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Similar a Fluids and Electrolytes Imbalance: Causes, Signs, Nursing Care
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Fluids and Electrolytes Imbalance: Causes, Signs, Nursing Care
- 1. By Hidayatullah khan KMU Fluids & Electrolytes imbalance
- 2. Composition of Body Compartments Total Body Water (TBW)= 50-75% of Total Body Mass TBW = Intracellular Fluid (ICF) + Extracellular Fluid (ECF) ICF = 2/3 of TBW ECF = 1/3 of TBW -- 25% of body weight ECF = Plasma (intravascular) + Interstitial fluid Fluid % in child body ( 75%-80%)
- 3. Regulation of Body Fluids and Electr olytes Anti-Diuretic Hormone (ADH) Thirst Aldosterone Atrial Natriuretic Factor
- 4. Daily Maintenance Requirements Add 12 % for every 0 C
- 5. 4cc, 2cc, 1cc rule 4 cc for the first 10 kg 2 cc for the next 10 kg 1 cc for each kg after Example: 27 kg child 4 cc for the first 10 kg = 40cc 2 cc for the next 10 kg = 20cc 1 cc for each kg after = 7 cc 67 cc/hr
- 7. Nursing requirements of FLUID Increased requirement : Fever Vomiting Renal failure Burn Shock Tachypnea Gastroenteritis Diabetes (Insipidus, mellitus - DKA) Cystic fibrosis
- 8. Decreased requirement CHF Postoperatively oliguric ( RF ) Increase ICP
- 9. Dehydration Classification Isotonic Serum Sodium 130-150 mEq Hypotonic Serum Sodium < 130 mEq Hypertonic Serum Sodium >150 mEq
- 10. Diagnostic Evaluation 1. Physical assessment (V/S) 2. Type of dehydration Nursing Therapeutic management of fluid loss Oral rehydration therapy Parenteral fluid therapy Meet ongoing daily loss Replace previous deficit Replace ongoing abnormal losses
- 11. Management of Dehydration General Principles: Supply Maintenance Requirements Correct volume and electrolyte deficit Replace ongoing abnormal losses
- 12. Management of Dehydration Oral Rehydration: Effective for mild and some moderate dehydrations Child may be able to tolerate PO intake Small aliquots as tolerated Mild: 50 cc/kg over 4 hours Moderate: 100 cc/kg over 4 hours 2 types of oral solution Maintenance Rehydration
- 13. Composition of Body fluids 1. D5W (5 g sugar/100 ml) 2. D10W (10 g sugar/100 ml) 3. NS (0.9% NaCl) 9 gm NaCl/L 4. 1/2 NS (0.45% NaCl) 4.5gm/L 5. D5 .18 NS 1.80gm/L 6. 3% NaCl 30gm/L
- 14. IV fluids Lactated Ringer’s 0-10 gram glucose/100cc Na 130 meq/L NaHCO3 28 meq/L as lactate K 4 meq/L
- 15. Pediatric Fluid Therapy Principles Assess water deficit by: 1. weight: weight loss (Kg) = water loss (L) OR 2. Estimation of water deficit by physical exam: Mild moderate severe Infants < 5 % 5 - 10 % >10 % Older children < 3 % 3 - 6 % > 6 %
- 16. Physical Signs of Dehydration Signs&sym pt. M IL D M oderate Severe G eneral T hirsty, allert, restless T hirsty, irritable, ordrow sy D row sy–lim p, skincold/ sw eaty R adial pulse N orm al rate R apid, w eak R apid, feeble R espiration N orm al D eep D eep&rapid A nteriorfont. N orm al Sunken V erysunken Skinturgor P inchretracts im m ediately R etractsslow ly P oor E yes N orm al Sunken G rosslysunken T ears P resent A bsent A bsent M ucousm em b. M oist D ry V erydry U rineflow N orm al D ark& decreased O liguria/ anuria
- 17. Correction of Dehydration Mild dehydration: increase oral intake Moderate to severe dehydration: IV push 10-20 cc / Kg Normal saline May repeat. Half deficit over 8 hours, and half over 16 hours. If hypernatremic dehydration, replace deficit over 48 hours .
- 18. Disturbance of acid based balance Disturbance Plasma PH Plasma PCO2 Plasma HCO3 Respiratory Acidosis Respiratory Alkalosis Metabolic A cidosis Metabolic Al kalosis
- 19. Nursing Intervention 1. Assessment 2. History 3. Clinical observation 4. Intake & output measurement 5. Replace orally or IVF ( 1g wet diaper wt =1 ml urine )
- 20. When administrating I.V fluid nurse should Monitors the response of the fluids. Considering the fluid volume. Content of fluid. Patient clinical status.
- 21. Hyponatremia Predisposing Factors Diabetes mellitus (hyperglycemia) Cystic fibrosis Gastroenteritis Excessive water intake (formula dilution) Diuretics (thiazides and furosemide) Renal disease
- 22. Vomiting, diarrhea, sweating, and burns cause Na+ loss. Dehydration, tachycardia and shock (see above) can result. Intake of plain water worsens the condition. Pedialyte is a better fluid to drink.
- 23. Hyponatremia Hyponatremic Dehydration Hypovolemic Hyponatremic Dehydration High urine output and Na excretion Increase in atrial natriuretic factor Hypervolemic Hyponatremic Dehydration Edematous disorder (nephrotic syndrome, CHF, cirrhosis)
- 24. Hyponatremia Acute Hyponatremia (<24 hours) Early Onset (Serum Sodium <125 meq/L) Nausea Vomiting Headache Later or Severe (Serum Sodium <120 meq/L) Seizure Coma Respiratory arrest
- 25. Hyponatremia Chronic Hyponatremia (>48 hours) Lethargy Confusion Muscle cramps Neurologic Impairment
- 26. Hyponatremia Management Na Deficit: Na Deficit = (Na Desired - Na observed) x 0.6 x body weight(kg) Replace half in first 8 hours and the rest in the following 16 hours Rise in serum Na should not exceed 2 mEq/L/h to prevent Central Pontine Myelinolysis In cases of severe hyponatremia (<120 mEq) with CNS symptoms: 3% NaCl 3-5 ml/kg IV push for hyponatremia induced seizures 6 ml/kg of NaCl will raise serum Na by 5 mEq/L
- 27. Hypernatremia Hypernatremia leads to hypertonicity Increase secretion of ADH Increase thirst Patients at risk Inability to secrete or respond to ADH No access to water
- 28. Hypernatremia Etiology Pure water depletion Diabetes insipidus (Central or Nephrogenic) Sodium excess Salt poisoning (PO or IV) Water depletion exceeding Na depletion Diarrhea, vomiting, decrease fluid intake Pharmacologic agents Lithium, Cyclophosphamide, Cisplatin
- 29. Hypernatremia Signs and symptoms Disturbances of consciousness Lethargy or Confusion Neuromuscular Irritability Muscle twitching, hyperreflexia Convulsions Hyperthermia Skin may feel thick
- 30. Hypernatremia Management Normal Saline or Ringer lactate to restore volume Hypotonic solution (D5 1/5 NS) to correct calculated deficit over 48 hours Water Deficit Normal body H20 - Current body H20 Current body water 0.6 x body weight (kg) x Normal Na/Observed Na Normal Body water 0.6 x body weight (kg) Decrease Na concentration at a rate of 0.5 mEq/hr or ~ 10 mEq/day: Faster correction can result in Cerebral Edema
- 31. Potassium Most abundant intracellular cation Normal serum values 3.5-5.5 mEq Abnormalities of serum K are potentially life- threatening due to effect in cardiac function
- 32. Hypokalemia Diagnosis Symptoms Arrhythmias Neuromuscular excitability (hyporreflexia, paralysis) Gastrointestinal (decreased peristalsis or ileus) Serum K < 3mEq/L ECG: Flat T waves Short P-R interval and QRS U waves
- 33. Hypokalemia Nutritional GI Loss Renal Loss Endocrine Poor intake Diarrhea Renal tubular acidosis Insulin therapy IVF low in K Vomiting Chronic renal disease Glucose therapy Anorexia Malabsorbtion Fanconi's syndrome DKA Intestinal fistula Gentamicin, Hyperaldosteronism Laxatives Amphotericin Adrenal adenomas Enemas Diuretics Mineralocorticoids Bartter's syndrome Bartter’s syndrome: Hypereninemia and hyperaldosteronism
- 34. Hypokalemia Management: Cardiac Arrhythmias or Muscle Weakness KCl IV (cardiac monitor) PO K - Depend of etiology Hypophoshatemia = KPO4 Metabolic acidosis = KCl Renal tubular acidosis = K citrate
- 35. Hyperkalemia Differential Diagnosis Pseudohyperkalemia - from blood hemolysis Metabolic Acidosis Chronic Renal Failure Congenital Adrenal Hyperplasia Females = Usually Dx at birth - Ambiguous Genitalia Males = Dehydration, hyponatremia, hyperkalemia Medications ACE inhibitors and NSAID’s
- 36. Hyperkalemia Diagnosis: Symptoms Cardiac Arrhythmias Paresthesias Muscle weakness or paralysis ECG Peaked T waves Short QT interval (K>6 mEq) Depressed ST segment Wide QRS (K>8 mEq)
- 37. Hyperkalemia Management Close cardiac monitoring Life -threatening hyperkalmia Intravenous Calcium - rapid onset, duration< 30 min NaHCO3 or glucose and insulin Ion exchange resins Sodium polystyrene sulfonate (Kayexelate) PO or Enema Hemodyalisis