Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example

Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example

Adaptation- Cellular level- hypertrophy,

hyperplasia, metaplasia. Fluid and

Electrolyte impact on adaption involves

maintain acid-base balance (renal, vascular

and respiratory systems) Pressure gradients

are maintained through fluid shifts and

component shifts. Example- If a condition

exists and the solution is concentrated, water

moves to dilute the solution, or components

move to change the concentration.(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

Fluid Compartments

– Fluid is distributed between the

intracellular compartments(ICF)

fluid inside the cells, extracellular

compartments (ECF)

Extracellular compartments :

-Intravascular fluid (IVF) or blood

– interstitial fluid (ISF) or intracellular

fluid (ICF)(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

– cerebrospinal fluid

Hydrostatic and Osmotic Pressure

In the capillaries, hydrostatic pressure

increases filtration by pushing fluid and

solute OUT of the capillaries, while oncotic

pressure ( also known as colloid osmotic

pressure) pulls the fluid into the capillaries

and/or prevents fluid from leaving.(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

Movement of Water

-Fluid constantly circulates throughout the

body and moves relatively freely, depending

on the permeability of the membranes

between compartments by the processes of

filtration or osmosis.(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

-depending on the relatively hydrostatic and

osmotic pressure within the compartments.

Proteins and electrolytes contribute to the

osmotic pressure of a fluid and therefore are

important in maintaining fluid volumes.

-Fluid excess occurs in the extracellular

compartment and may be referred to as

isotonic/iso-osmolar, hypotonic/ hypo-

osmolar, or hypertonic/hyper-osmolar,

depending on the cause.(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

ELECTROLYTES

SODIUM (135-145)

-Primary cation (positively charged ion) in

the extracellular fluid

-Sodium is important for the maintenance of

extracellular fluid volume through its effect

on osmotic pressure because it makes up

approximately 90% of the solute in

extracellular fluid.(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

HYPONATREMIA

sodium deficit can result from direct loss of

sodium from the body or from an excess of

water in the extracellular compartment,

resulting in dilution of sodium.

CAUSES:

– sodium deficit – excess water in the

extra cellular compartment.

– Common causes for low sodium

– Excessive sweating, vomiting, and

diarrhea(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

– Use of certain diuretics drugs with

low salt diets

– Hormonal imbalances (insufficient

ADH secretion)

– Early chronc renal failure

– Excessive water intakeDocument continues below

EFFECTS:

Low levels impair nerve conduction,

-manifestations include fatigue, muscle

cramps, and abdominal discomfort or

cramps with nausea and vomiting(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

HYPERNATREMIA

Excessive sodium level in the blood and

extracellular fluid > 145

CAUSES:

Specific causes include the following:

1. Insufficient ADH, which results in a

large volume of

dilute urine (diabetes insipidus)

2. Loss of the thirst mechanism

3. Watery diarrhea

4. Prolonged periods of rapid

respiration(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

EFFECTS:

The major effect of hypernatremia is a fluid

shift out of the cells owing to the increased

osmotic pressure of interstitial or

extracellular fluid; this effect is manifested

by the following:(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

Weakness, agitation

Firm subcutaneous tissues (see Table

2.5)

Increased thirst, with dry, rough

mucous membranes

Decreased urine output because

ADH is secreted(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

S & S

Hyponatremia

Anorexia, nausea, cramps Fatigue, lethargy,

muscle weakness

Headache, confusion, seizures Decreased

blood pressure

Hypernatremia

Weakness, lethargy, agitation

Fatigue, lethargy, muscle weakness

Edema, elevated BP

Thirst; tongue and mucosa are dry

and

POTASSIUM (3.5-5)

**Most important, abnormal potassium

levels, both high and low, have a significant

and serious effect on the contractions of

cardiac muscle causing changes in the

electrocardiogram (ECG) and ultimately

cardiac arrest or standstill. **(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

HYPOKALEMIA:

Low potassium levels < 3.5 mEq/ L

CAUSES:

Low serum potassium levels may result

from the following:

1. Excessive losses from the body due to

diarrhea

2. Diuresis associated with certain diuretic

drugs ; patients with heart disease who are

being treated with certain diuretic drugs

such as furosemide may have to increase

their intake of potassium in food or take a

potassium supplement because hypokalemia

may increase the toxicity of heart

medications such as digitalis(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

3. The presence of excessive aldosterone or

glucocorticoids in the body (in Cushing

syndrome, in which glucocorticoids have

some mineralocorticoid activity, retaining

sodium and excreting potassium)

4. Decreased dietary intake, which may

occur with alcoholism, eating disorders, or

starvation(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

5. Treatment of diabetic ketoacidosis with

insulin

EFFECTS:

Cardiac dysrhythmias , ECG patter

changes; lead to cardiac arrest.

Hypokalemia interferes with

neuromuscular function. Muscles

less respondent to stimuli; shown in

fatigue & muscle weakness

Parasthesias (pins and needles

develop)

Decreased GI , decreased appetite

In severe defieciency; muscle

become weak; followed by shallow

respirations

In severe cases; renal function is

impaired ; increased urine output.(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

HYPERKALEMIA

Increased levels of potassium > 5 mEq/L

CAUSES:

1. Renal failure

2. Deficit of aldosterone

3. Use of “potassium-sparing” diuretic

drugs, which prevent potassium from being

excreted in adequate amounts(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

4.Leakage of intracellular potassium in to

the extracellular fluids in patients with

extensive tissue damage such as traumatic

crush injuries or bums

5. Displacement of potassium from cells by

prolonged or severe acidosis

EFFECTS:

ECG shows typical dysrhythmias;

can progress to cardiac arrest

Muscle weakness, progression to

paralysis(possible)

Fatigue, nausea, paresthesias also

common

S&S

Hypokalemia

Cardiac arrhythmias, cardiac arrest

Anorexia, nausea, constipation

Fatigue, muscle twitch, weakness,

leg cramps(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

Shallow respirations, paresthesias

Postural hypotension, polyuria, and

nocturia

Serum pH elevated-7.45 (alkalosis)

Hyperkalemia

Arrhythmias, cardiac arrest

Nausea, diarrhea(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

Muscle weakness, paralysis

beginning in legs

Paresthesias-fingers, toes, face,

tongue

Oliguria(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

Serum pH decreased-7.35 (acidosis) Document continues below

CALCIUM ( 4.5- 5)

Extracellular cation, calcium balance

controlled by PTH (parathyroid

hormone)

Also influenced by Vitamin D and

phosphate levels

HYPOCALCEMIA < 4 mEq/L

CAUSES:

1. Hypoparathyroidism-decreased

parathyroid hormone results in

decreased intestinal calcium

absorption

2. Malabsorption syndrome-resulting in

decreased intestinal absorption of

vitamin D or calcium

3. Deficient serum albumin

4. Increased serum pH-resulting in

alkalosis In renal failure,

hypocalcemia results from retention

of phosphate ion, which causes loss

of calcium; also, vitamin D is not

activated, thereby decreasing the

intestinal absorption of calcium.

EFFECTS:

Increase permeability & excitability of nerve

membranes( muscle twitching

Contraction of the fingers & hyperactive

reflexes

Chvostek signs (spasms of the lip, face)

Trousseau sign (carpopedal spasms when a

blood pressure cuff blocks circulation)

Tetany (skeletal muscle spasms. Causing

contraction and or cramps)

Heart contractions (become weak),

conduction is delayed ; arrythmias develop ,

BP drops

HYPERCALCEMIA:

CALCIUM LEVELS > 5 mEq/L

CAUSES:

1. Uncontrolled release of calcium ions

from the bones

2. Hyperparathyroidism

3. Immobility, which may decrease

stress on the bone leading to

demineralization.

4. Increased intake of calcium due

either to excessive

5. vitamin D or to excess dietary

calcium

5. Milk-alkali syndrome, associated

with increased milk and antacid

intake, which may also elevate serum

calcium levels(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

EFFECTS:

Depression of neuromuscular

activity ; leads to muscle weakness ,

loss of muscle tone, lethargy and

stupor (accompanied by personality

changes, anorexia, nausea)

High levels interfere with function of

ADH, if case is severe blood volume

drops, renal function decreases,

nitrogen waste accumulates ; lead to

cardiac arrest)Document continues below

Cardiac contractions increase ;

dysrhythmias develop

If excess PTH bone density will

decrease leads to spontaneous bone

fractures.

Formation of kidney stones

S&S

Hypocalcemia

Tetany-involuntary skeletal muscle

spasm, carpopedal spasm,

laryngospasm

Tingling fingers

Mental confusion, irritability

Arrhythmias, weak heart

contractions

Hypercalcemia

Apathy, lethargy Anorexia, nausea,

constipation

Polyuria, thirst

Kidney stones Arrhythmias,

prolonged(Fluid electrolyte and acid base imbalance Comprehensive Nursing Paper Example)

strong cardiac contractions,

increased blood pressure

MAGNESIUM (1.5- 2.5)

Intracellular

Stored in bone

HYPOMAGNESEMIA

Often linked with chronic alcoholism,

malabsorption. Malnutrition

Causes of Hypomagnesemia

Use of diuretics

Diabetic ketoacidosis

Hyperparathyroidism

Hyperaldosteronism

Effects of Hypomagnesemia

Neuromuscular hyperirritability

Tremors or chorea (involuntary

repetitive movements)

Insomnia

Personality changes

Increased heart rate with arrhythmias

HYPERMAGNESEMIA

Cause of Hypermagnesemia

Usually occurs with renal failure

Effects of Hypermagnesemia

Depressed neuromuscular

function

Decreased reflexes

Lethargy

Cardiac arrhythmias

PHOSPHATE (2.5- 4.5)

FUNCTIONS:

In bone and tooth mineralization

In many metabolic processes,

particularly those involving the

cellular energy source, adenosine

triphosphate (ATP)

As the phosphate buffer system for

acid-base balance, and it has a role in

the removal of hydrogen ions from

the body through the kidneys Document continues below

sm,

malabsorption. Malnutrition

Causes of Hypomagnesemia

Use of diuretics

Diabetic ketoacidosis

Hyperparathyroidism

Hyperaldosteronism

Effects of Hypomagnesemia

Neuromuscular hyperirritability

Tremors or chorea (involuntary

repetitive movements)

Insomnia

Personality changes

Increased heart rate with arrhythmias

HYPERMAGNESEMIA

Cause of Hypermagnesemia

Usually occurs with renal failure

Effects of Hypermagnesemia

Depressed neuromuscular

function

Decreased reflexes

Lethargy

Cardiac arrhythmias

PHOSPHATE (2.5- 4.5)

FUNCTIONS:

In bone and tooth mineralization

In many metabolic processes,

particularly those involving the

cellular energy source, adenosine

triphosphate (ATP)

As the phosphate buffer system for

acid-base balance, and it has a role in

the removal of hydrogen ions from

the body through the kidneys

Causes of Hyperphosphatemia

• Often results from renal failure.

Dialysis patients often take

phosphate binders with meals to

control their serum phosphate levels.

• Tissue damage or cancer

chemotherapy may cause the release

of intracellular phosphate.

Effects of Hyperphosphatemia

• The manifestations of

hyperphosphatemia are the same as

those of hypocalcemia.

CHLORIDE(95-105)

Chlorideionstendtofollowsodiumbecause

oftheattractionbetweentheelectrical

chargeontheions,thereforehighsodium

levelsusuallyleadtohighchloridelevels.

CausesofHypochloremia

•Associatedwithalkalosisintheearly

stagesofvomitingwhenhydrochloricacidis

lostfromthestomach.

Excessiveperspirationassociatedwithfever

orstrenu-ouslaboronahotdaycanleadto

lossofsodiumchloride,resultingin

hyponatremiaandhypochloremia,and

ultimately,dehydration.

EffectsofHypochloremia

Nausea

V omiting

Diarrhea

Muscle twitching

Confusion, sleepiness

CausesofHyperchloremia

Excessive intake of sodium

chloride,orallyor

intravenously

Hypernatremia due to other

causes

EFFECTS:

Edema,weightgain

ACID-BASEIMBALANCES

References

https://www.ncbi.nlm.nih.gov/