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Chapter 16 - Fluid and Electrolyte Replacement
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85
Pharmacology
Undergraduate 3
09/01/2011

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Term
Functions of Ka+
Definition
-Transmission and conduction of nerve impulses
-Contraction of skeletal, cardiac, and smooth muscles
-Glycolysis
-Protein synthesis from amino acids
-Regulation of osmolality
Term
Hypokalemia
Definition
Insufficient potassium (below 3.5 mEq/L)
Term
Hypokalemia results from
Definition
Cell damage. Potassium leaks from the cells into the intravascular fluid and is excreted by the kidneys
Term
What happens to Ka+ after cell damage
Definition
Potassium leaks from the cells into the intravascular fluid and is excreted from the kidneys. When cells lose Ka, Ka shifts from the blood plasma into the cells to restore Ka balance. Hypokalemia usually results
Term
Normal serum potassium level
Definition
3.5-5.3 mEq/L
Term
How much Kcl is needed to increase serum potassium level 1 mEq when levels are between 3.0 and 3.5 mEq/L
Definition
100-200 mEq
Term
How much Kcl is needed to increase serum potassium level 1 mEq when levels are less than 3.0 mEq/L
Definition
200-400 mEq
Term
What is potassium combined with when given orally or IV
Definition
An anion, such as chloride or bicarbonate
Term
When Ka+ is given orally, how much fluid should accompany it, if any?
Definition
1/2 glass at least - preferably one whole glass
Term
Can Ka+ be given Intravenously?
Definition
Yes. It must be diluted in IV solutions.

IT IS NEVER GIVEN AS AN IV PUSH OR BOLUS!!
Term
S&S of hypokalemia
Definition
N/V
Polyuria
Confusion
Dysrhythmias
Abdominal distention
Soft, flabby muscles
Term
How is potassium excreted? (Percentages and how)
Definition
80-90% in urine
8% in feces
Term
T/F - Potassium maintains neuromuscular activity
Definition
True
Term
What should be monitored when administering large doses of potassium?
Definition
EKG and serum potassium levels
Term
Hyperkalemia usually results from:
Definition
renal insufficiency or administration of large doses of potassium over time
Term
What may be prescribed to immediately decrease a temporary potassium excess in the serum potassium level?
Definition
Sodium bicarb
Calcium gluconate
Insulin and glucose
Term
S/S hyperkalemia
Definition
Nausea
Abdominal cramps
Oliguria
Tachycardia followed by bradycardia
Weakness
Numbness/tingling in extremities
Term
Potassium-wasting diuretics excrete
Definition
Potassium
sodium
chloride
Term
Potassium-sparing diuretics excrete
Definition
sodium
chloride
Term
What are some drugs that can cause hypokalemia
Definition
Laxatives
Corticosteriods
Antibiotics
Potassium-wasting diuretics
Term
What drugs can cause hyperkalemia
Definition
Oral and IV potassium salts
CNS agents
Potassium sparing diuretics
Term
What is the major cation in the ECF
Definition
Sodium
Term
What is the normal serum or plasma sodium level
Definition
135-145 mEq/L
Term
What is the major electrolyte that regulates body fluids?
Definition
Sodium
Term
Function of sodium
Definition
Promotes transmission and conduction of nerve impulses
Part of the sodium/potassium pump that causes cellular activity
Term
What happens when sodium shifts into the cell?
Definition
Depolarization occurs
Term
What happens when sodium shifts out of the cell?
Definition
Potassium shifts back into the cell and repolarization occurs
Term
What does sodium combine readily with to promote acid-base balance?
Definition
chloride and bicarbonate
Term
What can cause sodium loss?
Definition
Vomiting
diarrhea
surgery
potent diuretics
Term
S/S of hyponatremia
Definition
muscle weakness
headaches
lethargy
confusion
seizures
abdominal cramps
nausea and vomiting
tachycardia
hypotension
pale skin
dry mucous membranes
Term
What should be given for a serum sodium level between 125-135 mEq/L
Definition
Normal saline 0.9%NaCl
Term
What should be given for sodium levels lower than 115 mEq/L?
Definition
A hypertonic 3% saline solution
Term
S/S of Hypernatremia
Definition
Flushed, dry skin
agitation
elevated body temp
rough, dry tongue
N/V
anorexia
tachycardia
hypertension
muscle twitching
hyperreflexia
Term
Dietary requirement for sodium?
Definition
2-4 g/day... we all know sodium rich foods
Term
Normal serum calcium range
Definition
4.5-5.5 mEq/L
or
9-11 mg/dL
Term
What percent of calcium is bound to protein (in the body)?
Definition
about 50%
Term
Calcium unbound to protein is
Definition
Free, ionized calcium. This can cause a physiologic response
Term
Normal serum iCa range
Definition
2.2-2.5 mEq/L
or
4.25-5.25 mg/dL
Term
Function of calcium
Definition
Promote normal nerve and muscle activity.
Increase3s contraction of myocardium
Converts prothrombin into thrombin
Needed in formation of bone and teeth
Term
What is needed for absorption of calcium from the GI tract?
Definition
Vitamin D
Term
What can result from hypocalcemia?
Definition
Bone fractures due to loss from bones.
Term
What are common causes of hypocalcemia?
Definition
Hypoparathyroidism
vitamin D deficiency
multiple blood transfusions
Term
S/S of hypocalcemia
Definition
Anxiety
irritability
tetany
Term
Calcium can be administered how?
Definition
Orally or IV
Term
S/S of hypercalcemia
Definition
flabby muscles
pain over bony areas
kidney stones
Term
With what and why should calcium not be mixed?
Definition
Normal saline solution
This is not done because sodium promotes calcium loss
Term
Magnesium is a (cation or anion)
Definition
Cation
Term
When there is a loss of potassium, what electrolyte is also lost?
Definition
Magnesium
Term
Normal serum magnesium level
Definition
1.5-2.5 mEq/L
or
1.8-3 mg/dL
Term
What does magnesium do?
Definition
Promotes transmission of neuromuscular activity
Mediator of neural transmission in the CNS
Promotes contraction of my
Term
What does magnesium do?
Definition
Promotes transmission of neuromuscular activity
Mediator of neural transmission in the CNS
Promotes contraction of myocardium
Activates many enzymes for metabolism of carbs and protein
Responsible for transport of Na and Ka across cell membranes
Term
When there is a magnesium deficit, there is frequently what other types of deficits?
Definition
potassium or calcium deficit
Term
Hypotension and heart block may result from too much
Definition
Magnesium
Term
Hypomagnesemia is frequently undiagnosed because it is asymptomatic until serum magnesium levels approach
Definition
1 mEq/L
Term
Magnesium and calcium absorption is inhibited by
Definition
Sodium
Term
What can be given to correct digitalis (digoxin) toxicity?
Definition
Magnesium sulfate.
This is common practice afer bypass surgery or MIs to help prevent ventricular arrhythmias
Term
Chloride is a(n) (cation or anion)
Definition
Anion
Term
Normal serum chloride level
Definition
95-108 mEq/L
Term
Sodium and chloride have an inverse relationship. T/F
Definition
False
During sodium retention, chloride is also frequently retained
Term
CM of hypochloremia include
Definition
tremors
twitching
slow/shallow breathing
Term
CM of hypochloremia
Definition
weakness
lethargy
deep/rapid breathing
unconsciousness (late)
Term
Phosphorus is a major (anion/cation)
Definition
Anion
Term
Normal serum phosphorus level
Definition
1.7-2.6 mEq/L
Term
What percent of phosphorus is ionized (free) and what percent is protein-bound?
Definition
55% ionized
45% protein-bound
Term
Phosphorus is essential in
Definition
bone and teeth formation
neuromuscular activity
important in DNA and RNA
Term
CM of hypophosphatemia
Definition
muscle weakness
tremors
paresthesia
bone pain
hyporeflexia
seizures
hyperventilation
anorexia
dysphagia
Term
S/S of hyperphosphatemia
Definition
hyperreflexia
tetany
flaccid paralysis
muscular weakness
tachycardia
nausea
diarrhea
abdominal cramps
Term
What percent of the body is made up of water?
Definition
60%
Term
What percent of the body's water is found in the ICF?
Definition
40%
Term
What percent of the body's water is found in the ECF?
- what percent of that is found in interstitial fluids (tissue)
- what percent of fluids found in ECF are intravascular?
Definition
20%
15%
5%
Term
A cation is (-/+)
Definition
positive
Term
An anion is (-/+)
Definition
Negative
Term
What is the function of cations?
Definition
Transmit nerve impulses to muscles
Contract skeletal and smooth muscle
Term
What is osmolarity?
What is its unit of measure?
Definition
The osmotic pull exerted by all particles per unit of water. (concentration of body fluids)
mOsm/kg
Term
What is normal serum osmolality? (a figure)
Definition
280-295 mOsm/kg
Term
What is the definition of tonicity?
Definition
The effect of fluid on cellular volume
Term
What is the isotonicity range of IV fluid? (a figure)
Definition
240-340 mOsm/L
Term
What is crystalloid fluid used for?
Definition
replacement and maintenance fluid therapy
Term
What's an easy way of calculating serum osmolality?
Definition
Double the serum sodium (this is approximate)
Term
Why are colloids used?
Definition
They are volume expanders.
Term
Why are lipid IVs used?
Definition
Lipid IVs are indicated when IV therapy lasts longer than 5 days. (TPN)
Term
How many mL/kg and mL/lb of water are needed per day for the human body?
Definition
30 mL/kg
(about 15 mL/lb)
Term
What are the normal levels of potassium?
Definition
3.5-5.3 mEq/L
Term
In what general foods is potassium found?
Definition
Fruits
Fruit juices
Veggies
Term
What is the recommended daily potassium intake?
Definition
40-60 mEq/day
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