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Examples of third spacing Ascites, edema, burn Dilutional Hyponatremia Excessive fluid intake Edema, confusion, weight gain Treatment: decrease fluid intake "swells, rings tight" True Hyponatremia Loss of fluid and Na Weight loss, DRY, hypotensive, tachy, DEHYDRATED Tx: replace both sodium and water Hypernatremia Causes Fevern unresponsive to traditional interventions, Na IV fluids, DI, tube feeds Hypernatremia Symptoms DRY, thirst, tachy, oliguria(compensating) Hypernatremia treatment Decrease Na and replace fluids Cl Acts like Na Buffer to maintain pH Hyperkalemia Causes Cell wall destruction Increased intake K sparing diuretics Renal failure Acidosis Hyperkalemia symptoms Irritable muscles Dysrhythmias Hyperactive bowels/bladder- diarrhea, frequency, urgency Hyperkalemia tx Limit intake Kayexalate Ca gluconate IV glucose Dialysis Don't know? Hypokalemia Causes Vomiting Diarrhea NG suction Decreased PO Burns K wasting diuretics Hypokalemia Symptoms Muscle flaccidity- not there to stimulate Weakness Constipation Alkalosis-resps Shallow Resps Cardiac arrest Hypokalemia Tx Supplement Foods high in potassium Citrus fruits and dried fruits, bananas, watermelon, potatoes, legumes, tea and peanut butter, avocado Calcium purpose Sedative at nerve level Coagulation- look at level with invasive procedures!! Bone/teeth strength Hypercalcemia Causes Cancer Metastatic bone disease hyperparathyroidism Thiazide diuretics Excessive vitamin D Hypercalcemia Symptoms Sedation Lethargy Hypoactive reflexes Slurred speech Impaired memory Hypercalcemia Tx Decrease intake Fluids Loop diuretics Give phosphate Hypocalcemia Causes Decrease PO of Ca and Vitamin D Increased Phosphate Renal disease Alcoholism Pregnancy POST PARATHYROIDECTOMY Hypocalcemia Symptoms Tetany Trousseaus- BP cuff Chvostek's- facial nerve "Pins and needles, lips burning, numbness" Hypocalcemia Tx Increase Ca and vitamin D intake