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Fluid and Electrolyte Imbalance - Coggle Diagram
Fluid and Electrolyte Imbalance
Fluids
Imbalance
Hypervolemia
Cause
Increased fluid intake
Abnormal fluid retention
CHF (Congestive Heart Failure)
Not enough pressure to push blood = Decreased renal perfusion = Triggers
RAAS
Fluid shift
Treatment
Diuretics
Removes Water and Na+
Na+ causes water to follow
Fluid restriction
Effect
Increased weight
Edema
Fluid leaks or shifts into ISF
Increased BP
Distended neck veins
Bounding pulses (4+)
Increased HP (Hydrostatic pressure)
Edema
Third spacing
Hypovolemia
Cause
Decreased fluid intake
Water loss
Fluid shift
Third spacing
Treatment
Determine and treat the
cause
Replace water/blood/electrolytes
IVF
Effect
Decreased weight
Daily weight measurement
-1 L fluid = -1 Kg of weight
Loss of fluid can lead to
loss of electrolytes
Decreased BP
From Decreased HP
Weak, thready pulse (1+)
Prolonged capillary refill
Dizziness, syncope/pre-syncope
Syncope = Fainting
Triggers RAAS
Increased HR
To compensate for decreased BP
Flattened neck veins
VS. Distended veins
Oliguria
Low urine output
Tenting
Hypovolemia = Higher ECF osmotic pressure = Fluid shift = Decreased ISF fluid = Decreased tissue turgor
Furrowed tongue
Lab values
Correlates to
electrolyte and blood
lab values
Blood value because concentration of blood (Hg, Hct) depends on fluid volume
Correlates to relative anemia/
Dilutional anemia
Fluid spacing
Second
spacing
Edema
in ISF/Tissues
Increased fluid in ISF can move into ICF
Third
spacing
In potential spaces that makes it
impossible to be reabsorbed
into the plasma
First
spacing
Normal
The fluid is where it is usually found
Kind of like "First degree burn"
Electrolytes
K+
Imbalance
Hypokalemia
Cause
Potassium Loss
Potassium shift into cells
Lack of potassium intake
Effects
CNS symptoms
Anorexia
Not enough potassium intake
Hypotension
Problems with repolarization of the
heart
, smooth muscle
blood vessel
contraction
Decreased BP and HP
Treatment
Potassium drug
Replaces K+
Monitor for hyperkalemia and its symptoms; monitor for phlebitis (IV); Monitor for GI symptoms
Hyperkalemia
Causes
Excess potassium intake
Potassium shift out of cells
Failure to eliminate
Effects
Nausea and vomiting
To excrete excess potassium
Cardiac rhythm and muscle symptoms
Treatment
Emergency
Sodium bicarbonate
IV
Dextrose with insulin
IV
Increases glucose uptake
into cells - Decreasing blood glucose;
Indirectly decreases serum potassium
by activating ATPase
Non-emergency
Calcium gluconate
Calcium replacement
To stabilize
cardiac
(muscle) cells
1 more item...
Kayexalate
PO
Binds K+ in intestines =
Excretion of K+ in feces
Dialysis
"Replaces kidney"
Excretion of potassium along with water
Diuretic
Furosemide
Loop of Henle
: Blocks sodium and water reabsorption ; Increased potassium secretion
K+
Important for
repolarization
Muscle contraction
Cardiac
Smooth muscles
Blood vessels
Skeletal muscles
Brain impulses
Na+
Imbalance
Hyponatremia
Cause
Not enough salt
Too much water
Effects
Hypotonicity = Fluid shift into ICF =
Brain cellular swelling
Malaise
Discomfort
Nausea
Emesis/Vomiting
Seizures
Coma
Lethargy
Anorexia
Not enough sodium intake
Treatment
Determine cause
(Think about how it will affect fluid AND Na+)
Too much water
Fluid restriction
During seizures - 3% NS
Not enough salt
IVF
Situational
Na+
Important for
depolarization
/generation of
AP
Important for
water regulation
/balance
Hypernatremia
Cause
Too much salt
Not enough water
Effects
Hypertonicity = Fluid shift into ECF =
Brain cellular shrinkage
Oliguria
Low urine output
Polydipsia
Agitation
Lethargy
Coma
Seizures
Treatment
Determine cause
(Think about how it will affect fluid AND Na+)
Too little water
0.9% NS
Treat underlying cause
Too much salt
Diuretics
Excretes salt AND fluid
D5W
Treat underlying cause
Would you like some Na+? "Nah"; How about K+? "K"
Na+ higher @ ECF; K+ higher @ ICF
Affects fluid balance -
Osmotic pressure
Glucose, protein (albumin), Na+
Order of Decreasing
Water Volume
: ICF > ISF > ECF
Both fluid and electrolyte imbalance
Imbalances
DI (Diabetes Insipidus)
Cause
Central (Neurogenic)
Problem with either ADH release or production
Damage to the
brain
Nephrogenic
Lack of renal
response
to ADH
Damage
renally
Primary (psychogenic)
Excessive water intake (You're the problem)
Effects
Similar to
hypovolemia and hypernatremia
Polydipsia
Extreme thirst
Weight loss
*Daily weight measurement
Treatment
Central
DDAVP (desmopressin acetate) -
ADH replacement
0.45% NS IV
If you're losing water, osmosis towards ECF =
Risk for cell shrinkage
= Hypotonicity allows fluid to shift back ICF
Nephrogenic
Low sodium diet
Loss of fluid = Hypernatremiaa
Thiazide diuretics
High serum sodium = Decreased ADH = Increased urine excretion
Decreasing sodium = Returns to homeostasis = Eventually decreases fluid loss
SIADH (Syndrome of Inappropriate Antidiuretic)
Cause
Tumours
Meningitis/Brain trauma
Pertains to the brain - Relates to hypothalamus = Problem with hypothalamus/pituitary gland
Effects
Hypervolemia
Hyponatremia
Treatment is similar to hypervolemia/hyponatremia
IV Fluids
Purpose
Fluid
replacement
Maintenance
Osmolality
Definition: Concentration
Types
Isotonic
Increase fluid volume but not electrolyte
Hypertonic
Fluid shift
into ECF
Increases
ECF osmolality
Hypotonic
Fluid shift
into ICF
Dilutes
ECF = Decreases
ECF osmolality
Solute
Types
Crystalloid
Saline Solutions
Types
0.9 % NS
Isotonic
Provides Na+ and Cl-
higher than ECF
For patients that has both
fluid and sodium losses
Adverse effects: Risk for
hypervolemia/hyperchloremic acidosis
0.45% NS
Hypotonic
Provides
free water
, Na+, Cl-
To
promote osmosis to ICF
, wouldn't want to have a high solute concentration at ECF
1 more item...
Free water is from not enough solutes to bind to water
3% Saline
Hypertonic
Hypertonicity replaces need in
hyponatremia
Adverse effects: Risk for
hypervolemia/pulmonary edema
1 more item...
Component: NaCl
Has no calories
Dextrose solutions
Component: Glucose
Provides calories
Provides
free water
because glucose circulates the body as
blood sugar
and is consumed/serve as
energy source
Types
D5 1/2 NS
Hypotonic, same as 0.45% NS
Glucose is used to prevent
ketosis
Not enough calories to burn for energy
Dextrose 5% in Water (D5W)
Isotonic
Becomes
hypotonic
because glucose is
used up in the body
2 more items...
Dextrose 10% in Water (D10W)
Hypertonic
Provides glucose, free water
1 more item...
Multiple Electrolyte Solution
Lactated Ringer's (LR or RL)
Isotonic
More similar to plasma concentration
compared to 0.9% NS
Less Na+ Cl-
Has K, Ca, PO4 (Phosphate), lactate (metabolized to HCO3)
Common replacement fluid
Colloids