FLUID AND ELECTROLYTES
1. Overview:
● Main source of fluid and electrolytes: food and fluid intake
● Main site of fluid and electrolyte regulation: kidneys
● To evaluate the severity of imbalance:
- Degree: high/low
- Symptoms: mild/severe, present/absent
- Duration: acute/chronic
● Overcorrection is the most adverse effect of electrolyte imbalance Tx → monitor and assess always
● Muscle weakness is the most common clinical manifestation for ALL electrolyte imbalance.
● Hemodialysis is the common Tx of electrolyte imbalance, especially when the kidneys are damaged ⇒ ALWAYS monitor & assess for overcorrection during Tx of
electrolyte imbalance
2. Relationship between electrolytes:
Directed Related ↑↑ Reversely Related ↑↓
Na+, Cl- Ca2+, Na+
Mg2+, K+, Ca2+ (hypo only) Ca2+, (PO4)2-
Cl-, HCO3-
In general:
● Ca2+stabilizer
● Mg2+ = modulator
● (PO4)2- = component of ATP
3. IV Fluid
● Crystalloids: all NS, regardless of concentration (e.g. 0.45% NS, 3% NS, 0.9% NS, …)
● Dextrose-containing crystalloids: NS + dextrose (e.g. D5NS, D51/2NS, …)
● Balanced crystalloids: LR
● Colloids: Albumin, Hetastarch → keep the fluid intravascular (plasma) → ↑BP, ↓ edema
● Non-electrolyte solutions: D5W → aka “free water”, contain glucose → used to remove excessive electrolytes, treat hypoglycemia in non-diabetic patients !!! (do NOT
use dextrose for diabetic patient because it may worsen the condition)
4. IV Therapy resuscitate (stabilize) → maintain/replace/remove → assess
● RESUSCITATION when SYMPTOMATIC hypoperfusion (hypotension, tachycardia, tachypnea, poor cap refill, peripheral cold to touch, mental changes) → give IV
fluid (isotonic for acute/standard Tx, hypertonic for critical Tx)
, Note: skip resuscitation if ASYMPTOMATIC!!!!
● Once pt is stabilized → maintain/replace/remove as protocol
5. IV Catheter & Complications
Central Line (destination: vena cava) Peripheral line (to peripheral veins)
PICC: on upper arm, 1 or 2 lumens Saline lock: short, on lower hand or arm
Midline catheter: upper arm (antecubital)
Non-tunneled central catheter: on chest
Tunneled central catheter (Hickman): on chest
, Implanted port (Port cath): underneath the chest skin, use Huber needles
● IV catheter complications: try to avoid AC area to prevent complications
Local
Complication Cause Intervention
Hematoma ● Vein nicked during IV insertion *** ● Remove IV, apply cold compress
● Not enough pressure when removing IV ● Elevate extremity
● Tight tourniquet
Thrombosis ● Remove IV, apply cold compress, check circulation
Phlebitis ● Prolonged use of the same IV ● Remove IV, apply cold compress for 45’ then warm compress
● S/sx: erythema, pain, edema, palpable vein, purulent drainage ● Choose larger vein, smallest IV gauge
1. Overview:
● Main source of fluid and electrolytes: food and fluid intake
● Main site of fluid and electrolyte regulation: kidneys
● To evaluate the severity of imbalance:
- Degree: high/low
- Symptoms: mild/severe, present/absent
- Duration: acute/chronic
● Overcorrection is the most adverse effect of electrolyte imbalance Tx → monitor and assess always
● Muscle weakness is the most common clinical manifestation for ALL electrolyte imbalance.
● Hemodialysis is the common Tx of electrolyte imbalance, especially when the kidneys are damaged ⇒ ALWAYS monitor & assess for overcorrection during Tx of
electrolyte imbalance
2. Relationship between electrolytes:
Directed Related ↑↑ Reversely Related ↑↓
Na+, Cl- Ca2+, Na+
Mg2+, K+, Ca2+ (hypo only) Ca2+, (PO4)2-
Cl-, HCO3-
In general:
● Ca2+stabilizer
● Mg2+ = modulator
● (PO4)2- = component of ATP
3. IV Fluid
● Crystalloids: all NS, regardless of concentration (e.g. 0.45% NS, 3% NS, 0.9% NS, …)
● Dextrose-containing crystalloids: NS + dextrose (e.g. D5NS, D51/2NS, …)
● Balanced crystalloids: LR
● Colloids: Albumin, Hetastarch → keep the fluid intravascular (plasma) → ↑BP, ↓ edema
● Non-electrolyte solutions: D5W → aka “free water”, contain glucose → used to remove excessive electrolytes, treat hypoglycemia in non-diabetic patients !!! (do NOT
use dextrose for diabetic patient because it may worsen the condition)
4. IV Therapy resuscitate (stabilize) → maintain/replace/remove → assess
● RESUSCITATION when SYMPTOMATIC hypoperfusion (hypotension, tachycardia, tachypnea, poor cap refill, peripheral cold to touch, mental changes) → give IV
fluid (isotonic for acute/standard Tx, hypertonic for critical Tx)
, Note: skip resuscitation if ASYMPTOMATIC!!!!
● Once pt is stabilized → maintain/replace/remove as protocol
5. IV Catheter & Complications
Central Line (destination: vena cava) Peripheral line (to peripheral veins)
PICC: on upper arm, 1 or 2 lumens Saline lock: short, on lower hand or arm
Midline catheter: upper arm (antecubital)
Non-tunneled central catheter: on chest
Tunneled central catheter (Hickman): on chest
, Implanted port (Port cath): underneath the chest skin, use Huber needles
● IV catheter complications: try to avoid AC area to prevent complications
Local
Complication Cause Intervention
Hematoma ● Vein nicked during IV insertion *** ● Remove IV, apply cold compress
● Not enough pressure when removing IV ● Elevate extremity
● Tight tourniquet
Thrombosis ● Remove IV, apply cold compress, check circulation
Phlebitis ● Prolonged use of the same IV ● Remove IV, apply cold compress for 45’ then warm compress
● S/sx: erythema, pain, edema, palpable vein, purulent drainage ● Choose larger vein, smallest IV gauge
