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Disturbances
Hypervolemia
Fluid Volume Excess
Inadequate intake
GI losses
GU losses
Skin losses
Third-space losses
Urine output :
oliguria
anuria
Signs of Hypervolemia
Acute weight gain
Edema
Pulmonary edema
shortness of breath
rales
dyspnea
cough
Venous distention
Pulmonary Edema
Hypoxia
Dyspnea
Hypo-osmolar Imbalance:
Hyponatremia
The serum sodium level falls below 135
mEq/L
Cellular Effect
Hypo-osmolar Imbalance
Hyponatremia
Sweating
GI losses
Diuresis
Adrenal insufficiency
Hypo-osmolar Imbalance
Hyponatremia
Hypo-osmolar Imbalance:
Hyponatremia
SIADH
tuberculosis
pneumonia
oat cell carcinoma
encephalitis
meningitis
pancreatic carcinoma
Major Complications of
Hyponatremia
Neurological Disturbances
cerebral edema
Headache, Lethargy
Depression, Confusion
Convulsions
Coma
Cardiovascular Disturbances
Postural hypotension
Shock
Hypo-osmolar Imbalance:
Hyponatremia
Laboratory Values
Serum sodium is less than 135 mEq/L
Serum osmolarity is decreased
Dilution of chloride, hematocrit, and BUN
Hyperosmolar Imbalance:
Hypernatremia
There is an increase in the serum
sodium level.
Cellular effect
cells shrink
Hyperosmolar Imbalance:
Hypernatremia
Causes of Hypernatremia
Hyperosmolar Imbalance
Hypernatremia
Manifestations
thirst
dry, sticky mucous membranes
tongue dry and swollen
elevated temperature
agitation
convulsions
tachycardia
Hyperosmolar Imbalance
Hypernatremia
Manifestations
Oliguria or anuria
Increased urine specific gravity
Major Complications of
Hypernatremia
Osmotic Diuresis
Water moves out of the cells into the
circulation
Cellular dehydration
Circulation decreases
Cell function is impaired
Brain cells particularly susceptible
Hypokalemia
Etiology
poor nutrition
diuretic therapy
gastric suctioning
vomiting, diarrhea
burns
alkalosis
hyperaldosteronism
Major Complications of
Hypokalemia
Cardiovascular
dysrhythmias, hypotension, digitalis
toxicity, myocardial damage, cardiac arrest
Neurological
lethargy, confusion, depression
Gastrointestinal
paralytic ileus
Major Complications of
Hypokalemia
Skeletal Muscle
weakness, flaccid paralysis, weakness of
respiratory muscles, respiratory arrest
Renal System
decreased ability to concentrate urine, water
loss, kidney damage
Acid-Base Balance
metabolic alkalosis
Hyperkalemia
Etiologies
retention of potassium
renal failure, potassium sparing diuretics,
adrenocortical insufficiency
Major Complications of
Hyperkalemia
Nervous System
Paraesthesia
Neuromuscular
Muscle twitching, muscle weakness,
paralysis
Cardiovascular
Bradycardia
Cardiac arrest
Hypocalcemia
Etiologies
Hormone
Hypoparathryoidism
Elevated calcitonin
Vitamin D Deficiency
Renal
Renal failure
Hyperphosphatemia
Loop diuretics
Hypocalcemia
Etiologies
Acid Base Imbalance
Alkalosis
Nutritional
Malnourishment
Malabsorption syndromes
Major Complications of
Hypocalcemia
Nervous System
Paraesthesia
Muscular System
Tetany, Laryngeal spasms
Cardiovascular System
Hypercalcemia
Etiologies
Hormone Imbalance
Hyperparathyroidism
Vitamin D excess
Major Complications of
Hypercalcemia
Neurological Manifestation
lethargy, confusion, coma
Skeletal Manifestations
deep bone pain
pathological fractures
Renal Manifestations
kidney stones
Hypercalcemia
Gastrointestinal Manifestations
Constipation
Anorexia
Nausea and Vomiting
Cardiovascular Manifestations
Shortened QT interval
Bradycardia
Cardiac arrest
Hypercalcemia
Treatment
Hypomagnesemia
Etiologies
malnutrition
chronic alcoholism
loop diuretics
diarrhea
severe dehydration
Hypomagnesemia
Manifestations
Hypomagnesemia
Treatment
IV Magnesium Sulfate
2 Grams over 2 minutes
12 Grams over 12 hours
Hypermagnesemia
Etiologies
Chronic renal failure
Laxatives that contain magnesium
Antacids that contain magnesium
Hypermagnesemia
Manifestations
Hypermagnesemia
Discontinue all magnesium containing
drugs
Fluid therapy
Calcium gluconate to counteract the
effects of magnesium
Mechanical ventilation
Hypophosphatemia
Causes
alcoholism
malnutrition
diabetic ketoacidosis
Hypophosphatemia
Manifestations
Hemolytic anemias
Muscular weakness
Paraesthesias
GI distress from reduced energy and
oxygen stores to cells
Hyperphosphatemia
Etiologies
Chronic renal failure
Rapid cell catabolism
Excessive intake of phosphates
Hyperphosphatemia
Treatment
Edema
Expansion or accumulation of interstitial
fluid volume
Third-spacing is the movement of fluid
to areas where it becomes unavailable
for use by the body
Causes of Edema
Increased hydrostatic force
Decreased colloid osmotic pressure
Increased capillary permeability
Obstruction of a lymphatic vessel
Sodium and water excess
Distribution of Edema
Localized
Venous or lymphatic obstruction
Generalized
hypoproteinemia
Dependent
heart failure
Edema
Ascites
fluid within the peritoneal cavity
Pleural effusion
fluid within the pleural space
Pericardial effusion
fluid within the pericardium
Pulmonary edema
fluid within the alveoli
Includes
urine
vomitus
diarrhea
drainage
perspiration
4 - 11 CM of water
Crystalloids
Dextrose
Saline
Colloids
Albumin
Plasma protein fraction
Colloid Substitutes
Dextran
Hetastarch
Blood Transfusions
Packed Red Blood Cells
Whole Blood
Thiazide Diuretics
Examples
Chlorothiazide (Diuril)
Hydrochlorothiazide (HCTZ, Esidrix)
Actions
Loop Diuretics
Furosemide (Lasix)
Ethacrynic acid (Edecrin)
Bumetanide (Bumex)
Actions
Osmotic Diuretics
Mannitol
Increases osmotic pressure and causes
intracellular and interstitial fluids to enter
the vascular spaces
Actions
Hyponatremia
Hypochloremia
Increased extracellular volume