2. Water and Electrolyte Balance

3. Water 60% - 90% of BW in most life forms 2/3 intracellular fluid
1/3 extracellular fluid
plasma
lymph
interstitial fluid
gut

5. Fluid Imbalance

6. Dehydration Occurs when fluid loss exceeds intake
sweating vs time
Fluid lost mostly from ECF
decreased circulating blood volume inadequate tissue perfusion, inefficient transport of substrates to muscle, and elevated Heart Rate.

7. Dehydration Treatment IV or oral fluids and electrolytes
Clinical Signs
persistent elevation of HR and RR
weak pulse
poor capillary refill
muscular weakness, tremors
Depression
muscle cramps
Treatment
IV or oral fluids and electrolytes

8. Estimates of Fluid Loss
Weigh animal before and after exercise
1 kg = 1 L
loss of 2-3% of BW = reduce performance
loss of 10% of BW = serious, possibly life threatening

9. Detecting Dehydration
Skin pinch test
falls back instantly - normal
2 - 4 sec - moderate
4 -6 sec - severe
Capillary refill
press finger on gums above an upper tooth
if it takes longer than 2 seconds for blood to return - dehydration

10. Estimates of Fluid Loss
Blood analysis
PCV and total plasma proteins
Rise indicates dehydration
if PCV > 50% indicates hazardous fluid loss

11. Fluid Volume Deficit (Hypovolemia, Isotonic Dehydration)
Common Causes
Hemorrhage
Vomiting
Diarrhea
Burns
Diuretic therapy
Fever
Impaired thirst

12. Clinical Manifestations
Signs/Symptoms
Weight loss
Thirst
Changes in pulse rate and BP
Weak, rapid pulse
Decreased urine output
Dry mucous membranes
Poor skin turgor

13. Treatment/Interventions (FVD)
Fluid Management
Mild to moderate dehydration.
Correct with oral fluid replacement.
Oral rehydration therapy – Solutions containing glucose and electrolytes. e.g., Pedialyte, Rehydralyte, ORS,
IV therapy – Type of fluid ordered depends on the type of dehydration and the clients cardiovascular status.

14. Safety Alert

15. Implications
Monitor postural Heart Rate and Blood Pressure, when getting patients out of bed

16. Fluid Volume Excess (FVE)
Common Causes:
Congestive Cardiac Failure (CCF)
Early Renal Failure
IV therapy
Excessive sodium ingestion
ADH
Corticosteroid

17. Clinical Manifestations
Signs/Symptoms
Increased BP
Bounding pulse
Venous distention
Pulmonary edema
Dyspnea
Orthopnea (difficulty breathing when supine)
Crackles

18. Treatment/Interventions (FVE)
Drug therapy
Diuretics may be ordered if renal failure is not the cause.
Restriction of sodium and saline intake

19. More to consider? Age Prior medical history Infants Older adults
Acute illness
Chronic illness
Environmental factors
Diet
Lifestyle
Medications

20. Physical Assessment
Body systems
I/O
Weight
Labs

21. Electrolyte Imbalance

22. Hypokalemia (<3.5mEq/L)
Pathophysiology –
Normal Serun Level is meqt/L
Decrease in K+ causes decreased excitability of cells, therefore cells are less responsive to normal stimuli

23. Hypokalemia (<3.5mEq/L)
Contributing factors:
Diuretics
Shift into cells
Digitalis
Water intoxication
Corticosteroids
Diarrhea
Vomiting

25. Hypokalemia (<3.5mEq/L)
Interventions
Assess and identify those at risk
Encourage potassium-rich foods
K+ replacement ( IV or Oral )
Monitor lab values
Discontinue potassium-wasting diuretics
Treat underlying cause

26. Hyperkalemia (>5.0mEq/L)
Pathophysiology –
Increase in K+ causes increased excitability of cells.

27. Hyperkalemia (>5.0mEq/L)
Contributing factors:
Increase in K+ intake
Renal failure
K+ sparing diuretics
Shift of K+ out of the cells

28. ECG

29. Hyperkalemia (>5.0mEq/L)
Interventions
Need to restore normal K+ balance:
Eliminate K+ administration
Inc. K+ excretion
Lasix
Polystyrene Sulfonate)
Infuse glucose and insulin
Cardiac Monitoring

30. Hyponatremia (<135mEq/L)
Contributing Factors
Excessive diaphoresis
Wound Drainage
CCF
Low salt diet
Renal Disease
Diuretics

31. Hyponatremia (<135mEq/L)
Assessment findings:
Nervous - Generalized skeletal muscle weakness. Headache / personality changes.
Lungs -Shallow respirations
Heart - Cardiac changes depend on fluid volume
GI – Increased GI motility, Nausea, Diarrhea
Kidney - Increased urine output

32. Hyponatremia (<135mEq/L)
Interventions/Treatment
Restore Na levels to normal and prevent further decreases in Na.
Drug Therapy –
(FVD) - IV therapy to restore both fluid and Na. If severe may see 2-3% saline.
(FVE) – Administer osmotic diuretic (Mannitol) to excrete the water rather than the sodium.
Increase oral sodium intake and restrict oral fluid intake.

33. Hypernatremia (>145mEq/L)
Contributing Factors
Hyperaldosteronism
Renal failure
Corticosteroids
Increase in oral Na intake
Na containing IV fluids
Decreased urine output with increased urine concentration

34. Hypernatremia (>145mEq/L)
Contributing factors (cont’d):
Diarrhea
Dehydration
Fever
Hyperventilation

35. Hypernatremia (>145mEq/L)
Assessment findings:
Neuro - Spontaneous muscle twitches. Irregular contractions. Skeletal muscle wkness. Diminished deep tendon reflexes
Resp. – Pulmonary edema
CV – Diminished CO. HR and BP depend on vascular volume.

36. Hypernatremia (>145mEq/L)
GU – Dec. urine output. Inc. specific gravity
Skin – Dry, flaky skin. Edema r/t fluid volume changes.

37. Hypernatremia (>145mEq/L)
Interventions/Treatment
Drug therapy
(FVD) .45% NSS. If caused by both Na and fluid loss, will administer NaCL. If inadequate renal excretion of sodium, will administer diuretics.
Diet therapy
Mild – Ensure water intake

38. Hypocalcemia (<9.0mg/dL)
Contributing factors:
Dec. oral intake
Lactose intolerance
Dec. Vitamin D intake
End stage renal disease
Diarrhea

39. Hypocalcemia (<9.0mg/dL)
Contributing factors (cont’d):
Acute pancreatitis
Hyperphosphatemia
Immobility
Removal or destruction of parathyroid gland

40. Hypocalcemia (<9.0mg/dL)
Assessment findings:
Neuro –Irritable muscle twitches.
Positive Trousseau’s sign.
Positive Chvostek’s sign.
Resp. – Resp. failure d/t muscle tetany.
CV – Dec. HR., dec. BP, diminished peripheral pulses
GI – Inc. motility. Inc. BS. Diarrhea

41. Positive Trousseau’s Sign

42. Positive Chvostek’s Sign

43. Hypocalcemia (<9.0mg/dL)
Interventions/Treatment
Drug Therapy
Calcium supplements
Vitamin D
Diet Therapy
High calcium diet
Prevention of Injury
Seizure precautions

44. Hypercalcemia (>10.5mg/dL)
Contributing factors:
Excessive calcium intake
Excessive vitamin D intake
Renal failure
Hyperparathyroidism
Malignancy
Hyperthyroidism

45. Hypercalcemia (>10.5mg/dL)
Assessment findings:
Neuro – Disorientation, lethargy, coma, profound muscle weakness
Resp. – Ineffective resp. movement
CV - Inc. HR, Inc. BP. , Bounding peripheral pulses, Positive Homan’s sign.
Late Phase – Bradycardia, Cardiac arrest
GI – Dec. motility. Dec. BS. Constipation
GU – Inc. urine output. Formation of renal calculi

46. Hypercalcemia (>10.5mg/dL)
Interventions/Treatment
Eliminate calcium administration
Drug Therapy
Isotonic NaCL (Inc. the excretion of Ca)
Diuretics
Calcium reabsorption inhibitors (Phosphorus)
Cardiac Monitoring

47. Hypophosphatemia (<2.5mg/L)
Contributing Factors:
Malnutrition
Starvation
Hypercalcemia
Renal failure
Uncontrolled DM

48. Hypophosphatemia (<2.5mg/L)
Assessment findings:
Neuro – Irritability, confusion
CV – Dec. contractility
Resp. – Shallow respirations
Musculoskeletal - Rhabdomyolysis
Hematologic – Inc. bleeding
Dec. platelet aggregation

49. Hypophosphatemia (<2.5mg/L)
Interventions
Treat underlying cause
Oral replacement with vit. D
IV phosphorus (Severe)
Diet therapy
Foods high in oral phosphate

50. Hyperphosphatemia (>4.5mg/L)
Causes few direct problems with body function. Care is directed to hypocalcemia.
Rarely occurs

51. Hypomagnesemia (<1.4mEq/L)
Contributing factors:
Malnutrition
Starvation
Diuretics
Aminoglcoside antibiotics
Hyperglycemia
Insulin administration

52. Hypomagnesemia (<1.4mEq/L)
Assessment findings:
*Neuro - Positive Trousseau’s sign. Positive Chvostek’s sign. Hyperreflexia. Seizures
*CV – ECG changes. Dysrhythmias. HTN
*Resp. – Shallow resp.
*GI – Dec. motility. Anorexia. Nausea

53. Hypomagnesemia (<1.4mEq/L)
Interventions:
Eliminate contributing drugs
IV MgSO4
Assess DTR’s hourly with MgSO4
Diet Therapy

54. Hypermagnesemia (>2.0mEq/L)
Contributing factors:
Increased Mag intake
Decreased renal excretion

55. Hypermagnesemia (>2.0mEq/L)
Assessment findings:
Neuro – Reduced or weak DTR’s. Weak voluntary muscle contractions. Drowsy to the point of lethargy
CV – Bradycardia, peripheral vasodilatation, hypotension. ECG changes.

56. Hypermagnesemia (>2.0mg/dL)
Interventions
Eliminate contributing drugs
Administer diuretic
Calcium gluconate reverses cardiac effects
Diet restrictions