IV THERAPY AND ELECTROLYTES

Sodium- increase blood pressure, triggers muscle movement and nerve impulse

Potassium- food of our heart, help nerves and muscle, help to level the ph of blood

Chloride- engaged in fluid balance, regulate hormones in system

LOSS OF FLUID

Electrolyte can be eliminated through sweating (perspiration) through running and such, defecation, and
urination, (severe vomiting and diarrhea)

FLUID REPLACEMENT

 Artificial sweeteners
 Replacement of electrolytes ( iv therapy, food)

Potassium- advice to take more bananas and apple, spinach

Sodium- canned soup, soy sauce

Extracellular fluid - Chloride, sodium (moutside the cell, masmadami)

Intracellular fluid - Potassium phosporus, magnesium (inside the cell)

Ps. If u don’t have money to hospitalize the patient, we can used orisol

(Pocari sweat, garorade)

- As for the rapid replacement for fluid and electrolytes (severe cases), bring the patient to the
hospital and replaced the fluid intravenously

CLASSIFICATION OF IV FLUID

Isotonic

- Iso (equal) tonic (concentration of solution)

- familiarization, the cell affects through the osmosis that includes

0.9 % saline, D5water, D5w, 0.25% normal saline, Lactated ringers

Belongs to isotonic choice of a fluid (when is the time to use the isotonic solution to a patient?)

- Patient is suffering from diarrhea and vomiting

- rapid loss of Blood
- patient is dehydrated
- When the patient is in surgery

Hypotonic- hypo (under or beneath) tonic (concentration of solution)

0.45% normal saline, 0.25% normal saline, 0.33 normal saline

Ps. Contraindicated to patient with Increased Intracranial pressure

Hypertonic- hyper (excessive) tonic (concentration of solution)

3% normal saline, 5% saline, 10% dextrose in water, 5% dextrose and 0.9%normal saline, 5% dextrose
and sodium chloride mixtures, 5% dextrose alone

When to use?

When the pt is suffering hypernatremia

Severe edema

Crystalloids fluid

Lactated ringers, 0.45 % sodium chloride, 3% sodium chloride, D5w, D10w

Colloids

Human albumin, Milk, Blood, Detergents, foams, cosmetics

(jeva’s report)

SIGNIFICANCE OF CALCIUM

- More than 99% of the body’s calcium is located in the skeletal system
- Major components of bones and teeth
- Calcium plays a major role in transmitting nerve impulse
- Regulate muscle contraction and relaxation (cardiac muscle)
- Instrumental in activating enzymes (stimulates chemical reactions)
- Blood coagulation

Total serum calcium level (8.6-10.2 mg/dl)

Forms to exist in plasma

Calcium-ionized-plasma

Calcium-bound-plasma

Calcium-complexed-plasma

Serum ionized calcium- active form, for neuromuscular activity + blood coagulation normal level (4.5-5.1
mg/dl)

- Absorbed from foods in the presence of normal gastric activity + vitamin D, excreted through
feces, the remainder in urine.

HYPOCALCEMIA (calcium deficit)

Causes:

Osteoporosis, Hypoparathyroidism, Inflammation of pancreas, Excessive secretion of the glucagon from

the inflamed pancreas results in increase calcitonin, Renal failure, High phosphate, Inadequate Vit d
consumption, Alkalosis, Alcohol abuse, Meds predisposing hypocalcemia

s/sx: tetani, sensation tingling, trousseaus ischemia, twitching of muscle, mental changes (depression,
delirium, confusion, hallucination) , prolonged QT interval (seen o ECG), ventricular tachycardia, fatigue,
cramping, dry and course skin.

HYPERCALCEMIA (calcium excess) Excess of calcium in the plasma

Causes:

Malignant tumors, Hyperparathyroidism, Excessive parathyroid secretion, Milk-alkali syndrome (high

blood calcium + ,metabolic alkalosis cause by high too much calcium + absorbable alkali),Prolonged
immobilization, Thiazide diuretics (potentiate the action of the PTH on the kidney, low urinary calcium
excretion

s/sx

anorexia, nausea and vomiting, constipation, fatigue, diminished reflexes, lethargy, decreased level of
consciousness, confusion, personality changes, cardiac arrest if severe, poor feeding, hypertension,
hallucination

medication:

dovonex, Fosamax, Dendronal, Actonel, Vitamin d

 (deyonne’s report)

HYPER AND HYPONATREMIA (sodium imbalance)

Every cell in the body needs water to survive, but it's possible to get too much or too little of the liquid,
and that can cause some pretty serious problems.

The body's fluid balance is not only affected by water that's taken in by consuming food and beverages
and released in urine and sweat, but also by the concentration of sodium, an electrolyte. Electrolytes are
minerals that carry an electrical charge when dissolved in a liquid such as blood. In the body, sodium is
mainly found in the fluid outside of cells and plays an important role in the movement of water into and
out of them.

Two different disorders, known as hyponatremia and hypernatremia, may result from changes in the
balance of water in the body and levels of sodium in the blood.

Hyponatremia and hypernatremia are primarily disorders of water metabolism, said Dr. David Mount, a
kidney specialist and clinical chief of the renal division at Brigham and Women's Hospital in Boston.

In hyponatremia, an excess of water in the body can lead to a low concentration of sodium in the blood,
he said. And in hypernatremia, a deficit of water in the body can lead to a high concentration of sodium
in the blood.

Hyponatremia
Hyponatremia is a low concentration of sodium in the blood because of an excessive retention of water.
In this electrolyte abnormality, there is too much water in the body and this dilutes sodium levels in the
bloodstream.

Hyponatremia occurs when blood sodium goes below normal levels, which is 135 milliequivalents/liter
(mEq/L).

When sodium levels in the blood are too low, extra water goes into body cells causing them to swell.
This swelling can be especially dangerous for brain cells, resulting in neurological symptoms such as
headache, confusion, irritability, seizures or even coma.

The symptoms of hyponatremia may be more serious when blood sodium levels drop very quickly and
may be milder when they dip gradually, as that allows the body more time to adjust to the change.
Other symptoms of the disorder include muscle cramps or weakness, nausea, vomiting, tiredness and a
lack of energy.

Hyponatremia can result from an illness or from taking certain medications. According to the  National
Kidney Foundation, some of the causes may include:
 Severe vomiting or diarrhea.
 Excessive fluid intake, such as during endurance activities or from excessive thirst.
 Taking diuretics, medications that help flush excess water and sodium from the body.
 Kidney failure, a condition in which the kidneys have difficulty eliminating extra fluid from the
body.
 Congestive heart failure, which can lead to a build-up of excess fluid in the body.
 Burns affecting a large area of the body.
 Small cell lung cancer.
 Taking antidepressants, including some commonly used selective serotonin reuptake inhibitors,
particularly in older adults.
 Syndrome of inappropriate antidiuretic hormone secretion, a condition in which the body makes
too much antidiuretic hormone, causing the body to retain too much water and diluting levels of
sodium.

People can also consume excessive amounts of water during exercise and develop hyponatremia,
Mount told Live Science. Exercise-associated hyponatremia is more likely to affect endurance athletes,
such as marathoners, triathletes and ultra-distance race competitors.

Hyponatremia is not a permanent condition, although certain people may be more prone to the disorder
than others because of lifestyle habits or a medical condition.

Treatment for hyponatremia depends on its cause and seriousness. In moderate cases of hyponatremia
that are the result of diet, taking diuretics or drinking too much water, a person may need to restrict
water intake, consume salty foods — such as bouillon or pretzels — or adjust diuretic intake to raise
blood sodium levels.

A person with severe hyponatremia may be given a very concentrated saline solution intravenously. But
sodium levels need to be corrected slowly and in a controlled fashion, to prevent swollen brain tissue,
Mount said.

Hypernatremia
In hypernatremia, the body contains too little water relative to the amount of sodium, Mount said. This
causes sodium levels to become abnormally high in the blood — more than 145 mEq/L — which causes
water to move out of body tissues and into the blood in an attempt to equalize the concentration
between the two. Water can be lost from brain cells, causing them to shrink, which can be dangerous.

Too much sodium in the blood is a common problem in older adults, especially those who have been
hospitalized or are in long-term care facilities, Mount said. The disorder can also affect much younger
people: Infants may experience hypernatremia if they have severe diarrhea, for example.

Besides thirst, many of the symptoms of hypernatremia, such as irritability, restlessness and muscle
twitching, affect the central nervous system and stem from a loss of water content from brain cells. In
some cases, hypernatremia can be life-threatening. Similar to hyponatremia, other symptoms of
hypernatremia include feeling tired or lacking energy, confusion, seizures or coma.

The main cause of hypernatremia usually involves dehydration due to an impaired thirst mechanism or
limited access to water. The disorder can also result from diarrhea or vomiting, taking diuretics or having
a high fever.

People who aren't always able to provide water for themselves may be more at risk for hypernatremia.
This includes people on tube feedings and those with altered mental status (stroke or dementia), plus
people who are very young or very old and frail, according to a review in the New England Journal of
Medicine.
Older people are more prone to hypernatremia because their thirst mechanism, kidney function, and
hormones regulating salt and water balance may not work as effectively.

The main treatment for hypernatremia is simply to replenish fluids. A person with a mild case of
hypernatremia can usually just drink fluids to recover. But in more severe instances, water and a small
amount of sodium are given intravenously in controlled amounts over a 48-hour period to slowly reduce
sodium levels to a normal range.

Fluid levels are corrected slowly to avoid the risk of cerebral edema, a dangerous condition in which
there is swelling of the brain. Hypernatremia can be fatal, and may cause permanent brain damage if
not treated properly.

Date: (09/05/20)

PHOSPHATE

HYPOPHOSPHATEMIA- occurs only when the phosphate level in the blood becomes very low

s/sx: Muscle weakness, stupor, comma, death

mild: weakened the bones leading to fracture

HYPERPHOSPHATEMIA- high level of phosphate

normal value of phosphorus is 3.4-5.4 mg/dcliter

s/sx: joint pain, muscle pain, muscle weakness, itchiness (orticaria) , redness of the eyes

severe cases: constipation, nausea and vomiting and dhiarrhe

MAGNESIUM

normal magnesium

1.7-2.2 mg/l

Don’t give potassium alone (iv push)

Protamine sulfate (vitamin k antidote)