Fluid/Electrolytes-Helpful Study Materials

tsm007 · Feb 10, 2014

This helped me with fluid & electrolytes http://www.mhprofessional.com/downloads/products/007148986X/hurst_pathophysiology-ch01_986x.pdf

Halcyonn · Feb 10, 2014

Wow, thanks for posting that resource! Just skimmed through it, but from what I saw I really like the way it's laid out. S/S alongside an explanation or a "why" seems to help my information retention. Very effective - good stuff!

Esme12, ASN, BSN, RN · Feb 11, 2014

https://allnurses.com/nursing-student-assistance/med-surg-fluid-804058.html

table of commonly used iv solutions.doc - most commonly used iv solutions; includes tonicity, ph, the ingredients of the solutions, its uses and complications

icufaqs

http://www.merckmanuals.com/professi...scitation.html

There are 6 major electrolytes. Sodium, potassium, calcium, chloride, magnesium and phosphorus. It is primarily potassium, calcium and sodium that will cause problems when they are out of whack.

hypokalemia
hyperkalemia
hypocalcemia
hypercalcemia
hyponatremia
hypernatremia

When there is a sodium imbalance quite often there will be changes in mental status - confusion, delirium, etc. Often seen with traumatic brain injury where diabetes insipidus (pathological voiding of large amounts of dilute urine) and its opposite SIADH (syndrome of inappropriate antidiuretic hormone - minimal urine output but very concentrated) may occur. Sodium imbalances are also seen with dehydration in some patients (elderly, burn victims, many others) and the blood levels will go up. Very rarely, sodium levels in the blood will go down because of consuming large quantities of fluids.

The other main electrolyte imbalance seen is when potassium is out of whack, and its most serious consequence is cardiac problems that can be life-threatening (you will see T wave changes: depression with hypokalemia, elevation with hyperkalemia, among other changes in the EKG like QRS interval changes).

For these 2 main electrolyte imbalances remember: Sodium equals mentation, and Potassium equals cardiac.

Sodium does affect fluid. In fact, they say sodium always follows water. There are a lot of people with edema related hypernatremia; and a lot of dehydration related to sodium and chloride losses. Potassium tends to affect the heart and in the clinical area you will see dramatic instances of people with hypokalemia and hyperkalemia. Calcium affects the muscles and is not as commonly seen clinically because it is detected because of lab testing.

Sodium - body water balance
Potassium - contraction of skeletal and smooth muscle and nerve impulse conduction
Calcium - formation and structure of bones and teeth, cell structure and function, cell membrane permeability and impulse transmission, the contraction of all muscle types and is necessary in the blood clotting process
Chloride - important in the digestive acids; closely linked to sodium
Magnesium - affects nerve and muscle action by affecting calcium usage, activates enzymes involved in carbohydrate and protein metabolism, helps in the transport of sodium and potassium across cell membranes, and influences the levels of sodium, potassium, calcium and some body hormones (parathyroid hormone)
Phosphorus - formation and structure of bones and teeth, this electrolyte is needed in the following activities: utilization of B vitamins, acid base homeostasis, bone formation, nerve and muscle activity, cell division, the transmission of hereditary traits, metabolism of carbohydrates, proteins and fats
http://www.elmhurst.edu/~chm/vchembook/253fluidkidneys.html

Third-spacing: Where has all the fluid gone?

c-electrolyte-surface-of.gif

table of commonly used iv solutions.doc

IV fluids: Do you know what's hanging and why? | Modern Medicine

http://ww2.rch.org.au/emplibrary/clinicalguide/IVFLUIDCHART.pdf

http://www.med.mun.ca/getdoc/6f26f870-6c78-4a73-80f0-98200858aafd/IntravenousFluids.aspx

Halcyonn · Feb 11, 2014

Esme, thank you for your very informative post. I am stuck on one thing regarding hypo/hypernatremia. You mentioned that a patient with edema may experience hypernatremia, but you also mentioned that a patient who consumes large amounts of fluids may experience hyponatremia. In my mind, excess fluid is excess fluid, so let me attempt to understand this.

Bear with me...

When you say "sodium always follow water", is that to say your patient with edema may experience hypernatremia because they have excess fluid, therefor their body retains more sodium (follows/stays with the water), which leads to an elevated lab value?

Conversely, if a patient consumes excess amounts of fluid they may experience hyponatremia because they have essentially diluted themselves (eg. hypovolemia)?

I suppose I'm getting caught up in the fact that in both cases the patient has extra fluid on board, but ends up with two different lab values.

Does this make sense? :confused:

PayitForwardHolistic · Feb 12, 2014

I thought I shared this somewhere on AN...but I can't find it, so I guess I didn't LOL. Here is a link to a chart I made during the good ol' Med-surg years

Fluid & Electrolyte Chart

Esme12, ASN, BSN, RN · Feb 12, 2014

Esme, thank you for your very informative post. I am stuck on one thing regarding hypo/hypernatremia. You mentioned that a patient with edema may experience hypernatremia, but you also mentioned that a patient who consumes large amounts of fluids may experience hyponatremia. In my mind, excess fluid is excess fluid, so let me attempt to understand this.
Bear with me...
When you say "sodium always follow water", is that to say your patient with edema may experience hypernatremia because they have excess fluid, therefor their body retains more sodium (follows/stays with the water), which leads to an elevated lab value?
Conversely, if a patient consumes excess amounts of fluid they may experience hyponatremia because they have essentially diluted themselves (eg. hypovolemia)?
I suppose I'm getting caught up in the fact that in both cases the patient has extra fluid on board, but ends up with two different lab values.
Does this make sense?

Water intoxication/dilutional hyponatremia, is a potentially fatal disturbance in brain functions that results when the normal balance of electrolytes in the body is pushed outside safe limits by over-hydration.

Most water intoxication is caused by hyponatremia, an overdilution of sodium in the blood plasma, which in turn causes an osmotic shift of water from extracellular fluid (outside of cells) to intracellular fluid (within cells). The cells swell as a result of changes in osmotic pressure and may cease to function. When this occurs in the cells of the central nervous system and brain, water intoxication is the result.

mzrainydayz, BSN, RN · Feb 12, 2014

The F & E / acid base reviews and rationale book helped me. I passed that test with a 88. The book has pre and post test and in between it has the info. It breaks down the info perfectly. I recommend all the entire series for studying throughout nursing school.

Halcyonn · Feb 12, 2014

Alright, I understand the osmosis portion of that. My original reply should have said (hypervolemia) instead of (hypovolemia). Anyway, my take away from that is water will move to dilute the solute. In this case, sodium. When the Na content inside the cell is > than the Na content outside the cell the water moves into the cell. An intake of too much fluid causes the dilution of the blood plasma. Yes?

Treatment for this condition would be diuretics?

Still kinda hung up on the concept of edema related hypernatremia.

I think I need to review my NANDA book. Perhaps looking at interventions will help it make sense.

Halcyonn · Feb 12, 2014

mzrainydayz, what book did you use to review? The Hurst review that was posted at the top?