Lab Day

Michele Brynelsen
 Do you remember?/ Matching
• 1. NG suctioning
• a. Hypokalemia
• 2. Overhydration with IV 1000 ml NS
• b. Hyperkalemia
• 3. Use of diuretics, such as
• c. Hypernatremia
furosemides
• 4. Renal failure • d. Hyponatremia
• 1. d
• 2. c
• 3. a
• 4. b

Matching
 Dehydration leads to increased electrolyte
concentration in which space?

• A. Intracellular
• B. Extracellular
• C. Transcellular
• D. None of the above
• Answer
B. extracellular

Dehydration leads to increased electrolyte

concentration in which space?
 Serum electrolyte values in a patient experiencing
fluid volume deficit are expected to be:

• A. decreased
• B. increased
• C. Unchanged
• D. reflected via intake and output
• Answer
• B. Increased

Serum electrolyte values in a patient

experiencing fluid volume deficit are
expected to be:
Clinical features of fluid volume excess include
which of the following?

• A. Tachycardia, flat jugular vein, infrequent edema.

• B. Tachycardia, distended jugular vein, toneless tense skin
• C. Tachycardia, distended jugular vein, good skin turgor
• D. Tachycardia, distended jugular vein, output greater than intake.
• Answer
• C. Tachycardia, distended jugular vein, good skin turgor

Clinical features of fluid volume excess

include which of the following?
 Which common isotonic solutions are often
used to expand the ECF?

 A. 0.9% sodium chloride, 5% dextrose/lactated ringer’s, 5% dextrose and

water
 B. 0.33% sodium chloride, 0.45% sodium chloride, 5% dextrose/0.2% sodium
chloride
 C. 3% sodium chloride, 5% dextrose/0.45% sodium chloride, 10% dextrose
and water
 D. 0.9% sodium chloride, 5% dextrose and water, lactated Ringers.
• answer
• D. 0.9% sodium chloride, 5% dextrose and water, lactated Ringers.

Which common isotonic solutions are

often used to expand the ECF?
 Do you remember?

• Your patient is experiencing 100 ml output per hour from her NG tube, and
she has received 80 mg of the diuretic furosemide (Lasix). What two
electrolyte laboratory values would you expect under these circumstances?
• Hyponatremia from GI suctioning
• Hypokalemia from diuresis

Do you remember/answer
 An otherwise unexplained weight change of
1KG (2.2 Lb) represents:

• A. 0.25 L of body water

• B. 0.50 L of body water
• C. 1.0 L of body water
• D. 2.0 L of body water
• Answer
• C. 1.0 liter of body water
• Hint
• Peripheral edema is usually not noted until the patient has retained 5 to
10 lbs of fluid

An otherwise unexplained weight change

of 1KG (2.2 Lb) represents:
 Osmolality
Osmolality 275 – 295
Hypertonic >295 – 300
Hypotonic <275

1 T salt in 2
1 T salt in 2 T salt
L water
1 L water in 1 L water
Hypo-
Normal Hyper-
Osmolality
Osmolality
IV Solutions
What is the difference between a Crystalloid and a
Colloid?
 Colloids
• Albumin
• Do not use in patients with severe anemia, heart failure
• ACE inhibitors should be withheld for at least 24 hours before administering due to
risk of atypical reactions (flushing and hypotension)
• Hespan
• Synthetic traits similar to albumin but has longer lasting effects
• Intravascular volumes loss related to trauma
• Burns, hemorrhage
 Question
A patient is hypotensive. A nurse closely monitors the patient's electrolytes
because the nurse knows that renin is released in response to decreased blood
flow to the kidneys. Which electrolytes are dependent on the renin angiotensin-
alsosterone system and should be closely monitored by the nurse?

a. Sodium, potassium, and chloride

b. Sodium, chloride, and calcium
c. Calcium, phosphate, and magnesium
d. Magnesium, potassium, and sodium
 Answer

•A
Aldosterone regulates sodium in the body. It tells the kidney tubules to keep
sodium in. Where sodium goes, chloride follows (except in an acidotic state,
but we are not addressing this here). Potassium is affected due to the inverse
relationship it has with sodium.
 Electrolyte disturbances

• Underlying disease process – seek the cause

• Urgency is determined by clinical manifestations
• Know where your patient lives
 Na+ Sodium ( think water)
Hypo Presents Causes Treatment

<135 mEq/L Weakness Excess free H2O Cautious replacement

<120 mEq/L AMS r/t osmotic CHF per protocol
<110 shifts/swelling H2O loss (N& V)
SIADH
Hyper Presents Causes Treatment

>145 mEq/L Weakness Dehydration Cautious H2O

>160 mEq/L Neuromuscular DI replacement (r/f
irritability cerebral edema
ADH for DI
 Serum potassium
• sodium and potassium pump
• Intracellular
• Normal cardiac
• Relationship between Na and K is reciprocal.
• When Na falls K rises
 Hyperkalemia

• Hyperkalemia
• Irritable restless
• Nausea
• diarrhea
 Question

• A nurse is caring for a patient admitted with fluid volume overload. The
patient is receiving diuretic therapy with a loop diuretic. On which day
should the nurse expect an order for potassium replacement?
a. Day 1 - 5.6 mEq/L
b. Day 2 - 4.4 mEq/L
c. Day 3 -3.5 meq/L
d. Day 4 - 3.0 mEq/L
 Answer

•C
Since we are regulating fluid, one must look at the impact on electrolytes of
this fluid loss and, in this situation, potassium. The trends are decreasing. To
wait to the values getting lower than norm can get this person in trouble. One
needs to look at the lower end of normal.
 Calcium

• Fluid and electrolytes

• Acid-base balance
• Stabilizes cell membranes
• Blood coagulation
• Heart rate
• Muscle contraction
• Schreiber, M. Topics in Progressive Care: Electrolytes Article Series, Nursing 2013 Critical Care Journal
 Calcium
• Low calcium level
• Positive signs
• Trousseau
• Chevostek hypocalcium
• 99% stored in skeletal
• Ionized calcium
• Calcium and albumin
• Renal failure cancer
 What do you think?

• Mrs. Smith is a 75 year old with a history of congestive heart failure and
hypertension admitted with confusion, dehydration, and malnutrition
• What electrolyte imbalance can she develop?
• What medications might she be on?