hi guys I'm dianisha Thomas I'm your instructor and today we'll be going over fluing electrolytes so let's get into it the body being in Harmony in all systems or within normal limits is homeostasis body fluid compartments you have your intracellular fluid this contains within the cells this is essential for cell function and Metabolism it contains salutes um oxygen electrolytes like potassium and glucose extracellular um is found outside the cells this carries water electrolytes um such as sodium chloride bicarb nutrients and oxygen to the cells this removes the waste products of cellular metabolism three main locations um in intertial fluid intravascular fluid transcellular fluid interstitial fluid is the space between the body cells this has excess fluid within interal space called edema so this is where you have edema intravascular fluid is the plasma within the blood main function is to transfer blood cells trans cellular fluid specializes fluid contained in the body spaces and the digestive juices and here would be like your um cerebral spinal fluid pericardial fluid pancreatic plural intraocular bilary pertin umov then you have something called third spacing this is fluid trapped in a third compartment is not in cells or vessels um examples would be AES pericardial infusion and blisters we also have um different solutions um one is isotonic solution um this is Need for volume expansion more so for patient that has um more Su formations for hyp ensive and hypo valenia Hyo um this doesn't move so no osmoses with this solution it doesn't move it gives um this goes through an infusion when the blood volume is low this is when you give this solution hyperonic solution pulls fluids from the cells in the vascular space the cells shrink you have elevated ICP and hypotonic solution is fluids move from the vascular space into the cells um this would be for dehydration hyper nit treia okay this is when you have patients with um lots of sodium sodium is outside the cell causing water to leave the cell and go into area with higher sodium concentration after getting a hyic solution it will draw the water back into the cell causing it to swell okay fluid andt primarily through drinking fluids um normally 2700 is a 3700 Ms per dat at moderate activity and temperature um intake is shorted as anything that goes into the body but it must be measurable then we have output um your urine you will each grade about 1400 to 1500 m per day you have sensible fluid loss um which the sensible fluid loss um through the skin occurs through like perspiration at 300 to 600 meals per day piration varies based on the temperature skeletal muscle activity and metabolic activity fever exercise and some disease processes increase metabolic activity and heat production leading to increased fluid loss lungs about 300 M per day insensible loss occurs through the lungs as water is exhale with the bread an increase in respiratory rate increases the amount of fluid L feces 100 to 200 m per day soft stools contain more water than hard stools as sto frequency increases water loss also increases output is shored as anything that comes out of the body but must be measurable as well uh major electrolytes um sodium this is a major C in the extracellular fluid its primary function is to regulate fluid volume when sodium is reabsorbed in the kidney water and potassium are also reabsorbed therefore maintaining ECF volume adult should limit intake of salt to 2300 milligrams per day for older adults African-Americans who are statistically more risk and a person with chronic diseases for example like hypertension or kidney disease the amount should be limited to 1500 milligrams per day another major electrolyte is potassium this major C of the interest cellular fluid ICF only 2% of body potassium is found in the extracellular fluid potassium is a key electrolyte in cellular metabolism according to the dietary gues of Americans 2020 to 2025 at least 4700 Mig per day of potassium is recommended however most American women ages 31 to 50 consume less than half of the recommended amount of potassium and intake is only moderately higher for me sodium um regulates fluid volume maintains the volume maintains muscle contraction with calcium stimulates um conduction of nerve impulses regulated by alestone and is reabsorb reabsorbed and excreted through the kidneys low sodium caused by excess water intake with pot with potassium uh it maintains the ICF asmal regulates conduction of the cardiac Rhythm transmits electrical impulses to multiple body systems that is regulated by aester excreted and conserved in the kidneys lost through vomiting and diarrhea other major electrolytes you have calcium mag and chloride calcium is responsible for bone health and neuromuscular and cardiac function it is also essential factors in blood Hing about 99% of body calcium is located in bones and teeth the remaining 1% circulates and the blood and affect system functions as serum levels drop calcium leeches from the bones into the blood to compensate if dietary intake is not sufficient to replace it bone loss occurs prolonged deficiencies lead to osteoporosis magnesium is a mineral used in more than 300 biochemical reactions in the body like calcium only about 1% of Mag is found in the blood the remaining 99% is divided between ICF and bone in combination with calcium and phosphorus although magnesium deficiency is rare you may find low levels and individuals who have high alcohol in some male absorption um disorders may also cause magnes magnesium depletion chloride is the most abundant an ion in the extracellular fluid it is usually bound with other ions especially sodium and potassium um a sodium chloride ass a healthy adult between ages of 19 and 50 should consume 2.3 G of chloride each day along with 1.5 gr of sodium to replace daily losses and maintain serum blood levels according to the National Academy of Science engineering medicine calcium promotes transmission of nerve impulses major component of um the bone and tee regulars muscle contractions um again maintain cardiac automaticity and citral for blood clots combines with P for teeth and bones pth stimulates release of calcium from Bones and reabsorption from the kidneys calcitonin thyroid block bone breakdown and lowers calcium levels absorption is stimulated by V vitamin D with magnesium protein and carb metabolizes metabolism maintains normal intracellular levels of potassium involved in electrical activity in nerve muscle membranes um ingested in the diet and absorb through the small intestines excreted by the kidneys loss may be triggered by diuretics um diabetes these excess alcohol chloride works with sodium to maintain fluid compartments so when you see chloride think sodium the kidneys okay most phosphorus in the body is combined with oxygen forming phosphate mostly bound with calcium in the teeth and bones as calcium phosphate phosphate is the most abundant intracellular an ion phosphate and calcium exist in an inverse relationship bicarb is present in both ICF and ECF the kidneys regulate extracellular bicarbs to maintain an acid base balance when serum levels rise the kidneys excrete excess by card if serum levels are low the kidneys conserve byard so remember phosphate combines with calcium to form bones um is excreted and reabsorbed in the kidneys it's opposite of calcium electrolytes what are electrolytes here is a sharp video of electroly is what are electrolytes it's the functions of electrolytes may not play in the recording but you can look it up and watch it probably about 5 minutes all right here you have electrolyte relationships um when sodium increases potassium decreases when um phosphate increases magnesium decreases when sodium decreases chloride decreases when Calum increases pottassium decreases when magnesium decreases calcium decreases when magnesium decreases potassium decreases when Calum decreases vitamin D decreases so I have a little picture of SpongeBob he was like I'm head out and like head in so um those are like the inverse relationships and how they work if your B if your body deviates below or above this PH range it won't function well and you become unwell so since they healthy your body needs to regulate its intern of pH um this is the measure of how acidic or alkaline a solution is aceptable range is 7.35 to 7.45 having the right balance of electrolytes is fundamental into maintaining your blood pH level I just wanted to let you know that briefly but you're going to see more of that later as you progress on laboratory studies that we will focus on is CBC um you know you have your serum electrolytes serum asmal urine ASM asmal urinalysis um as far as your CBC as as fluid decreases your htic rate would increase as fluid increases your hematic rate decreases right so that's the main one um as far as your serum electroly you have your electrol panel you focus more on you know your being P um calcium your bu your Crea racial glucose um those we focus more on when it comes to fluid and electrolytes those are the main ones we focus on and we look at your Serum is malady 275 to 295 mlio per kilogram this increases as fluid decreases urine asmal will be 50 to 1200 M moles per kilogram it increases as fluid decreases your analysis um your pH will increase as um fluid decreases um you will see acidosis and with starvation um your pH would decrease and you would get a alkalic or alkalosis urine specific gravity is 1.5 to 1.30 USG U this increases with fluid excess and it increases when you have a fluid deficit you should have your um paper with you guys and I want you to go over these lab studies all right diuretics we have Loop thy case sparing which is protag sping diuretic Loop Diuretics increase urine output and treat fluid retention these are often used to treat edema and hyper attention secondary to CHF liver and chronic kidney disease um what are some examples or a popular Loop diuretic that you guys may know of so that would be like [Music] f thides are also um also help the body get rid of EX fluid through the kidneys these are known to treat high blood pressure and can help with other conditions like you know again heart liver and kidney failure it also increases plasma levels of calcium and uric acid um what are some common thide diuretics you have hydrochloride and um chlorthalidone um potassium sparing promote diuresis as well but while preserving potassium levels in the body these are good to use when a patient's potassium levels are low um examples are of these are um amide spino lactone also known as aldactone these medications has to be monitored and I put a little picture up there um so you can see um the medical class and what potassium do in each section like the loop diuretic is a potassium wasting so memory trick Loop loses potassium and complication you get hypokalemia th di think there goes potassium leaving the body complication hypokalemia and spin lactone is a potassium sparing than sparing you know you keep in potassium so um complication would be what hyperia fluid imbalances um you have a deficit fluid volume right hypo bmia this occurs when there is a proportional loss of fluid and electrolytes from the extracellular fluid loss of blood volume is called hypo Valia and dehydration dehydration um you know you have dry skin dry mucous brains non elastic skin trigger um decrease yourinal put decrease blood pressure hypotension increase heart rate te a card and Rising temperature do of signs and symptoms um but the hydration describes a state of negative fluid balance in which there is a loss of water Hydro water from the intracellular extracellular or intravascular SP you lose so much body fluid to where your body can't function on it this can happen if you sweat too much if you're sick with fever diarrhea have diarrhea or you're vomiting it can happen if you don't drink enough water or you take medications that make you urinate a lot right like those diuretics what are symptoms of dehydration again those were some but you have extreme thirst less frequent urine urinating um dark color urine fatigue this this confusion what would be the the first symptom of dehydration first symptom would be thirst um with weight loss weight loss of a weight loss of a stting 5% 5% loss of body weight is considered clinically significant when loss approaches 8% fluid loss is considered severe a sudden loss of 15% of body weight due to fluid loss is usually you know fatal the patient with fluid volume deficit usually has elevated blood Ural nitrogen which is your B to creatin ratio and an elevated hematic both values increase because there is less water in proportion to the solid subsistance being measured here we have fluid volume excess what is fluid volume excess it is too much fluid overhydration right so hyperemia this involves excessive retention of sodium and water in the extracellular fluid fluid volume excess can result from excessive salt intake failure of the organs when the heart kidneys and liver aren't functioning properly um the the retain sodium increases axotic pressure in the ECF this pressure pulls fluid from the cells into the ECF signs of flu overloop the blood pressure is elevated your pulse pulse is bounding um a respirations are increased and shallow the neck veins may become distant along with this um increased intravascular Vine you may accumulate um in the tissu so especially if in dependent areas you will see edema the skin is pale and cool there may be low or no urine output and if it's low it becomes dilute and volume increases the patient rapidly gains weight and severe fluid ovlo the patients develops crackles moist crackles in the lungs desia and AES AES is excess Partin fluid um hemo hemo dilution causes bu hematic and the specific gravity of the urine to decrease so plan of care what you want to do you want to monitor inake an output um you might want to give diuretics you might want restriction of fluid low sodium diet Elevate arms and legs you want to monitor that edema you want to assess breath sounds you want to monitor abgs um electrolyte and valid is table 35 5 so um sodium hypon nmia this is caused by diuretics GI fluid loss adrenal insufficiency excessive intake of hypotonic Solutions such as water or D5W IV fluids syndrome of inappropriate ADH signs and symptoms would be anorexia nausea vomiting weakness lethargy confusion muscle cramps um levels low sodium levels below 120 can cause convulsions coma or death um diuretics GI flu adrenal in insufficiency excess intake of hyponic solutions again the D5W um we went over that um also you should also know about foods that are high in sodium so bacon ham processing canned foods processed cheese table salap and to treat all of this to treat hypon n you want to monitor ey no monitor the sodium increase sodium intake administer staline infusion and seizure precautions um think safety U you want to you know monitor Etc call the doctor about blazic give Adavan may have to um you know give out V and stop the late you just you know hyper nmia is caused by excessive sodium intake um water deprivation you have increased water loss through perus um sweating heat stroke diabetes uh you may see incipit um you can't get it from administration of hyperonic to feedings with Hyper nutria you will see dehydration so signs and symptom would be thirst elevated temperature dry mouth sticky mucous membranes increased blood pressure um severe you will see SE seizures and hallucinations some risk factors are Advanced age mental or physical impairment diuretic therapy uncontrolled diabetes underlying polya um polya polya Jesus disorders um nursing home resident inadequate nursing care and H hospitalization um foods low in sodium uh you want to avoid you want to avoid Beacon right and the can f and the process and the T so want to avoid those things monor otive sodium levels minor Vital Signs level of Consciousness restrict sodium increase water intake IV Solutions without sodium you want to monitor eye and nose monitor Lo minus sodium and educate the patient um and IV Therapy potassium hypokalemia it's caused by diuretics GI fluid loss through vomiting gastric section of diarrhea steroid ministration hyperism anorexia aimia hypokalemia can be from diarrhea signs and symptoms is dis rmas flat or inverted t-wave muscle cramps fatigue anorexia nausea viin DEC inre GI motility perthus uwave formation risk factors would be GI or urinary losses due to viting diarrhea or diuretic therapy it may also result from transient entry of potassium into the cells known as redistributive hypokalemia foods high in potassium bananas oranges cantelopes sweet potatoes potatoes with skin legumes green leafy vegetables apricots figs dates carrots spinach severe potassium can put you in Cardiac Arrest right so treatment you want to administer potassium supplements um with the IV it should be slow monitor IO monitor potum encourage intakes of foods rich and potassium figure out causes first change to potassium sparing diuretic monitor EKG you want to educate the patient call MD you want to call them the patient if patient started on IV fluids and um intervenous potassium chloride prot replacement hyperkalemia is called by Rena failure potassium sparing diuretics hypo destron high potassium intake coupled with Ren insufficiency acidosis major trauma hem serum sample produces pseudo hypokalemia hyperemia can result from missing diet alysis signs and symptoms would be muscle weakness drias flaccid paralysis antinal cic tall t- waves kidney fa spinal lactone incess pseudo hypoc doe to breakdown of cells during or taking the blood sample H potassium intake with Reno sufficiency and Trauma with hyperal you want to avoid bananas oranges cantaloup sweet potatoes legumes green leaf and vegetables figs St carrots all of those foods that we mentioned for hpia you want to monitor I no monitor potassium you want to be cautious about potassium rich foods in dialysis K aate insulin glucose spard hypocalcemia this calcium you have hypoglycemia and hyperemia hypocalcemia is called by hypoparathyroidism malabsorption pancreatitis alkalosis vitamin D deficiency and Graves disease diarrhea signs and symptom diarrhea numbness tinking of extremities muscle cramps um LEL spasms cardiac arability positive trousil and chok [Music] sign um foods are you know high and calcium will be of course not really foods but you know milk milk products k o salmonfish tuna fish orange juice with severe hypokalemia can cause seizures muscle spasms so you want to make sure to Monitor and take an output monitor calcium levers encourage calcium intake calcium supplements monitor Airway patency Institute seizure and safety precautions ad Minister parino calcium monitor AE seizure and safety um G vitamin D and calcium hyper calcemia is caused by hyper parathyroidism malignant bone disease prolonged immobil immobilization like when you're not moving you're confin to excess calcium supplementation thide diuretics hyper calcemia hyperism signs and symptoms muscle weakness constipation polya poly ipsia kidney stones braad cardia anorexia nausea and vomiting bizarre behavior and you want to avoid um the calcium rich foods right the dark green leafy vegetables the milk the milk products salmon celum fortified food cereal you want to monitor IR encourage fluid intake to prevent kidney stones encourage Inc increase fiber eliminate calcium supplements and calcium rich foods avoid calcium based Antics dialysis um you want to Monitor and safety magnesium hypom magnesium is caused by chronic Al holism malabsorption diabetic keto acidosis prolong gastric suction hypom magnesium alcohol abuse neuromuscular um signs and symptom be neuromuscular arability disorientation mood changes dismas hyper reflexia um some RIS factors uh chronic alcoholism malabsorption diabetic keto acidosis prolong gastric suction foods high in M cereal grains nuts dry fruits legumes green leaf and vegetables dairy products Meat and Fish to um not enough mag can cause seizures so you want to monit encourage Magnum rich foods avoid alcohol intake you know give magnesium hyper magnesium is caused by renal failure adrenal insufficiency excess replacement hypermagnesemia overcorrection so signs and symptoms flushing warm skin hypertension hypotension driness lethargy hypo reflexia depressed respirations braady cardia risk factors renal failure adrenal insufficiency excess replacement you want to avoid magnesium rich foods you want to avoid those cereal grain nuts vegetables greenf vegetables meat fish and hypom magnesium severe can cause obstruction of the airway that this resis is so you want to Minit Vital Signs and Airway monitor reflexes avoid those magnesium based Antics and Laxus restrict dietary intake mag when a monitor dialysis calcium glucan why don't they love each other mag plays a role in the transport of calcium ions across the C membrane so question on assessment of a patient with acute renal failure the nurse finds the following descended neck veins cool Andel skin and crackles in alone the nurses suspect that the patient is experiencing what right the answer is C hyperemia this patient is showing signs of fluid ovalu or hyperemia other findings includes elevated blood pressure bound post and increased respiration due to increased intravascular volume preventing fluid and electrolyte imbalances dietary um changes you want to promote fluid and electrolite balance most people need to limit their sodium intake and increase their dietary potassium and calcium as previously discussed most people in United States consume more sodium than they should and not enough potassium and calcium so you want to teach the clients to eat food that's rich in potassium and calcium every day and to avoid sodium rich foods for example you want to instruct clients to read food labels particularly when trying to limit sodium intake or electrolyte supplements you want to encourage clients to encourage patients to take potassium supplements with juice to mass The Taste teach patients to take supplements as prescribed to maintain electrolyte balance remind them that supplements are medications and should be viewed as a part of the treatment plan if the patient medications or alter review the continue need for supplements caution them that salt substitutes contain potassium if the client has been advised to use salt substitutes review the need for potassium supplements perinal replacement of fluids and or electrolytes when the fluid lost is severe the patient cannot tolerate oral or too feedings fluid volume is replaced parentally IV therapy is the administration of fluids electrolytes medication or nutrients by the Venus route interventions and therapy so um you want to monitor intake and output monitor daily intake of electrolytes and reported document daily weights um you want to engage the patient in a plan of care provide patient education seizure precautions and safety uh you want to collaborate intervenous management monitoring fluid balance blood transfusions medication therapy you want to collaborate with um electrolyte correction to restore balance and dietary recommendations with dietary so let's prioritize who would you see first look at the chart so we have a sodium of 1 38 a potassium of 5.8 chloride of 100 B carb 21 bu 13 creatinin 1.2 that's one patient's lab values then the other patient lab Valu you have a sodium of 128 potassium 3.3 chloride 92 by carb 28 B 13 and Crea in 0.6 so the patient you want to see first is the patient with so this is why you guys need to know the um the norm you know sodium serum level normal is 136 to5 145 M equivalent per liter potassium serum LEL is 3.5 to 5 so we know the patient that has a potm of 5.8 is the patient you would see first because 5.8 is literally considered on their way to that chloride level is 98 to 106 and B carb is 2128 FYI B 10 to 20 Mig per decil creatinine is 0.5 to 1.2 Mig per prioritize what lab would you fix first so we have a hemoglobin is 6.8 white blood CS 2000 platelets 107,000 and metac 26% what you fix first okay what's the normal 5 to 10,000 right what's the normal hemoglobin 12 to 18 what's the normal hematocrite 37 to 52 platelets should be 150,000 to 400,000 so at at this point all of the labs are out of right this is called pitopia this is when you have a significant reduction in all the blood cells either your body doesn't have enough vitamin B12 and fola to make these healthy cells or uh your patient may drink too much alcohol this can be caused from excessive alcohol intake so this is um and at this point you know you in increased risk for infection due to your white blust has been infected you add you know you can have excess bleeding your plists are affected so this needs to be corrected ASAP let's test your knowledge your patient comes into the emergency department with complaints of nausea Vin diarrhea for 3 days you notice their skin turg is sluggish their eyes are sunken and the blood pressure is 90 over 60 you review the patient short and notice that he has a history of hypertension the patient reports he has been taking his medication is prescribed based on the renin angens system you would expect in order to discontinue which medication um a b l z z Okay so so it would be Lino B because it is an Ace inhibitor and stops the body from retaining fluids th further decreasing you know the blood pressure so