Mount D.B. Mount, David az-links.info and Electrolyte Disturbances. Changes in blood volume and blood pressure are also direct stimuli for AVP release and ECF volume strongly modulates the relationship between circulating osmolality and. State the distribution as percentage of body weight of fluid volumes in the normal adult and the pediatric patient. constant concentration of ions, pH and osmotic pressure in the is an inverse relationship between body water and fat content. ensures that the clinician applies proper goal-directed fluid and electrolyte Cardiac output and blood pressure play a role in volume regulation. . BUN and creatinine levels may be elevated (BUN/Cr ratio > suggests volume depletion.
The body's electrolytes are positively or negatively charged as shown below: Sodium plays a primary role in terms of the body's fluid balance and it also impacts on the functioning of the bodily muscles and the central nervous system. This electrolyte is most abundant in the blood plasma; and bodily water goes where sodium is.
Fluid and Electrolyte Imbalances: NCLEX-RN || az-links.info
For example, high levels of fluid in the plasma will occur when the plasma has high sodium content and the converse is also true. Hypernatremia, that is a sodium level higher thancan result from a number of different factors and forces such as diabetes insipidus, dehydration, as the result of a fever, vomiting, diarrhea, diaphoresis, extensive exercise, exposures of long duration to environmental heat, and Cushing's Syndrome.
The signs and symptoms of hypernatremia, among others, include agitation, thirst, restlessness, dry mucous membranes, edema, confusion and, in more severe cases, seizures and coma. The treatment of hypernatremia, like other electrolyte disorders includes the correction and management of any underlying causes and dietary sodium restrictions.
It must be noted, however, that a rapid reduction of sodium in the body can lead to the rapid flow of water which can result in cerebral edema, permanent brain damage which is often referred to as central pontinemyolysis, and even death. Hyponatremia, that is a sodium level of less thancan result from the syndrome of inappropriate antidiuretic hormone, some medications like diuretics, some antidepressants, water intoxication and as the result of diseases and disorders such as a disorder of the thyroid gland, cirrhosis, renal failure, heart failure, pneumonia, diabetes insipidus, Addison's disease, hypothyroidism, primary polydipsia, severe diarrhea or vomiting, cancer, and cerebral disorders.
The signs and symptoms associated with hyponatremia include confusion, vomiting, seizures, muscle weakness, nausea, headaches, loss of energy, fatigue, and restlessness and irritability.
The treatments of hyponatremia include the correction and management of any underlying causes, diuretic medications, fluid restrictions, intravenous sodium, and, if Addison's disease is the cause then hormone replacement may be necessary. Potassium The normal potassium level is 3. Unlike sodium that is an extracellular electrolyte that is found in the blood plasma, potassium is most abundant in the cells of the body; it is primarily an intracellular electrolyte.
This electrolyte promotes and facilitates electrical impulses that are necessary for muscular contractions and also for the normal functioning of the brain. Hyperkalemia, which is a potassium level greater than 5. Hyperkalemia is most frequently associated with renal disease, but it can also occur as the result of some medications. Life threatening hyperkalemia is treated with renal dialysis and potassium lowering medications.
Fluid and Electrolyte Balance
Lower less threatening levels of hyperkalemia can sometimes be treated with the restriction of dietary potassium containing foods. Hypokalemia, which is a potassium level less than 3. Mild cases of hypokalemia can be asymptomatic but moderate and severe hypokalemia can be characterized with muscular weakness, muscular spasms, tingling, numbness, fatigue, light headedness, palpitations, constipation, bradycardia, and, in severe cases, cardiac arrest can occur.
In addition to treating the underlying cause of this electrolyte imbalance, supplemental potassium is typically administered. Calcium The normal level of calcium is between 8. The levels of calcium in the body are managed by calcitonin which decreases calcium levels and parathyroid hormone which increases the calcium levels.
Calcium is essential for bone health and other functions. Hypercalcemia, which is a calcium level of more than Hypercalcemia is characterized with thirst, renal stones, anorexia, paresthesia, urinary frequency, bone pain, muscular weakness, confusion, abdominal pain, depression, fatigue, lethargy, constipation, nausea and vomiting.
The treatment of hypercalcemia can include intravenous fluid hydration and medications like prednisone, diuretics, and bisphosphonates.
Symptomatic relief measures and interventions can include analgesia to decrease the client's level of pain, vitamins D and A, and the protection of the client against injuries and accidents, such as falls, because pathological bone fractures can occur secondary to the bone decalcification that occurs in many cases of hypercalcemia. Because magnesium levels are highly associated with calcium levels, it is often necessary to also correct and treat the magnesium levels before the calcium levels can be corrected.
Hypocalcemia, which is a calcium level less than 8.
Symptoms can range from mild and barely noticeable to severe and life threatening. Some of these signs and symptoms include muscular aches and pain, bronchospasm which can cause respiratory problems, seizures, tetany, life threatening cardiac arrhythmias, and tingling of the feet, fingers, tongue and lips.
The treatment of hypocalcemia includes the monitoring of the client's respiratory and cardiac status in addition to providing the client with calcium supplements coupled with vitamin D because vitamin D is necessary for the absorption of calcium.
Magnesium The normal level of magnesium in the blood is 1. ADH secretion is influenced by several factors note that anything that stimulates ADH secretion also stimulates thirst: By special receptors in the hypothalamus that are sensitive to increasing plasma osmolarity when the plasma gets too concentrated. These stimulate ADH secretion. By stretch receptors in the atria of the heart, which are activated by a larger than normal volume of blood returning to the heart from the veins.
These inhibit ADH secretion, because the body wants to rid itself of the excess fluid volume.
Fluid and Electrolyte Imbalances: NCLEX-RN
By stretch receptors in the aorta and carotid arteries, which are stimulated when blood pressure falls. These stimulate ADH secretion, because the body wants to maintain enough volume to generate the blood pressure necessary to deliver blood to the tissues. Sodium balance In addition to regulating total volume, the osmolarity the amount of solute per unit volume of bodily fluids is also tightly regulated. Extreme variation in osmolarity causes cells to shrink or swell, damaging or destroying cellular structure and disrupting normal cellular function.
Regulation of osmolarity is achieved by balancing the intake and excretion of sodium with that of water. Sodium is by far the major solute in extracellular fluids, so it effectively determines the osmolarity of extracellular fluids.
An important concept is that regulation of osmolarity must be integrated with regulation of volume, because changes in water volume alone have diluting or concentrating effects on the bodily fluids. For example, when you become dehydrated you lose proportionately more water than solute sodiumso the osmolarity of your bodily fluids increases. In this situation the body must conserve water but not sodium, thus stemming the rise in osmolarity. If you lose a large amount of blood from trauma or surgery, however, your loses of sodium and water are proportionate to the composition of bodily fluids.
In this situation the body should conserve both water and sodium. As noted above, ADH plays a role in lowering osmolarity reducing sodium concentration by increasing water reabsorption in the kidneys, thus helping to dilute bodily fluids.
To prevent osmolarity from decreasing below normal, the kidneys also have a regulated mechanism for reabsorbing sodium in the distal nephron. This mechanism is controlled by aldosterone, a steroid hormone produced by the adrenal cortex. Aldosterone secretion is controlled two ways: The adrenal cortex directly senses plasma osmolarity.