Blogger Widgets Blogger Widgets

2017 PNLE REVIEW MATERIALS FOR SALE

Sunday, May 20, 2012

Major Fluid and Electrolytes Imbalances


Major Fluid and Electrolyte Imbalances   

Imbalance

Contributing Factors

Signs and Symptoms / Laboratory Findings

Potassium deficit
(hypokalemia)

Serum potassium
 < 3.5 mEq/L

·     Diarrhea, vomiting
·     Gastric suction
·     Corticosteroid administration
·     Diuretics
·     Hyperaldosteronism
·     Alkalosis
·     Carbenicillin, Amphotericin B
·     Bulimia, starvation
·     Osmotic diuresis
·     Digoxin toxicity


Fatigue, anorexia, nausea and vomiting, muscle weakness, polyuria, decreased bowel motility, ventricular asystole or fibrillation, parethesias, leg cramps, â BP, ileus, abdominal distention, hypoactive reflexes

ECG:
Flattened T waves, prominent U waves, ST depression, prolonged PR interval


Potassium excess
(hyperkalemia)

Serum potassium
 > 5.0 mEq/L


·     Pseudohyperkalemia
·     Oliguric renal failure
·     Use of potassium-conserving diuretics in pts. with renal insufficiency
·     Metabolic acidosis
·     Addison’s dse
·     Crush injury
·     Burns
·     Stored bank blood transfusions
·     Rapid IV administration of potassium


Vague muscular weakness, tachycardia à bradycardia, dysrhythmias, flaccid paralysis, paresthesias, intestinal colic, cramps, irritability, anxiety

ECG:
Tall tented T waves, prolonged PR interval and QRS duration, absent P waves, ST depression
Major Fluid and Electrolyte Imbalances   

Imbalance

Contributing Factors

Signs and Symptoms / Laboratory Findings

Calcium deficit
(hypocalcemia)

Serum calcium
 < 8.5 mg/dL

·     Hypoparathyroidism (may follow thyroid surgery or radical neck dissection)
·     Malabsorption
·     Pancreatitis
·     Alkalosis
·     Vitamin D deficiency
·     Massive SQ infection
·     Generalized peritonitis
·     Massive transfusion of citrated blood
·     Chronic diarrhea
·     Diuretic phase of renal failure
·     Decreased PTH, á PO4
·     Fistulas, Burns


Numbness, tingling of fingers, toes, and circumoral region; positive Trousseau’s sign and Chvostek’s sign; seizures, carpopedal spasms, hyperactive deep tendon reflexes, irritability, bronchospasms, anxiety, impaired clotting time, â prothrombin

ECG:
Prolonged QT interval and lengthened ST

Lab findings:
â Mg++


Calcium excess
(hypercalcemia)

Serum calcium
 > 10.5 mg/dL


·     Hyperparathyroidism
·     Malignant neoplastic dse
·     Prolonged immobilization
·     Overuse of calcium supplements
·     Vitamin D excess
·     Oliguric phase of renal failure
·     Acidosis
·     Corticosteroid therapy
·     Thiazide diuretic use
·     Increased PTH
·     Digoxin toxicity


Muscular weakness, constipation, anorexia, nausea and vomiting, polyuria, polydipsia, dehydration, hypoactive deep tendon reflexes, lethargy, deep bone pain, pathologic fractures, flank pain, and calcium stones

ECG:
Shortened ST segment and QT interval, bradycardia, heart blocks
Major Fluid and Electrolyte Imbalances   

Imbalance

Contributing Factors

Signs and Symptoms / Laboratory Findings

Magnesium deficit
(hypomagnesemia)

Serum magnesium
 < 1.8 mg/dL

·     Chronic alcoholism
·     Hyperparathyroidism
·     Hyperaldosteronism
·     Diuretic phase of renal failure
·     Malabsorptive disorders
·     Diabetic ketoacidosis
·     Refeeding after starvation
·     Parenteral nutrition
·     Chronic laxative use
·     Diarrhea
·     Acute MI, heart failure
·     Decreased serum K+ and Ca++
·     Certain pharmacologic agents (gentamicin, cisplatin, cyclosporine)


Neuromuscular irritability, positive Trousseau’s and Chvostek’s signs, insomnia, mood changes, anorexia, vomiting, increased tendon reflexes, á BP

ECG:
PVCs, flat or inverted T waves, depressed ST segment, prolonged PR interval and widened QRS


Magnesium excess
(hypermagnesemia)

Serum magnesium
 > 2.7 mg/dL


·     Oliguric phase of renal failure (particularly when magnesium-containing medications are administered)
·     Adrenal insufficiency
·     Excessive IV magnesium administration
·     DKA
·     hypothyroidism


Flushing, hypotension, drowsiness, hypoactive reflexes, depressed respirations, cardiac arrest and coma, diaphoresis

ECG:
Tachycardia à  bradycardia, prolonged PR interval and QRS
Major Fluid and Electrolyte Imbalances   

Imbalance

Contributing Factors

Signs and Symptoms / Laboratory Findings

Chlorine deficit
(hypochloremia)

Serum chloride < 96 mEq/L

·     Addison’s disease
·     Reduced chloride intake or absorption
·     Untreated diabetic ketoacidosis
·     Chronic respiratory acidosis
·     Excessive sweating
·     Vomiting, diarrhea
·     Gastric suction
·     Sodium and potassium deficiency
·     Metabolic alkalosis
·     Loop, osmotic, or thiazide diuretic use
·     Overuse of bicarbonate
·     Rapid removal of ascitic fluid w/ high Na content
·     IVF that lack chloride (dextrose and water)
·     Draining fistulas and ileostomies
·     Heart failure
·     Cystic fibrosis


Agitation, irritability, tremors, muscle cramps, hyperactive deep tendon reflexes, hypertonicity, tetany, slow shallow respirations, seizures, dysrhytmias, coma

Lab findings:
â serum chloride, â serum sodium, á pH,
á serum bicarbonate, á total carbon dioxide content, â urine chloride level, â serum potassium


Chloride excess
(hyperchloremia)

Serum chloride
 > 108 mEq/L


·     Excessive sodium chloride infusions with water loss
·     Head injury (sodium retention)
·     Hypernatremia
·     Renal failure
·     Corticosteroid use
·     Dehydration
·     Sever diarrhea (loss of bicarbonate)
·     Respiratory and metabolic alkalosis
·     Administration of diuretics
·     Overdose of salicylates (Kayexalate, Acetazolamide, phenylbutazone and ammonium chloride)
·     Hyperparathyroidism


Tachypnea, lethargy, weakness, deep rapid respirations, decline in cognitive status, decreased CO, dyspnea, tachycardia, pitting edema, dysrhythmias, coma

Labs indicate:
á serum chloride, á serum potassium and sodium, â serum pH, â serum bicarbonate,
á urinary chloride level


Related Posts Plugin for WordPress, Blogger...