievers2013
Causes: - Intake of Ca+ - Due to poverty, decreased socio-economic status - Lactose intolerance - Malabsorption syndrome o Small intestines are affected - Hypoparathyroidism o PTH Chvosteks Sign Trousseaus Sign o Vitamin D Deficiency Intake of MILK
Manifestations: - Numbness of fingers and toes - Tingling sensation - Seizures - Trousseaus Sign - Chvosteks Sign
Plan of Care - Level of Ca+ (Milk) - Ca Supplement o Calcium Chloride o Calcium Gluconate
b. Hypercalcemia Calcium Excess More than 10.5 mg/dL
Causes: 1. Intake of Ca+ (Milk / Cheese) 2. Prolonged immobilization Build up of Ca on bone 3. Massive fractures Bone cannot store Calcium 4. Bone disorders (Osteomyelitis, Bone Cancer) 5. Hyperparathyroidism ( PTH)
Management: - Mobilize client - Treat the underlying cause
STUDY OTHER ELECTROLYTES~
jcmendiola_Achievers2013 Acid Base Balance
2 Important Systems in the Regulation of Acid-Base Balance 1. Lungs Compensates FASTER a. Respiration Exchange of O 2 and CO 2
b. Ventilation Actual taking in and taking out of air 2. Kidney Compensates BETTER
R e s p i r a t o r y
Situations: Climb from ground floor and then to the top floor; Hyperventilation, what will happen? Respiratory Alkalosis or Respiratory Acidosis?? Duty at around 2 10 PM, Walking on the streets at 10:30 PM, then someone suddenly followed you, what will happen? Respiratory Alkalosis or Respiratory Acidosis?? Someone is strangling you, what will happen? Respiratory Alkalosis or Respiratory Acidosis?? You are choking on your food, what will happen? Respiratory Alkalosis or Respiratory Acidosis?? From being choked, someone gave you CPR, what will happen? Respiratory Alkalosis or Respiratory Acidosis??
3 Parameters Are Used in Acid-Base Balance 1. pH It is the ACIDITY / ALKALINITY of the blood It is the RATIO between BASE and ACID A more precise definition is the negative representation of Hydrogen ion concentration within the body HYDROGEN is an ACID DONOR
pH H 2 Acidosis pH H 2 Alkalosis Acidosis Alkalosis
jcmendiola_Achievers2013 Normal pH: 7.35 7.45 STRICT VALUE of pH 7.4 NORMAL 7.41 7.45 ALKALOTIC 7.35 7.39 ACIDOTIC pH Compatible with LIFE is 7 7.9!! ACCORDING TO MAM YAN
2. pCO 2 (Partial Pressure of Carbon Dioxide) A measure of respiratory functioning pCO 2 is an ACID! Normal pCO 2 : 35 45 mmHg
3. HCO 3 (Bicarbonate ) = A measure of metabolic functioning = HCO 3 Is a BASE! = Normal HCO 3 : 22 26 mEq/L
DIFFERENT TYPES OF ACID-BASE BALANCE 1. Uncompensated a. Metabolic Acidosis Uncompensated Parameter Amount Interpretation pCO 2 41 Normal HCO 3 20 Metabolic Acidosis pH 7.31 Acidosis
b. Respiratory Alkalosis Uncompensated Parameter Amount Interpretation pCO 2 30 Respiratory Alkalosis HCO 3 24 Normal pH 7.58 Alkalosis In uncompensated acid-base imbalance, there is ONE ABNORMAL SYSTEM The other system is NORMAL and is MADAMOT (Does nothing to compensate ) The pH remains abnormal and it follows the condition of the existing abnormal system
b. Metabolic Alkalosis Fully Compensated Parameter Amount Interpretation pCO 2 60 Respiratory Acidosis HCO 3 31 Metabolic Alkalosis pH 7.41 Alkalosis (Strict Value 7.4) In compensated acid-base imbalance, the two systems are ABNORMAL!! The primary abnormal system influences the other system to compensate! The pH determines if it will be considered PARTIALLY COMPENSATED or FULLY COMPENSATED !! - JUST REMEMBER THE STRICT VALUE OF pH WHICH IS 7.4!!! pCO 2 Respiratory Acidosis pCO 2 Respiratory Alkalosis HCO 3 Metabolic Alkalosis HCO 3 Metabolic Acidosis Situations: pCO 2 = 60 RAC HCO 3 = 30 MAL pH = 7.42 N(AL)