Electrolyte Imbalance

Plasma Membrane

Lysosome

Fluid Compartments• Intravascular – The water portion of the circulatory system

surrounding the blood cells, ( Heart, arteries, veins )• Interstitial – Water outside the vascular system between

surrounding cells.• Intracellular – Water within the cell itself.

Homeostasis• The normal balance condition of the body.When disturbances

in homeostasis occur as a result of water shifting within the body, certain conditions develop related to the type of shifting that occurs.

Fluid and Electrolyte Movement• Governing principles: unequal concentrations on different

sides of a cell membrane will move to balance themselves equally on both sides of the membrane.

• Two components:• Balance of compounds ( water,electrolytes )• Balance of charges ( positive, negative )

Diffusion• Compounds or charges concentrated on one side of a cell

membrane will move across it to an area of lower concentration to balance themselves across the membrane.

Filtration• Another type of diffusion, commonly used by the kidneys to

clean blood. The Tubules trap the dissolved compounds but let water pass through much like a coffee filter traps the grounds.

Osmosis• Diffusion of water across a cell membrane• Osmotic Pressure – The pressure exerted by the concentration

of solutes on one side of a membrane that, if hypertonic tends to pull water from the other side of the membrane

• Tonicity – The concentration of sodium in a solution and the movement of water in relation to sodium levels.

Basic Cell Physiology• Human cells can exist only in a special balanced environment.

Understanding how this environment is created and maintained will give you the foundation you need to perform IV therapy.

Basic Cell Physiology• Because the cell is completely enclosed by a cell membrane,

compounds must move through the membrane to enter the cell. Small compounds like water, carbon dioxide, hydrogen ions and oxygen can easily pass through the membrane.Larger charged compounds need assistance to cross the cell membrane to enter the cell. The cell is selective, therefore it decides which compounds can go through the membrane.

Basic Cell Physiology• The cell membrane is a Phospholipid Bilayer – Meaning two

parts.

• Hydrophilic – Outer layer made up of Phosphate groups.

• Hydrophobic – Inner layer made up of lipids and fatty acids.

Electrolytes• Charged atoms and compounds are called electrolytes made

from inorganic molecules. Electrolytes have the ability to conduct electricity. Electrolytes with an overall positive charge are called a cation and overall negative charged are called anions. The major cations of the body include sodium, potassium, and calcium; bicarbonate and phosphate are the major anions.

Osmosis• Isotonic Solution – same concentration of sodium as the cell. (

.9% NS, LR )• Hypertonic Solution – greater concentration of sodium than

the cell. ( 9.0% NS ) water is drawn out of the cell.• Hypotonic Solution – Lower concentration of sodium than the

cell. ( D5W ) water flows into the cell.

Sodium• Sodium (Na+) is the principal extracellular cation needed to

regulate the distribution of water throughout the body in the intravascular and interstitial fluid compartments, making it a major factor in adequate cellular perfusion.

Potassium• About 98% of all the body’s potassium (K+) is found inside the

cells of the body, making it the principal intracellular cation. Potassium plays a major role in neuromuscular function as well as in the conversion of glucose into glycogen.Cellular potassium levels are regulated by insulin.

• Hypokalemia – low potassium• Hyperkalemia – High potassium

Calcium (Ca+)• The principal cation needed for bone growth, blood clotting

nerve and heart function.

Bicarbonate ( HCO 3)• Determining factor between acidosis and alkalosis in the body.

Bicarbonate is the primary buffer used in all circulating body fluid.

Chloride (CI )• Primarily regulates the pH of the stomach. It also regulates

extracellular fluid levels.

Phosphorus (Ph 2 )• An important component in the formation of adenosine

triphosphate (ATP), the powerful energy supplier of the body.

Dehydration

Dehydration• Decreased LOC

• Postural Hypotension

• Tachypnea

• Dry mucous membranes

• Tachycardia

• Poor skin turgor

• Flushed, dry skin

Overhydration• Shortness of breath

• Puffy eyelids

• Edema

• Polyuria

• Moist crackles

• Acute weight gain

• Sodium• Potassium• Calcium• Magnesium

Sodium• Hyponatremia• Hypernatremia

Hyponatremia• Too little sodium• Causes: GI secretion loss, fluid shifts (edema, ascites, burns)• Symptoms: HA, anxiety, muscle weakness, seizures, confusion• Treatment: NS

Hypernatremia• Too much sodium• Causes: sweating, diarrhea, decreased fluid intake• Symptoms: thirst, dry mucous membranes, decreased urine• Treatment: D5W

Potassium• Hypokalemia• Hyperkalemia

Hypokalemia• Too little potassium• Causes: GI losses, diuretic therapy, diet, pH, renal disease,

increased Na intake• Symptoms: Cramps, weakness, flacid paralysis, confusion,

weak irregular pulse, flattened t-wave with increased QT.• Treatment: Potassium IV or po. 20 – 40 mEq/L

Hyperkalemia• Too much potassium• Causes: acidosis, decreased urine, renal failure, tissue injury

salt substitute, blood transfusions, severe infection.• Symptoms: parasthesia of face, tongue, cardiac dysrhythmias,

bradycardia, peaked t-waves, widening QRS.• Treatment: less potassium in food, Calcium gluconate, bicarb,

insulin, dialysis, diuresis

Calcium• Hypocalcemia• Hypercalcemia

Hypocalcemia• Too little calcium• Causes: decreased Ca intake, loss by kidneys, Vitamin D

deficiency, hypothyroidism, stored blood products• Symptoms: Irritability, coma, decreased muscle contractility,

tetany, cramps, change in personality, convulsions.• Hypocalcemia – overstimulation of nerve cells resulting in

muscle cramps, abdominal cramps, carpal/pedal spasms, hypotension and vasoconstriction.

• Treatment: Ca gluconate or Ca chloride, increase milk products

Hypercalcemia• Too much calcium• Causes: Vitamin D and A, hyperthyroidism, sarcoidosis, bone

metastisis• Symptoms: Anorexia, nausea, fatique, polyuria, dehydration,

short QT, depressed T waves, bradycardia, heart block• Hypercalcemia – decreased stimulation of nerve cells resulting

in muscle weakness, lethargy, ataxia, vasodilation, and hot flushed skin.

• Treatment: Restrict Ca, IV fluids, loop diuretic