Imbalance Contributing Signs/Symptoms

Factors and Laboratory

Findings

Fluid volume decit Loss of water and Acute weight loss,

(hypovolemia) electrolytes, as in decrease skin turgor,
vomiting, diarrhea, oliguria, concentrated
stulas, fever, excess urine, weak rapid pulse,
sweating, burns, blood capillary lling time
loss, prolonged, low CVP,
gastrointestinal suction, decrease blood
and third-space uid pressure, attened neck
shifts; and veins, dizziness,
decreased intake, as in weakness, thirst and
anorexia, nausea, and confusion, increase
inability to gain access pulse, muscle cramps,
to uid. Diabetes sunken eyes
insipidus and Labs indicate: increase
uncontrolled diabetes hemoglobin and
mellitus also contribute hematocrit, increase
to a depletion of serum and urine
extracellular uid osmolality and specic
volume. gravity, decrease urine
sodium, increase BUN
and creatinine, increase
urine specic gravity
and osmolality
Fluid volume excess Compromised Acute weight gain,
(hypervolemia) regulatory mechanisms, peripheral edema and
such as renal ascites, distended
failure, heart failure, jugular veins, crackles,
and cirrhosis; elevated CVP, shortness
overzealous of breath, increase
administration of blood pressure,
sodium-containing bounding pulse and
uids; and uid cough, increase
shifts (ie, treatment of respiratory rate
burns). Prolonged Labs indicate: decrease
corticosteroid hemoglobin and
therapy, severe stress, hematocrit, decrease
and hyperaldosteronism serum and urine
augment osmolality, decrease
uid volume excess. urine sodium and
specic gravity
Sodium decit Loss of sodium, as in Anorexia, nausea and
(hyponatremia) use of diuretics, loss of vomiting, headache,
Serum sodium GI uids, lethargy,
_135 mEq/L renal disease, and dizziness, confusion,
adrenal insufciency. muscle cramps and
Gain of water, weakness,
as in excessive muscular twitching,
administration of DW seizures, papilledema,
and water supplements dry skin, increase pulse,
for patients receiving decrease BP, weight
hypotonic tube gain, edema
feedings; disease states Labs indicate: decrease
associated with SIADH serum and urine
such as head trauma sodium, decrease urine
and oat-cell lung tumor; specic gravity and
medications associated osmolality
with water retention
(oxytocin and certain
tranquilizers); and
psychogenic polydipsia.
Hyperglycemia and
heart failure cause a
loss of sodium.

Sodium excess Water deprivation in Thirst, elevated body

(hypernatremia) patients unable to drink temperature, swollen
Serum sodium at will, dry tongue and sticky
_145 mEq/L hypertonic tube mucous membranes,
feedings without hallucinations, lethargy,
adequate water restlessness, irritability,
supplements, diabetes focal or grand mal
insipidus, heatstroke, seizures, pulmonary
hyperventilation, watery edema, hyperreexia,
diarrhea, burns, and twitching, nausea,
diaphoresis. Excess vomiting, anorexia,
corticosteroid, sodium increase pulse, and
bicarbonate, and increase BP
sodium chloride Labs indicate: increase
administration, and salt serum sodium, decrease
water near-drowning urine sodium, increase
victims urine
specic gravity and
osmolality, decrease
CVP
Potassium decit Diarrhea, vomiting, Fatigue, anorexia,
(hypokalemia) gastric suction, nausea and vomiting,
Serum potassium corticosteroid muscle weakness,
_3.5 mEq/L administration, polyuria, decreased
hyperaldosteronism, bowel motility,
carbenicillin, ventricular asystole
amphotericin B, bulimia, or brillation,
osmotic diuresis, paresthesias, leg
alkalosis, starvation, cramps, decrease BP,
diuretics, and digoxin ileus, abdominal
toxicity distention, hypoactive
reexes. ECG:
attened T waves,
prominent U waves, ST
depression,
prolonged PR interval
Potassium excess Pseudohyperkalemia, Muscle weakness,
(hyperkalemia) oliguric renal failure, tachycardia
Serum potassium use of bradycardia,
_5.0 mEq/L potassium-conserving dysrhythmias, accid
diuretics in patients with paralysis, paresthesias,
renal intestinal colic, cramps,
insufciency, metabolic abdominal distention,
acidosis, Addisons irritability, anxiety.
disease, crush injury, ECG: tall tented T
burns, stored bank waves, prolonged PR
blood transfusions, interval and
rapid IV administration QRS duration, absent P
of potassium, and waves, ST depression
certain medications
such as ACE inhibitors,
NSAIDs, cyclosporine
Calcium decit Hypoparathyroidism Numbness, tingling of
(hypocalcemia) (may follow thyroid ngers, toes, and
Serum calcium surgery or radical neck circumoral region;
_8.5 mg/dL dissection), positive Trousseaus
malabsorption, sign and Chvosteks
pancreatitis, alkalosis, sign; seizures,
vitamin D deciency, carpopedal spasms,
massive subcutaneous hyperactive deep
infection, generalized tendon reexes,
peritonitis, massive irritability,
transfusion of citrated bronchospasm, anxiety,
blood, chronic diarrhea, impaired clotting time,
decreased parathyroid decrease prothrombin,
hormone, diuretic phase diarrhea, decrease BP.
of renal failure, c PO ECG: prolonged QT
, stulas, burns, interval and lengthened
alcoholism ST
 Labs indicate: Decrease
Mg
Calcium excess Hyperparathyroidism, Muscular weakness,
(hypercalcemia) malignant neoplastic constipation, anorexia,
Serum calcium disease, nausea and vomiting,
_10.5 mg/dL prolonged polyuria and polydipsia,
immobilization, overuse dehydration,
of calcium hypoactive deep tendon
supplements, vitamin D reexes, lethargy, deep
excess, oliguric phase of bone
renal pain, pathologic
failure, acidosis, fractures, ank pain,
corticosteroid therapy, calcium stones,
thiazide diuretic use, hypertension. ECG:
increased parathyroid shortened ST segment
hormone, and digoxin and QT interval,
toxicity bradycardia, heart
blocks
Magnesium decit Chronic alcoholism, Neuromuscular
(hypomagnesemia) hyperparathyroidism, irritability, positive
Serum magnesium hyperaldosteronism, Trousseaus and
_1.8 mg/dL diuretic phase of renal Chvosteks signs,
failure, insomnia, mood
malabsorptive changes, anorexia,
disorders, diabetic vomiting, increased
ketoacidosis, refeeding tendon reexes, and
after starvation, increase BP. ECG: PVCs,
parenteral nutrition, at or inverted T waves,
chronic laxative use, depressed ST
diarrhea, acute segment, prolonged PR
myocardial infarction, interval, and widened
heart failure, decreased QRS
serum K and Ca and
certain pharmacologic
agents (such as
gentamicin, cisplatin,
and cyclosporine)
__
Magnesium excess Oliguric phase of renal Flushing, hypotension,
(hypermagnesemia) failure (particularly muscle weakness,
Serum magnesium when magnesium- drowsiness,
_2.7 mg/dL containing medications hypoactive reexes,
are administered), depressed respirations,
adrenal insufciency, cardiac arrest
excessive IV magnesium and coma, diaphoresis.
administration, diabetic ECG: tachycardia
 ketoacidosis, and bradycardia, prolonged
hypothyroidism PR interval and QRS,
peaked T
waves
Phosphorus decit Refeeding after Paresthesias, muscle
(hypophosphatemia) starvation, alcohol weakness, bone pain
Serum phosphorus withdrawal, diabetic and tenderness,
_2.5 mg/dL ketoacidosis, respiratory chest pain, confusion,
and metabolic alkalosis, cardiomyopathy,
decrease magnesium, respiratory
decrease potassium, failure, seizures, tissue
hyperparathyroidism, hypoxia, and increased
vomiting, diarrhea, susceptibility to
hyperventilation, infection, nystagmus
vitamin D
deciency associated
with malabsorptive
disorders,
burns, acidbase
disorders, parenteral
nutrition, and
diuretic and antacid use
Phosphorus excess Acute and chronic renal Tetany, tachycardia,
(hyperphosphatemia) failure, excessive intake anorexia, nausea and
Serum phosphorus of vomiting, muscle
_4.5 mg/dL phosphorus, vitamin D weakness, signs and
excess, respiratory and symptoms of
metabolic hypocalcemia;
acidosis, hyperactive reexes;
hypoparathyroidism, soft tissue calcications
volume depletion, in lungs,
leukemia/lymphoma heart, kidneys, and
treated with cytotoxic cornea
agents,
increased tissue
breakdown,
rhabdomyolysis
Chloride decit Addisons disease, Agitation, irritability,
(hypochloremia) reduced chloride intake tremors, muscle
Serum chloride or absorption, cramps, hyperactive
_96 mEq/L untreated diabetic deep tendon reexes,
ketoacidosis, chronic hypertonicity, tetany,
respiratory acidosis, slow shallow
excessive sweating, respirations, seizures,
vomiting, gastric dysrhythmias, coma
suction, diarrhea, Labs indicate: decrease
 sodium and potassium serum chloride,
deciency, metabolic decrease serum sodium,
alkalosis; loop, osmotic, increase pH,
or thiazide diuretic use; increase serum
overuse of bicarbonate, bicarbonate, increase
rapid removal of ascitic total carbon dioxide
uid with a high sodium content, decrease urine
content, intravenous chloride level, decrease
uids that lack chloride serum potassium
(dextrose and water),
draining stulas and
ileostomies, heart
failure, cystic brosis
Chloride excess Excessive sodium Tachypnea, lethargy,
(hyperchloremia) chloride infusions with weakness, deep rapid
Serum chloride water loss, head injury respirations, decline in
_108 mEq/L (sodium retention), cognitive status,
hypernatremia, renal decrease cardiac
failure, corticosteroid output, dyspnea,
use, dehydration, tachycardia, pitting
severe diarrhea (loss of edema, dysrhythmias,
bicarbonate), coma
respiratory alkalosis, Labs indicate: increase
administration of serum chloride, increase
diuretics, overdose of serum potassium and
salicylates, Kayexalate, sodium, decrease serum
acetazolamide, pH, decrease serum
phenylbutazone and bicarbonate, normal
ammonium chloride anion gap, increase
use, urinary chloride level
hyperparathyroidism,
metabolic acidosis