Major Fluid and Electrolyte imbalance: signs and symptoms by nurses note

 Fluid and Electrolyte Imbalance 

Fluid volume deficit (hypovolemia)

Contributing factors : Loss of water and electrolytes, as in vomiting, diarrhea, fever, excess sweating, burns, blood loss, gastrointestinal suction, and third-space fluid shifts; and decreased intake, as in anorexia, nausea, and inability to gain access to fluid. Diabetes insipidus and uncontrolled diabetes mellitus also contribute to a depletion of extracellular fluid volume.

Signs/symptoms and laboratory findings

Acute weight loss, decreased skin turgor, oliguria, concentrated urine, weak rapid pulse, capillary filling time prolonged, low central venous pressure, decreased blood pressure, flattened neck veins, dizziness, weakness, thirst and confusion, increase pulse, muscle cramps.

Labs indicate: increase hemoglobin and hematocrit, increase serum and urine osmolality and specific gravity, decrease urine sodium, increased BUN and creatinine. 

Fluid volume excess. (Hypervolemia)

Contributing factors: Compromised regulatory mechanisms, such as a renal failure, heart failure, and cirrhosis; and overzealous administration of sodium-containing fluids. Prolonged corticosteroid therapy, severe stress, and hyperaldosteronism augment fluid volume excess. 

Signs/symptoms and laboratory findings.

Acute weight gain, edema, distended jugular veins, crackles, and elevated CVP, shortness of breath, increased blood pressure, bounding pulse and cough.

Lab indicate: decrease hemoglobin and hematocrit, decrease serum and urine osmolality, decrease urine sodium and specific gravity. 

Sodium Deficit (hyponatremia serum sodium <135 mEq/L

Contributing factors : Loss of sodium,  as in use of diuretics, loss of GI fluids, renal disease, and adrenal insufficiency. Gain of water, as in excessive administration of D5 W and water supplements for patient receiving hypotonic tube feedings; disease states associated with SIADH such as head trauma and oat-cell lung tumor ; and medication associated with water retention. Hyperglycemia and heart failure cause a loss of sodium. 

Signs/symptoms and laboratory findings

Anorexia, nausea and vomiting, headache, lethargy, confusion, muscle cramps and weakness, muscular twitching, seizure, papilledema, dry skin, increased pulse, decreased BP.

Lab indicate: decreased serum and urine sodium, decreased specific gravity and osmolality.

Sodium excess (hypernatremia) Serum sodium >145 mEqL

Contributing factors: Water deprivation in patients unable to drink at will, hypertonic tube feedings without adequate water supplements, diabetes insipidus, heatstroke, hyperventilation and watery diarrhea. Excess corticosteroid, sodium bicarbonate, and sodium chloride administration, and salt water near-drowning victims.

Signs/symptoms and laboratory findings 

Thirst, elevated body temperature, swollen dry tongue and sticky mucous membrane, hallucinations, lethargy, restlessness, irritability, focal or grand mal seizures, pulmonary edema, hyperreflexia, twitching, nausea, vomiting, anorexia. 

Lab indicate: increased serum sodium, decreased urine sodium, increased urine specific gravity and osmolality. 

Potassium deficit (hypokalemia) serum potassium <3.5 mEq/L

Contributing factors : Diarrhea, vomiting, gastric suction, corticosteroid administration, hyperaldosteronism, carbenicillin, amphotericin B,  bulimia, osmotic diuresis, alkalosis, diuretics. 

Signs/symptoms and laboratory findings

Fatigue, anorexia, nausea and vomiting, muscle weakness, polyuria, decreased bowel motility, ventricular asystole or fibrillation, leg camps,.hypotension.

ECG : flattened  T waves, prominent U waves, ST depression, prolonged PR interval.

Potassium excess (hyperkalemia) Serum potassium >5.0 mEq/L

Contributing factors: Pseudohyperkalemia, oliguric renal failure, use of potassium -conserving diuretics in patients with renal insufficiency, metabolic acidosis, Addison disease, crush injury, burns, stored blood bank transfusion, and rapid iv administration of potassium. 

Signs/symptoms and laboratory findings

Vague muscular weakness, tachycardia or bradycardia, dysrhythmias, flaccid paralysis, 

Ecg: tall tented T waves, prolonged PR intervals and QRS duration, absent P waves, ST depression. 

Calcium deficit (hypocalcemia ) serum calcium <8.5 mg/dL

Hypoparathyroidism (may follow thyroid surgery or radical neck dissection ),  malabsorption, pancreatitis, alkalosis, vitamin D deficiency, massive subcutaneous infection, generalized peritonitis, massive transfusion of citrated blood, chronic diarrhea, decreased parathyroid hormone, and diuretic phase of renal failure. 

Signs/symptoms and laboratory findings 

Numbness, tingling of finger, toes, and circumoral region; positive Trousseau's sign and Chvostek's sign; seizures, carpopedal spasms, hyperactive deep tendon reflexes, irritability, bronchospasm, anxiety, impaired clotting time. Decreased prothrombin level, ECG: prolonged QT interval and lengthened ST.

Calcium excess (hypercalcemia ) Serum calcium more than >10.5 mg/dL

Contributing factors : Hyperparathyroidism, malignant neoplastic disease, prolonged immobilization, overuse of calcium supplement, vitamin D excess, oliguric phase of renal failure, acidosis, corticosteroid therapy, increased parathyroid hormone and digoxin toxicity. 

Signs/symptoms and laboratory findings 

Muscular weakness, constipation, anorexia, nausea and vomiting, polyuria and polydipsia, lethargy, deep bone pain and calcium stones

Ecg: shortened QT interval, bradycardia, heart blocks. 

Magnesium deficit (hypomagnesium) Serum magnesium <1.8 mg/dL

Contributing factors: Chronic alcoholism, hyperparathyroidism, hyperaldo-steronism, diuretic phase of renal failure, malabsorptive disorders, diabetic ketoacidosis, parenteral nutrition, chronic laxative use, diarrhea, acute myocardial infarction 

Signs/symptoms and laboratory findings

Neuromuscular irritability, positive Trousseau's and Chvostek's signs, insomnia, mood changes, anorexia, vomiting 

Ecg: PVCs,  flat or inverted T waves, depressed ST segment. 

Magnesium excess (hypermagnesemia) serum magnesium >2.7 mg/dL.

Contributing factors: Oliguric phase of the renal failure, (partially when magnesium -containing medications are administered ), adrenal insufficiency, excessive IV magnesium administration and DKA.

Signs/symptoms and laboratory findings 

Flushing, hypotension, drowsiness, hypoactive reflexes, depressed respiration, cardiac arrest and coma, 

ECG: tachycardia →bradycardia, prolonged PR interval and QRS.

Phosphorus deficit (hypophosphatemia ) Serum phosphorus <2.5 mg/dL.

Contributing factors : Refeeding after starvation, alcohol withdrawal, diabetic ketoacidosis, respiratory alkalosis, ↓ magnesium, ↓potassium, hyperparathyroidism, vomiting, diarrhea, hyperventilation, vitamin D deficiency related with malabsorption disorders, burns, acid-base disorders, and diuretic use.

Signs/symptoms and laboratory findings

Paresthesias, muscle weakness, bone pain tenderness, chest pain, confusion, cardiomyopathy, respiratory failure, seizures, 

Phosphorus excess ( hyperphosphatemia) Serum phosphorus >4.5 mg/dL.

Contributing factors : Acute and chronic renal failure, excessive intake of phosphorus, vitamin D excess, respiratory acidosis, hypoparathyroidism, volume depletion, increased tissue breakdown. 

Signs/symptoms and Laboratory findings 

Tetany, tachycardia, anorexia, nausea and vomiting, muscle weakness, signs and symptoms of hypocalcemia. 

Chloride excess (hyperchloremia) Serum chloride >108 mEq/L.

Excessive sodium chloride infusions with water loss, hypernatremia, renal failure, corticosteroid use, dehydration, respiratory alkalosis, administration of diuretics, metabolic acidosis. 

Signs/symptoms and laboratory findings 

Tachypnea, lethargy, weakness, deep rapid respirations, decreased cardiac output, dyspnoea, tachycardia, pitting edema.

Lab indicate : increased serum chloride, increased serum sodium, decreased serum PH,  decreased serum bicarbonate, normal anion gap, increased urinary chloride level.

Chloride deficit (hypochloremia) Serum chloride <96 mEq/L

Contributing factors : Addison's disease, reduced chloride intake or absorption, untreated DKA, chronic respiratory acidosis, excessive sweating, vomiting, gastric suction, diarrhea, sodium and potassium deficiency, metabolic alkalosis, loop, osmotic rapid removal of ascitic fluid with high  sodium content, heart failure. 

Signs/symptoms and laboratory findings 

Agitation, irritability, tremors, muscle cramps, hypertonicity, tetany, slow, shallow respirations, seizure, dysrhythmias, coma.

Lab indicate: Decreased serum chloride, decreased serum sodium, increased PH, increased serum bicarbonate, decreased urine chloride level.