Output 1 Electrolytes- Draft

8/12/2019 Output 1 Electrolytes- Draft

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La onsolacion University Philippines

(formerly University of Regina Carmeli)

Graduate School Department

Name: Allan M. Manaloto, RN Professor: Dr. Amelia Sta Maria

Subject: Advanced Pathophysiology Date: November 09, 2013

F L U I D & E L E C T R O L Y T E

A N D A C I DB A S E B A L A N C E

Learning Objectives:

I. Describe the regulation of fluid & electrolyte, & acidbase balance in the body, including the mechanism involved to

maintain homeostasis.

II. . Identify factors affecting normal body fluid, electrolyte, and acidbase balance.

III. Discuss the risk factors for and the causes and effects of fluid, electrolyte, and acidbase imbalances.

IV. List the major electrolytes and the function of each.

V. Identify the signs and symptoms of the common fluid and electrolyte imbalances.

VI. Teach clients measures to maintain fluid and electrolyte, Acid-base balance.

I. I N T R O D U C T I O N

The cells of the body live in a fluid environment with an electrolyte and acid-base concentration maintained within a

narrow ranged. Fluid and electrolyte, Acid-Base Balance is the foundation for understanding many different disease

processes. Changes in Electrolyte concentration affect electrical activity of nerve and muscle cells, altered Acid-Base

balance disrupted cellular functions, and fluid fluctuation affects blood volume and cellular function.

II. CONCEPT OF FLUIDS

1. Functions:

1. Move electrolytes and water into and out of the cells.

2. Aid digestion.

3. Cleanse body of waste.

4. Regulate body temperature.

5. Lubricate joints and mucous membrane.

The distribution and amount of Total Body Water (TBW) change with age, and although daily fluid intake may

fluctuate widely, body regulates water volume within a relatively narrow range. Total body Water (TBW) is the sum of

fluids within all body compartments.

Individual TBW Condition Effect


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Newborn/ Infant About 75-80% of body

weight

-Greater body surf. area

-Renal: Not yet matured

Prone to Dehydration

Children/

Adolescents

60-65% of body weight Men- Increase muscle mass=

greater % of TBW

Women- more fat, lesser body

fluid.

Women are more prone to

Dehydration due to fat

(fats has tiny amount of

water)

Adult Range 45-75% (Ave.

60%)

Varies on individual

2. Regulation of Body fluids

Fluids and solutes move constantly within the body. That movement allows body maintains HOMEOSTASIS.

A. Membrane Transport: Cellular I & O

Cell continually take in nutrients, fluids and chemical messenger from the extracellular environment and expe

metabolites.

Passive Transport

- Water and small electrically uncharged molecules moves easily through pores of plasma

membrane. No need for energy expenditure cell.

- DIFFUSION: natural tendency of substance to move from area of higher concentration to one o

lower concentration.

Body Fluids

Intracellular Fluid (ICF):

>Fluids within Cell

>2/3 of TBW

Extracellular Fluid (ECF)

>Fluids outside cell

>1/3 of TBW

Interstitial Fluid

>space between cells &outside the blood

vessel. Bathes the cell.

Intravascular Fluid

>blood plasma


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- FILTRATION: it is the movement of the water and solutes through membrane because of a greate

pushing pressure on one side of membrane than the other. (Area with greater Hydrostatic pressure

to area with lower Hydrostatic pressure.)

- OSMOSIS: movement of water across semi-permeable membrane from region with higher wate

concentration to lower water concentration.

Osmotic pressure -the amount of hydrostatic pressure required to oppose the osmotic movement of

water

Oncotic pressure- is the osmotic pressure exerted by proteins.

Active tranpsort

- Sodium moving out and Pottasium moving into the cell uses the direct energy of ATP.

- SODIUM- POTTASIUM PUMP: is located in cell membrane and actively moves Sodium from the

cell to the ECF.

3. Fluid Intake and Losses (per day in a healthy adult)

INTAKE OUTPUT

Ingested: 1300ml Urine: 1500ml

Water in foods: 1000ml Stool: 200ml

Oxidation: 300ml Insensible Lung: 300ml

Skin: 600ml


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TOTAL GAIN= 2,600ml TOTAL LOSS= 2,600ml

Abnormal fluid loss:

Results from physiology imbalance, Examples: Fever,Increased body temperature, Hemorrhage, emesis, exudates

diaphoresis, thoracentesis.

Quick way to monitor fluid balance is to: Monitor I &O .

4. Homeostatic mechanism

Organs to remember in maintaining fluid and elctrolyte balance:C.1. Kidneys

- filter 170L of plasma everyday (Adult), excreting only 1.5L of urine.

- It only takes 20mins of poor perfusion to promote Acute Tubular

Necrosis if not recognzed.

C.2. Heart and Blood Vessels

- pumps & carries fluids to organs, esp. kidneys.

C.3. Lungs

- everytime you exhale, water is lost (vapor). Client who experience

rapid breathing (e.g anxiety) may need increase fluids to maintain

Homeostasis.

C.4. Pituitary

- Hypothalamus- posterior pituitary gland secretes ADH. ADH is a water

conserving hormone (causes water retention).

C.5. Adrenal Gland

-secretes Aldosterone (mineralocorticoid, a volume regulator) in which

Result in Sodium retention= Water retention and Pottasium loss.

C.6. Parathyroid Gland

-secretes PTH that causes increase calcium serum by pulling it from

Bones and placing into blood.

C.7. Other Mechanism

-Baroreceptor: responsible for monitoring circulating blood volume.

-Renin-Angiotensin-Aldosterone System (RAAS)

-Anti-Diuretic Hormoe (ADH)

-Osmoreceptors

Fluid Loss

Sensible:

-sweat, feces

Insensible

-Kidney, GIT,

Lungs, Skin


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-Atrial Natriuretic peptide (ANP)

5. Case Considerations

1. Burned Client

- adequate albumin needed to hold fluid in the vessels may not exist. Therefore, fluid may leak out of the blood

vessel into the tissues that can lead to shock.

-these client looks: they are in fluid volume excess because of swollen tissues due to fluid accumulation in tissues

and interstitial fluid.

2. Diabetic Client

-when blood has too many glucose/ sugar particles, it causes particle-induced diuresis. (resulting in fluid loss that

can lead to hypovolemia)

3. Gerontologic Client

-Decreased cardiac, kidney, lung function, decreased muscle mass that increases them a risks of fluid and

electrolyte imbalances.-Dehydration may present as confusion, cognitive impairment

-Monitor I and O accurately.

6. Fluid Volume Disturbances

Hypovolemia: Fluid Volume Deficit

Dehydration: loss of water alone, with increase Sodium level.

Fluid Volume Deficit (FVD)/ hypovolemia: occurs when water and electrolytes are lost in the same proportion. Sodium

and water are lost in equal amounts from the vascular space.

Causes -Decrease intake/ poor appetite, tube feedings,-Drugs affecting fluid and electrloytes (Ex. Diuretics)

-Diuresis (Diabetes insipidus, Addisons disease)

-Vomiting, diarrhea, GI suction, hemmorhage

Signs & Symptoms -Acute weight loss -Postural hypotension

-Decrease skin turgor -Weak, rapid pulse; Decrease BP

- Increase RR and Urine SG

Diagnosis -BUN: is elevated and out of proportion to Serum Creatinine

-Serum Electrolytes, Urine SG ang Hg & Hct (increased)

Complications -Shock! - Cogestive heart failure

-Poor Organ perfusion that may lead to ATN and Real Failure

Medical Management 1. Acute and Severe loss- IV route is required.

2. Intavenous Solution (Isotonic): Lactated Ringer,and 0.9NaCl because they

expand plama volume.

3. Accurate and frequent assessment of LOC, I & O, Skin, CVP, Weight, and


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VS.

Nursing Management 1. Moitor and measure I & O accurately.

2. Weigh client daily.

3.Observe for weak, rapid pulse.

4. Inspect Skin turgor (thigh, forehead and sternum) and Tongue (may become

smaller bec. of fluid loss) regularly.

Hypervolemia: Fluid Vloume Excess

Fluid volume excess (FVE): is the expansion of the ECF caused by abnormal retention of watera and sodium. Isotonic

overhydration.

Causes -diminished fuction of homeostatic mech. Eg.: Heart failure, Renal failure, liver

cirrhosis.

-excessive amout of salt consumption

-Medication: Steroids; Albumin infusion; Blood product admin.

Signs & Symptoms -Jugular vein distention, bounding pulse, tachycardia-Abnormal breath sounds (fluid collect- lung)

-Polyuria, Dyspnea, Edema- weight gain

-Increased BP and CVP

Diagnosis -Decreased hemoglobin & Hct, Decreased Sodium electrolytes

-BUN and Crea: Increased means kidney not functioning properly and not

excreting fluid.

Medical Management 1. Management is directed at the cause. (eg. Excessive sodium admin-

discontinue infusion).

2. Pharmacologic: Diuretics

Thiazide (Hydrochlorothiazide;Metozalone)

-for mild to moderate hypervolemia

-blocks sodium reabsoption at distal tubule

Loop Diuretic (Furosemide, Bumetanide, Torsemide)

-for severe hypervolemia

-block sodium reabsorption in loop of henle

3. Nutritional Management: mild sodium restriction to 250mg/day.

Drink distilled water.

Nursing Management 1. Measure I & O and Body weight.

2. Assess breath sounds.

3. Assess edema: feet, hands, and sacral area.

III. CONCEPT OF ELECTROLYTES


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Electrolytes are elements that, when dissolved in water, acquire an electrical charge. Cations are positively charged

(Sodium, Calcium, Pottasium, Magnesium and Hydrogen ions), Anions are negatively charged (Chloride, Phosphate,

Bicarbonate, and Sulfate).

Functions of electrolytes:

-Water distribution

-acid-base balance

-transmit nerve impulses

Abnormal Electrolyte losses:

-Vomiting

-NG Suctioning

-Drainage (wounds)

-Diarrhea, Diuretics

Causes of Excess electrolytein blood:

-Kidney trauma/ disease

-Massive blood transfusion

-Crushing injuries/ chemotherapyNote: Standard treatment to client with Fluid and Electrolyte imbalances- IV therapy.

1. SODIUM

Values >Normal Adult level: 135-145mEq/L.

>90% of ECF Cations (Chief electrolyte in the ECF is Sodium).

Functions along with Anions (Chloride and Bicarbonate) they regulate osmotic forces and

therefore regulate water balance.

assist generation and transmission of nerve impulses.

assist in Sodium-Potassium pump in cell membrane.

regulates osmolality.

Food Sources bacon, ham, cheese processed, catsup, mustard, relishes, canned vegies

bread, cereals, snack food

Concept >Excretion of Sodium retains Potassium. Sodium is the only electrolyte affected by water.

Sodium level decreases when there is high amount of water in the body, while sodium

level decreases when there is little amount of water in the body.

Regulation >Sodium is regulated by ADH, Thirst, and RAAS system in the body.

SODIUM IMBALANCES

HYPERNATREMIA HYPONATREMIA

Value Sodium level >145 mEq/L Less than 135mEq/L

Causes Acute Sodium gain: Infection, Renal failure,

High Na Intake

Net loss of Water: Hyperventilation, watery

Not enough sodium in ECF or too much water

diluting the blood.

Inadequate Intake, Diuresis, Diaphoresis,


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diarrhea, DI, Polyuria Diarrhea, SIADH

Signs/

Symptoms

Dry, sticky mucus membrane, swollen

tongue, decrease saliva

Change in LOC, Tachycardia, decreased

heart contractility

Poor skin turgor, dry mucosa, abdominal

cramping

Neuro changes: altered LOC, cerebral

edema, Coma

Anorexia, exhaustion

Diagnosis Serum Elec (Increase Na)

Increase urine SG, decreased CVP

Decreased serum sodium, and Urine SG

Treatment 1. Determine first the cause of Hypernatremia.

2. Restrict all forms of Sodium

3. Infuse hypotonic Electrolyte solution (e.g. 0.3

NaCl)

1. Key is assessment. ( Decreased Intake/

Increased Na loss?, Excessive water in

vascular?)

3. Sodium Replacement. IVF- LRS or Isotonic

saline.

4. Water restriction

Nursing

Management

1. Carefully monitor fluid I & O.

2. Take note of pts thirst, elevated temp, andhistory of meds taken.

3. Monitor chages in behavior.

1. Early detection and treatment.

2. Monitor fluids and body wt3. Note abnormal losses of Na or gains of

water, GI manifestation and CNS and monitor

serum Na.

4. Encourage foods high in Sodium, if

applicable. And Restrict fluid intake.

2. POTASSIUM

Values >Normal Adult level: 3.5-5.0 mEq/L.

>98% of bodys potassium is inside cell. (ICF)

Functions skeletal and smooth muscle cotraction.

transmission of electrical impulses.

Note: Sodium and Potassium are inversely related: if one is up, the other is down.

Stomach contains large amount of potassium.

Food Sources peaches, bananas, apricots, oranges, melons, raisins, prunes, brocolli, potatoes, meat,

milk

processed foods, whole grains, dairy products

POTASSIUM IMBALANCES

HYPERKALEMIA HYPOKALEMIA

Value Serum potassium >5.0 mEq/L Less than 3.5 mEq/L

Causes Decreased renal excretion of kidney,

Burns, tissue damage

Meds: KCL, Heparin, ACE inhibitors,

Reduce intake, GI loss- vomiting, diarrhea, GI

suction

K-losing diuretics, altered Acid-base, Meds-


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Captopril, NSAID

Acidosis

Corticosteroids, amphotericin B, Kidney disease,

Alkalosis

Signs/

Symptoms

Begins with muscle twitching,

hyperactive muscles with tingling and

burning sensation

Progress to numbness around the

mouth, weakness and flaccid paralysis.

Diarrhea, Cardiac arrythmia

(mild losses are asymptomatic) Sever

hypoKalemia: may lead to death due to heart/ respi

failure

Cramps first then, muscular weakness and flaccid

paralysis, hyporeflexia

Slow, DOB, weak and irregular pulse, decreased

LOC, N/V.

Diagnosis ECG: Peaked T-wave, Flat or no P-

wave, wide QRS complex

Increased serum K, ABG

metabolic acidosis.

ECG: flat/inverted T-wave, ST segment

depression, elevated U-wave.

Decreased serum K.

Treatment 1. Emergency pharma: give IV Ca

gluconate- to antagonize the adverseheart conduction. (If BP and HR drops,

STOP the infusion).

(IV) Regular Insulin- shift potassium into

cells.

Sodium bicarb- needed to alkalinize the

plasma and cause temp. potassium shift

to cells.

1. Admin of 40-80 mEq/L of K/day. (IV route: KCL,

K+ acetate).2. Potassium should be admin only after adequate

urine flow. Decreased urine vol (less 20ml/hr) for 2

consecutive hours is an indication to stop K+ admin.

NOTE: Admin of Potassium (max. conc.) is 20mEq/L

and rate no faster than 10-20 mEq/L. Potassium is

NEVER admin by IV push or IM.

Nursing

Management

1. Observe signs of muscle weakness

and dysrhythmias.

2. Always verify increase/ abnormal

result of serum K.

3. Adhere to Potassium restriction.

Foods low in K: butter, margarine, sugar,

cranberry juice, jellybeans, honey, hard

candy, root beer.

1. Monitor ECG and S/sx of K deficit.

2.Health teachings on Potassium rich foods.

3. CALCIUM

Values >Normal Adult level: 9.0-10.5 mg/dL

>more than 99% of bodys calcium is in skeletal system

Functions needed for vit. B12 absorption, acts like SEDATIVE on muscle, nerve impulse

transmission, blood clotting, muscle contraction and relaxation.

promotes strong bones and teeth.


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Inverse relatioship with Phosphorus.

Food Sources milk, cheese, dried beans, canned salmons , sardines

fresh oysters, green leafy vegetables

Concept >As Ionized Serum Ca decrease- PTH is secreted by parathyroid gland and thus,

Increased Ca absorption of GIT, Increased reabsorption from renal tubule, & releases Ca

from the bone.

CALCIUM IMBALANCES

HYPERCALCEMIA HYPOCALCEMIA

Value Calcium level >10.5 mg/dL Less than 9.0mg/dl

Causes Hyperparathyroidism, Immobilization,

Increase Ca and vit. D Intake, Thiazide

diuretics

primary hypoparathyroidism/surgical, radical neck

dissection, inflammed pancreas Vit D

consumption is inadequate and Mg def.

Alcohol abuse, Meds (caffeine, corticosteroids,

Loop diuretics)

Signs/

Symptoms

Reduced neuromuscular excitability,

decrease tone in smooth and striated

muscle (weakness, incoordination,

constipation, anorexia)

Decreased DTR, decreased bowel

sounds and respi arrest (sedates respi

muscle)

Late heart changes: decrease pulse ad

lead to cardiac arrest.

TETANY- tingling sensations (tip of fingers,

around mouth), spasm of muscles of

extremities/face.

Trousseaus sign- elicited by inflating BP cuff in

upper arm- causing carpal spasm: adducted

thumb, flexed wrist, extended interphalangeal

joints.

Chvosteks Sign- facial nerve is tapped about

2cm anterior to earlobe, result: twitching of

muscles of facial nerve.

Increased irritability of CNS-seizures, Dyspnea,

mental changes (depress, hallucination)

Diagnosis Serum Ca (increased)

X-ray (osteoporosis/ kidney stones),

ECG- arrythmias

ECG: QRS complex widen, prolonged ST

interval, prolonged QT interval.

Treatment 1. Pharmacologic

IV NaCl: dilute serum Ca

1. Acute symptomatic is life threatening: Admin IV

Ca gluconate, Ca Chloride


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Furosemide (Lasix): diuresis w/ Ca

excretion

Calcitonin- icrease bone resorption and

urinary Ca excretion

-too rapid admin causes heart arrest

-dagerous to pt having digitalis derive meds

-inspect IV site for extravasation.

2. Vit D Therapy

Nursing

Management

1. Monitor ct at risk.

2. If pt takes Digoxin, assess for toxicity.

Encourage ambulation.

3. Take safety/seizure precaution.

4. Force fluid with high acid-ash

concentration (cranberry juice).

1. Severe Hypocalcemia: WOF seizure precaution

and monitor airway.

2. Osteoporosis pt- health teachings of food.

4. MAGNESIUM

Values >Normal Adult level: 1.3-2.1 mEq/L

Functions acts directly @ myoneural junction

present in bone, heart, nerves, and muscle tissues

assist metabolism CHO & CHON, maintain electrical activity in nerves and muscle.Acts like a sedative on muscle.

Food Sources vegetables, nuts, fish, peas, whole grains

legumes, cocoa, peanut butter, seeds, seafoods

MAGNESIUM IMBALANCES

HYPERMAGNESIMIA HYPOMAGNESIMIA

Value Magnesium level >2.1 Eq/L Less than 1.3 mEq/L

Causes Renal Failure- kidney unable to excrete

Mg, Pt with untreated DKA, Excessive

antacid use, use of laxatives and MOM.

chronic alcoholism (most common), diuretics,

diarrhea, GI losses and Meds (digitalis, cisplatin)

Signs/

Symptoms

mild hyperMg: decreased BP, N/V,

weakness, facial flushing

Increase Mg conc: lethargy, difficulty

speaking, drowsiness, DTR lost, muscle

weakness.

if more than 10mEq/L=Respi Depress.

(Increased Mg=Sedative)

Neuromuscular changes: hyperexcitability with

muscle weakness, tremor, tetany, laryngeal stridor,

muscular spasm

cardiac changes: prolonged QRS, depressed ST

segment

marked mood alterations (Apathy, depression,

agitation, ataxia, insomnia)

Hyperactive DTR

Diagnosis Serum Mg (more than 2.5 mEq/L),

Increased Potassium and Ca are present

concurrently

ECG: Tall T-waves, widened QRS,

Prolonged PR interval.

Serum elec (decreased Mg), ECG, Urialysis


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Treatment 1. Avoid admi of Mg to pt with RF.

2. Emergency: Respi distress- ventilate

pt, if heart conduction is defective-give IV

Ca gluconate.

2.Admin Loop diuretic (lasix) & NaCl or

LR (IV) to enhance Mg excretion.

1. Mild Mg Def-Tx with diet alone (oral admin of Mg

salts)

2. IVF: Mg Sulfate-Assess BP, Heart ryhthm, Respi

distress, Notify MD if Urine output is less than 100ml

for 4hrs.

Nursing

Management

1. Monitor VS, noting pt hypotension

and shallow RR.

2.Assess for decrease patellar reflexes

and chage in LOC.

1. Monitor pt receiving digitalis.

2.If severe hypomagnesia-seizure precaution.

3. Dysphagia is present-test swallowing first before

giving water.

4.Assess DTR and give health teaching on Diet.

4. PHOSPHORUS

Values >Normal Adult level: 2.5 to 4.5 mg/dl (had inverse relationship with calcium).

Functions essential for RBC and muscle function, formation of ATP.assist with CHO,CHON, and fat met.

Food Sources milk and mlik products, organ meats, nuts, fish, kidneys

sardines, poultry, whole grains, dried fruits

PHOSPHORUS IMBALANCES

HYPERPHOSPHATEMIA HYPOPHOSPHATEMIA

Value Phosphorus level >4.5 mg/dL Less than 3.0mg/dl

Causes RF, Increased intake, decreased output,

chemo, DKA

Admin of calories to pt with severe protein-calorie

malnutrition

Malnourished pt

Pain, heat stroke, prolonged intense hyperventilation

Alcohol withdrawal, hepatic encephalopathy

Signs/

Symptoms

due from decreased Ca levels: Tetany ATP def.-impairs cellular energy resources

(impairs Oxygen delivery to tissue.

Neurologic: fatigue, irritability, weakness,

paresthesia, confusion, seizure, diplopia, dysphagia

Hypoxia (Increased RR, Respi alkalosis)

Diagnosis Serum phosphorus, X-ray Serum Elec, X-ray (bone becomes brittle and

weak)

Treatment 1. Treat underlying cause.

2.Admin Vit D prep (Calcitrol) to increase

Ca=decrease Phosphate

3. Admin Phosphate binding gels (may

1. Possible dangers of IV admin of phosphorus

include tetany from hypocalcemia and calcifications

from tissue.

2. Rate of IV should not exceed 10mEq/H


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lead to high Ca levels).

4. Restricted phosphorus diet.

Nursing

Management

1. Avoid phosphate-containig subs.

(enema and laxative)

1. Assess for Hyper/Hypo calcemia, and Health

teaching on diet.

IV. CONCEPT OF ACID-BASE BALANCE

Power of Hydrogen: Normal pH range: 7.35-7.45

-the more Hydrogen ions=more acidic the solution=Lower pH

-the lower Hydrogen ions=more basic the solution=Higher pH

Major Organs involved in regulating Acid-Base balance: Bones, Lungs and Kidneys.

NOTE:

Major LUNG chemical is= Carbon DioxideMajor KIDNEY chemicals are= Bicarbonate (HC03) and Hydrogen ion.

Respiratory Acidosis/ Alkalosis

>the problem is the Lungs.

If the Lungs are sick (retained too much C02), the kidney

compensates by kicking HC03 into the blood and excreting

hydrogen ion out of the body.

If lungs rids of too much C02 (Hyperventilation), the kidney

compensate by retaining Hydrogen Ion and excreting HC03.

Metabolic Acidosis/ Alkalosis

>Problem is the kidney.

If the kidney malfunction, the Lungs will

compensate (quickly)- C02 is excreted/retained.

1. BUFFER SYSTEM

Buffer occurs in response to changes in Acid-Base balance. Act by removing or releasing Hydrogen ions (quickly).

a. Carbonic Acid-Bicarbonate Buffering

b. Protein Buffering

c. Renal Buffering

NOTES:

the only way CO2 can build up in the blood is significant decrease in respiration.

the brain likes to the body pH to be perfect all the time. When pH gets out of whack= Neuro and LOC can occur,

therefore monitor them.

Arterial Blood Gas: Normal Values

pH Hydrogen ion concentration 7.35-7.45

Hydrogen ion= Acid

Bicarbonate= Base


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PCO2 Partial pressure carbon dioxide 35-45mmHg

PO2 Partial pressure Oxygen 80-100mmGHg

HCO3 Bicarbonate 22-26mEq/L

Metabolic Acidosis Metabolic Alkalosis

Concept charac. by low pH and low plasma HCO3

concentration.pH: less than 7.35

HCO3 less than 22mEq/L

charac. by high pH and high plasma HCO3

conc.pH: more than 7.45

HCO3 more than 26mEq/L

Causes DKA, malnutrition, starvation

Shock, kidney illness

Diarrhea, ASA overdose

Drugs (Diamox, Aldactone)

vomiting;NG suctioning

Excess antacid ingestion

BT, NaHCO3 admin

Drugs (Thiazide & Loop diuretic), Baking

soda, HypoK, steroids.

Signs and

Symptoms

hyperKalemia: if Hydrogen ion builds up in

blood=Potassium goes out of the cell.

(Muscle twitching, oral numbness,

weakness)

Kussmauls Breathing: Deep and rapid-

CO2 is blown off in high amount.

Early: Headache and lethargylate is

Comatose.

Chronic Renal Failure Pt

-chronic metabolic acidosis

(asymptomatic).

(related to decreased Ca)

Tingling of fingers and toes, dizziness,

tetany

Depress RR, HypoK

Hepatic Encephalopathy (due to

ammonia)

Diagnosis ABG: pH less than 7.35;

HCO3 less than 22 mEq/L

PCO2 less than 35mmhg (compensates)

Serum elec (high potassium)

ABG: pH more than 7.45;

HCO3 more than 26 mEq/L

PCO2 normal but increases with

compensation.

Medical

Management

1. Admin Sodium Bicarb (use only in quick,

temporary basis)

2. In chronic cases= treat first low Ca serum.

1. Admin NaCl fluids.

2. Admin Ammonium Cl (IV)

3. Admin Acetazolamide (Diamox).

Nursing

Management

1, Monitor ABG, HyperK, Arryhthmia,

HyperCa.

2. Closely monitor LOC.

3.Admin IVLR to increase base level.

1. Monitor ABG, LOC, RR, hypotension,

DTR.


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Respiratory Acidosis Respiratory Alkalosis

Concept due to inadequate CO2 excretion

(Hypoventilation).pH: less than 7.35

PCO2 more than 45mmhg

HYPERCAPNIA: build up of CO2 in the

blood to more than 45mmhg.

If PaCO2 is chronically more than 50mmhg,

the respi center is insensitive to CO2 as respi

stimulant. Therefore Admin of O2 may

remove the stimulus of Hypoxemia and pt

develops CO2 narcosis.

always caused by hyperventilation.

pH: more than 7.45PCO2 less than 35mmhg

HYPOCAPNIA: occurs when CO2 is low;

stimulates ANS which causes: Anxiety,

tingling sensation and sweating.

Causes Respi arrest, Airway Obstruction, Brain

trauma

Collapsed lung, weak respi muscle,

surgical incision

sleep apnea, excessive alcohol intake,

narcotics, sedatives

Hysteria/ Anxiety (Increased RR)

ASA overdose; Pain; Fever

Sepsis ,Anemia

Signs and

Symptoms

Sudden: Increased RR Bp,& PR, (Pt is

breathing too shallow, too slowly or nothing

at all)

Excess acid=Brain vasodilate (Head

fullness feeling, mental cloudiness,

Increased ICP, brain swelling and decreased

DTR.)

Acidic urine, Arrhythmias

Vasoconstriction/ decreased cerebral blood

flow (inability to concentrate and

lightheadedness)

Decreased Calcium (numbness and tingling

sensation)

Increased RR, rapid pulse

HypoK


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Chronic Respi Acidosis

-present in pt with chronic emphysema,

bronchitis, & obesity

Diagnosis ABG: pH less than 7.35;

HCO3 normal until kidney compensates

PCO2 more than 45mmhg

PO2 less than 80mmhg

ABG: pH more than 7.45;

HCO3 normal until kidney compensates

PCO2 less than 35mmhg

Management (Goal: CT blow off excess CO2)

1. Treat the cause.

2. Airway Clearance.

3. Mechanical ventilation with PEEP.

4. Admin Drugs to open airways and thin out

secretions.

5. Increase fluids; O2 Therapy; Elevate HOB.

Monitor ABG.

1. Treat the cause.

2. Monitor VS esp RR, electrolytes, and ABG.

3. Calm the patient. Admin anti-anxiety.

Have the client breath into a paper bag/re-

breather mask.

IV. C O N C L U S I O N

Nursesneed to understand the concepts of Fluid and Electrolyte/ Acid-Base to anticipate, Identify, and respond to

possible imbalances. An awareness of fluid and electrolyte regulation guides the nurse in anticipating potential problems

and ensuring that appropriate interventions take place. Integral part for the nurse is to identify/assess patient who are a

risk in developing imbalances in fluids, electrolytes, and acid-base. Its a challenge for us to maintain their specific ranges

in normal values.

V. R E F E R E N C E S

Understanding Pathophysiology, 3rd

Edition (S. Huether & K. McCance)

Brunner and Suddarths Textbook of MSN, 11thEdition

Hurst Reviews (Pathophysiology Review)

MSN made Incredibly easy, 3rd

edition

Output 1 Electrolytes- Draft

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