Volume Deficits
Hypovolemia
● Patho
○ removal of a sodium-containing fluid from the body
● Etiology
○ GI loss (emesis, GI suction, fistulas, diarrhea), adrenal insufficiency, diuretic use,
bed rest (3rd spacing), hemorrhage, burns, massive sweating
● CM
○ Weight loss, furrowed tongue, postured BP, high HR, weak pulse, flat neck vein,
lightheaded, oliguria, poor skin turgor, cool, clammy skin, muscle cramps, sunken
eyes
● Dx
○ BUN, HCT, Creatinine, BNP- ALL labs will be high!
● Interventions
○ Monitor I’s/O’s, daily weight in the morning, watch for weak, rapid pulse, and
orthostatic hypotension, large bore IV, encourage fluids
● Tx
○ 1st- oral fluid replacement
○ If severe- IV isotonic (lactated ringers or 0.9%)
○ Once normotensive, hypotonic IV (0.45%)
■ Water flush with tube feeds
● Pt Edu
○ Watch for urine output less than 1mL/Kg/Hr
○ Older people don’t drink to avoid incontinence
○ Older adults are more sensitive to fluid and electrolyte imbalance
Hypervolemia
● Patho
○ Increased amount of ECV when there's too much isotonic fluid
● Etiology - ANYTHING that causes the body to retain water
○ Increased aldosterone, heart failure, Cushing's, cirrhosis, renal disease, steroid use
● CM
, ○ Acute weight gain, pitting edema, bounding pulses, increased urine output, weak
muscles and joint pain, visual disturbances, severe pulmonary edema (pink, frothy
sputum)
● Dx
○ Hbg, Hct, BUN, creatinine, serum sodium- labs will be LOW
○ Chest Xray
○ Urine sodium, only lab that will be high
● Interventions
○ Fluid restrictions, daily weights, I/Os, breath sounds, 1L=1Kg (2.2lbs), edema
(mobile = ankles, immobile = sacral), semi-fowler's for orthopnea/dyspnea
● Tx
○ Diuretics
■ Thiazide - mild
■ Loop - severe
○ Dialysis (In extreme cases)
○ Dietary restriction
● Pt edu
○ Avoid processed foods, condiments, olives, seasoning, and Alka-Seltzer
○ Avoid water softeners
○ Read food labels
Electrolyte Imbalances
Hyponatremia
● Patho
○ ECV contains too much water for amount of sodium
● Etiology
○ Low aldosterone, excess ADH, diuretics, NG suction, vomiting, diarrhea,
hypotonic irrigations
● CM
○ Malaise, weakness, HA, confusion, seizures, coma, anorexia, N/V, papilledema,
high HR, low BP, abd cramping
● Dx
, ○ Low Na (<135)
○ High ADH
○ Low aldosterone
○ Low urine sodium, osmolality, and specific gravity
● RF
○ Exercise-induced
○ Post-op
○ NG tube suction
● Interventions
○ Monitor I&Os
○ Review meds
○ Daily weight
○ Falls/seizure precautions
○ Frequent neuro checks
● Tx
○ Oral sodium replacement (1st line)
○ LR or 0.9% saline
○ Isotonic then hypertonic (3%), if severe
● Pt edu
○ Eat sodium rich foods
■ Broth with beef cube
■ Tomato juice
■ Celery
○ Higher the age = Higher the risk
Hypernatremia
● Patho
○ Too much sodium, not enough water
● Etiology
○ Excess sodium intake, no access to water, hypertonic enteral feeds,
hyperventilation, burns, diabetes insipidus
● CM
Hypovolemia
● Patho
○ removal of a sodium-containing fluid from the body
● Etiology
○ GI loss (emesis, GI suction, fistulas, diarrhea), adrenal insufficiency, diuretic use,
bed rest (3rd spacing), hemorrhage, burns, massive sweating
● CM
○ Weight loss, furrowed tongue, postured BP, high HR, weak pulse, flat neck vein,
lightheaded, oliguria, poor skin turgor, cool, clammy skin, muscle cramps, sunken
eyes
● Dx
○ BUN, HCT, Creatinine, BNP- ALL labs will be high!
● Interventions
○ Monitor I’s/O’s, daily weight in the morning, watch for weak, rapid pulse, and
orthostatic hypotension, large bore IV, encourage fluids
● Tx
○ 1st- oral fluid replacement
○ If severe- IV isotonic (lactated ringers or 0.9%)
○ Once normotensive, hypotonic IV (0.45%)
■ Water flush with tube feeds
● Pt Edu
○ Watch for urine output less than 1mL/Kg/Hr
○ Older people don’t drink to avoid incontinence
○ Older adults are more sensitive to fluid and electrolyte imbalance
Hypervolemia
● Patho
○ Increased amount of ECV when there's too much isotonic fluid
● Etiology - ANYTHING that causes the body to retain water
○ Increased aldosterone, heart failure, Cushing's, cirrhosis, renal disease, steroid use
● CM
, ○ Acute weight gain, pitting edema, bounding pulses, increased urine output, weak
muscles and joint pain, visual disturbances, severe pulmonary edema (pink, frothy
sputum)
● Dx
○ Hbg, Hct, BUN, creatinine, serum sodium- labs will be LOW
○ Chest Xray
○ Urine sodium, only lab that will be high
● Interventions
○ Fluid restrictions, daily weights, I/Os, breath sounds, 1L=1Kg (2.2lbs), edema
(mobile = ankles, immobile = sacral), semi-fowler's for orthopnea/dyspnea
● Tx
○ Diuretics
■ Thiazide - mild
■ Loop - severe
○ Dialysis (In extreme cases)
○ Dietary restriction
● Pt edu
○ Avoid processed foods, condiments, olives, seasoning, and Alka-Seltzer
○ Avoid water softeners
○ Read food labels
Electrolyte Imbalances
Hyponatremia
● Patho
○ ECV contains too much water for amount of sodium
● Etiology
○ Low aldosterone, excess ADH, diuretics, NG suction, vomiting, diarrhea,
hypotonic irrigations
● CM
○ Malaise, weakness, HA, confusion, seizures, coma, anorexia, N/V, papilledema,
high HR, low BP, abd cramping
● Dx
, ○ Low Na (<135)
○ High ADH
○ Low aldosterone
○ Low urine sodium, osmolality, and specific gravity
● RF
○ Exercise-induced
○ Post-op
○ NG tube suction
● Interventions
○ Monitor I&Os
○ Review meds
○ Daily weight
○ Falls/seizure precautions
○ Frequent neuro checks
● Tx
○ Oral sodium replacement (1st line)
○ LR or 0.9% saline
○ Isotonic then hypertonic (3%), if severe
● Pt edu
○ Eat sodium rich foods
■ Broth with beef cube
■ Tomato juice
■ Celery
○ Higher the age = Higher the risk
Hypernatremia
● Patho
○ Too much sodium, not enough water
● Etiology
○ Excess sodium intake, no access to water, hypertonic enteral feeds,
hyperventilation, burns, diabetes insipidus
● CM
