FLUID VOLUME EXCESS
HYPERVOLEMEIA

TOO MUCH VOLUME IN VASCULAR SPACE

HYPERVOLEMIA CAUSES

1. CHF( HEART IS WEAK, CO DOWN, DECREASED KIDNEY PERFUSION, DECREASED UP)
2. RF
3. ALKASELTERS, FLEET ENEMAS, AND IV FLUIDS WITH SODIUM

(ALL THREE HAVE LOTS OF SODIUM)
4. ALDOSTERONE
5. ADH

ALDOSTERONE (STEROID, MINERALCORTICOID)

WHEN BLOOD VOLUME GOES DOWN ALDOSTERONE INCREASES
RETAIN SODIUM AND WATER

ALDOSTERONE TOO MUCH

CUSHINGS
HYPERALDOSTERONE
CONNS
ALSO SEEN IN LIVER AND HEART DISEASE

ALDOSTERONE TOO LITTLE

ADDISONS DISEASE

ADH

VASOPRESSIN ALSO CALLED
LIVES IN PITUITARY  
PROBLEMS:
CRANIOTOMY
HEAD INJURY
SINUS SURGERY
TRANSPHENOIDAL HYPOPHYSECTOMY

SIADH
ADH TOO MUCH

FLUID VOLUME EXCESS
URINE CONCENTRATED
LOW OUTPUT
BLOOD DILUTE

DI
TOO LITTLE ADH

FLUID VOLUME DEFICIT
SHOCK
URINE DILUTE
LARGE AMOUNTS
BLOOD VERY CONCENTRATED

S/S OF FVE

TREATMENT FVE

LOW SODIUM DIET
DIURETICS
1. LOOP
2. THIAZIDES
3. POTASSIUM SPARING
BED REST
GIVE IVF'S SLOWLY TO ELDERLY

FV DEFICIT CAUSES

THORACENTESIS
PARACENTESIS
VOMITING DIARRHEA
HEMMORHAGING
THIRD SPACING FROM BURNS AND ASCITES
DISEASE WITH POLYURIA-DM

S/S FVD

TX FVD

MILD DEFICIT PO FLUIDS
SEVERE IV FLUIDS

IV FLUIDS ISOTONIC

GO IN VASCULAR SPACE AND STAY THERE
NORMAL SALINE .9
LR
D5W

IV FLUIDS HYPOTONIC

HANG OUT IN VASCULAR SPACE FOR A LIL WHILE AND REHYDRATE
BUT DONT STAY THERE
WONT DRIVE PRESSURE UP
CAUSES FLUID SHIFT FROM VASCULAR SPACE INTO CELL

IV FLUIDS HYPERTONIC

VOLUME EXPANDER
SOLUTION THAT DRAWS FLUID INTO THE VASCULAR SPACE

MAGNESIUM AND CALCIUM

ACT AS SEDATIVES

MAGNESIUM
HYPER
CAUSES

CAUSES
RENAL FAILURE
ANTACIDS

HYPERMAGNESIUM
S/S

TX HYPERMAG

VENTILATOR
DIALYSIS
CALCIUM GLUCONATE

HYPERCALCIUM  CAUSES

HYPERPARATHYROIDISM
THIAZIDES-RETAIN CA
IMMOBILIZATION

HYPERCALC
S/S

BRITTLE BONES
KIDNEY STONES

TX HYPERCALC

MOVEMENT
FLUIDS
PHOSPHOSODA WITH FLEET ENEMAS
PHOSPHORUS INVERSES CALCIUM
STEROIDS-DECREASE CA
CALCITONIN-DRIVES BACK INTO BONES

CAUSES OF HYPOMAG

DIARRHEA
ALCOHOLISM
NOT EATING AND DRINKING

CAUSES OF HYPOCALCE

HYPOPARATHYOIDISM
RADICAL NECK
THYROIDECTOMY

S/S HYPOMAGNES AND HYPOCALC

TX HYPOMAG

CHECK KIDNEY FUNCTION DURING IV ADMIN OF MAGNESIA
SEIZURE PRECAUTIONS

TX HYPOCALCEM

AMPHOGEL-PHOSPHORUS BINDING GEL
IV CA-WATCH HEART

HYPERNATREMIA

DEHYDRATION
CAUSES
1. HYPERVENTILATION
2. HEAT STROKE
3. DI

S/S HYPERNATREMIA

DRY MOUTH
THIRSTY
SWOLLEN TONGUE

TX HYPERNATREMIA

RESTRICT NA
DILUTE WITH IV FLUIDS
DAILY WEIGHTS
I/O

HYPONATREMIA

LOW SALT TOO MUCH WATER

CAUSES HYPONATREMIA

VOMITING
SWEATING
THEN DRINKING WATER
PSYCOGENIC POLYDIPSIA
D5W
SIADH

TX HYPONATREMIA

NEEDS SODIUM NOT WATER
IF NEURO PROBS:NEED HYPERTONIC SALINE
3-5%NS

POTASSIUM FACTS

EXCRETED BY KIDNEYS
KIDNEYS NOT WORKING WELL
POTASSIUM GOES UP

HYPERKALEMIA CAUSES

KIDNET PROBLEMS
ALDACTONE-RETAIN K

S/S HYPERKALEMIA

BEGINS WITH MUSCLE TWITCHING
PROCEEDS TO WEAKNESS AND FLACCID PARALYSIS

TX HYPERKALEMIA

DIALYSIS
CALCIUM GLUCONATE-DECREASES ARRYTHMIAS
GLUCOSE AND INSULIN
INSULIN TAKES POTASSIUM AND GLUCOSE BACK INTO THE CELL
GIVE KAEXYLATE-EXCHANGES NA AND K INTO THE GI TRACT

HYPOKALEMIA CAUSES

1. VOMITING
2. NG SUCTIONING
3. DIURETICS
4. NOT EATING
THINK STOMACH

HYPOKALEMIA S/S

MUSCLE CRAMPS AND WEAKNESS

TX OF HYPOKALEMIA

GIVE K
EAT K
ALDACTONE
SODIUM AND POTASSIUM HAVE AN INVERSE RELATIONSHIP

EXTRAS POTASSIUM

ALWAYS PUT ON PUMP
NEVER GIVE PUSH
MIX WELL
WILL BURN
MAJOR PROBLEM WITH PO POTASSIUM IS STOMACH UPSET