Fluid and electrolytes

Sultan Muhammad
Lecturer JCN

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 Out line
 Body fluid distribution
 Body fluid compartment
 Regulation of Fluids in Compartments
 Fluid transportation
 Types of fluid i.e. Hypotonic , hypertonic & isotonic
 Fluid volume deficit , S/S , diagnosis & intervention .
 Fluid volume excess , S/S, diagnosis & intervention
 Hyponatremia & Hypernatremia and its management
 Hypokalemia & Hyperkalemia and its management
 Hypocalcemia & Hypercalcemia and its management
 Hypomagnesemia & Hypermagnesemia and its
management.
 Hypophosphotemia & hyperphosphotemia .

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We Need to Drink Water because..
 All chemical reactions occur in liquid medium
 It is crucial in regulating chemical and
bioelectrical distributions within cells.
 Transports substances such as hormones and
nutrients
 O2 transport from lungs to body cells.
 CO2 transport in the opposite direction.
 Dilutes toxic substances and waste products
and transports them to the kidneys and the
liver.
 Distributes heat around the body

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 Where does all this water go…..
 Water constitutes an average 50 – 70 %of the
total body weight;
Young males – 60% of total body weight
Older males – 52%
Yong females – 50% of total body weight
Older females – 47%
 Variation of + 15% in both groups is normal
 Obese have 25 to 30% less body water than lean
people.
 Infants 75 – 80%
• Gradual physiological loss of body water

• 65% at one year of age

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Components of body
fluid

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 Functional components of the body
fluid
The water of the body is divided in to 3 functional components (TBW – 60%
into 3

Intracellular fluid – 40%of Extracellular fluid – 20% of

the body Wight the body weight

Extra vascular interstitial Intra vascular 5%

fluid 15%of BW of BW

Rapidly equilibrating/functional Slowly equilibrating /non-functional

component 13 – 14% of BW Component 1 – 2 % BW

1. Connective tissue water

2. Transcellular fluid e.g. CSF, Joint fluid

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Total Body weight Total Body weight
(Female) (Male)

45% 40%
Solids Solids

2/3 Intracellular
Fluid (ICF)
55% 60%
Fluids Fluids
1/3 80%
Extracellular Interstitial
Fluid (ECF) 20% Plasma

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 Composition of body fluids
 Water is the universal solvent
 Solutes

 Electrolytes - inorganic salts, all acids and

bases, and some proteins.
 Non – electrolytes – most non electrolytes are
organic molecules- glucose, lipids, creatinine
and urea

 Electrolytes have greater osmotic power than

non electrolytes
 Water moves according to osmotic gradients

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Extracellular (ECF)
1/3 of body fluid
Comprised of 3 major components

Intravascular:
Plasma

Interstitial:
Fluid in and around tissues

Transcellular:
Over or across the cells (total body water
contained within epithelial lined spaces, is about
2.5% of the total body water)
A body fluid that is not inside cells but is separated
from plasma and interstitial fluid by cellular barriers.

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 Cont…
 Extracellular
 Nutrients for cell functioning
 Na

 Ca

 Cl

 Glucose

 Fatty acids

 Amino Acids

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 Cont…

 Intravascular Component
 Plasma
 Fluid portion of blood

 Made of:
 Water

 Plasma Proteins

 Small amount of other substances

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 Cont…
 Interstitial component
 Made up of fluid between cells
 Surrounds cells

 Transport medium for nutrients, gases,

waste products and other substances

between blood and body cells
 Back-up fluid reservoir

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 Cont…
 Transcellular component
 Located in joints, connective tissue, bones,
body cavities, CSF, and other tissues.

 Potential to increase significantly in abnormal

conditions.

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 Principles of body water distribution

 Body control systems regulate ingestion and

excretion:
Constant total body water
Constant total body osmolarity

Homeostatic mechanisms respond to changes in

ECF

No receptors directly monitor fluid or electrolyte

balance
Respond to changes in plasma volume or osmotic
concentrations.

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Homeostasis

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 Homeostasis means the constancy of the
internal environment by the coordinated
activities of all the systems of the body.

The working systems include;

1.Respiratory system
2.Excretory system
3.Digestive system
4.Circulatory system
5.Nervous and endocrine systems
The amount of water we drink is regulated by
homeostasis;
1.Output = intake
2.Thirst & satiety
3.Hormonal regulation
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Natriuretic
peptides

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 Imbalance of FLUID

Hypervolemia Hypovolemia
Excessive infusion of  Vomiting, diarrhea , fistulae
intravenous fluids
Retention of water in  When the patient is febrile;
abnormal conditions such as fluid loss increases by 12%
cardiac, renal and hepatic with every centigrade rise in
failure temperature
Absorption of water as during  Sequestration of fluid in third
transurethral resection of space/interstitial space
prostate using distilled water

 Hemorrhage

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 Degree of Loss of body Clinical
dehydration weight (%) features

Mild 5 Skin turgor , sunken

eyes, dry mucous
membranes

Moderates 10 Oliguria,
hypotension
tachycardia in
addition to above

Severe 15 Profound symptoms

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Serum electrolytes

Management

Treat the cause

Regulation of water and salt
Diuretics or dialysis: to remove excess of
water in case of hypervolemia

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/shrinkage

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Signs and symptoms of Signs and symptoms of
hypernatremia hyponatremia
Nausea and vomiting.
Early symptoms may include a
Strong Feeling Of Headache.
Thirst,
Weakness, Confusion.
Nausea,
Loss of appetite. Loss of energy and fatigue.

Severe symptoms include Restlessness and irritability.

confusion, muscle twitching,
and bleeding in or around the Muscle weakness, spasms or
brain. cramps.

Seizures.

Coma.

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 Etiology and management of
hypernatremia
Hypernatremia Etiology Treatment
Hypervolemic Administration of Diuretics
hypertonic sodium –
containing solution .
Minerolocorticoid
excess
Isovolemic Insensible skin and Water replacement
respiratory loss
diabetes insipidus

Hypovolemic Renal losses. Isotonic Na Cl, then

Gastrointestinal hypotonic saline
losses, respiratory
losses, profuse
sweating, adrenal
deficiencies
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 Imbalance of composition
 Imbalance of potassium
 Imbalances of chloride
 Imbalances of magnesium

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 Imbalances in levels of potassium
Major cation in intracellular compartments
Regulates metabolic activities , necessary for glycogen
deposits in liver and skeletal muscle, transmission and
conduction of nerve impulses, normal cardiac conduction
and skeletal and smooth muscle contraction.

Regulated by dietary intake and renal excretion

Normal level – 3.5 – 5.1 meq /l
Body conserves potassium poorly
Increased urine output decreases serum K

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 Osmoreceptors
 A receptor in the central nervous system
(probably the hypothalamus) that responds to
changes in the osmotic pressure of the blood.

Baroreceptor
 A sensory nerve ending especially in the walls
of large arteries (such as the carotid sinus)
that is sensitive to changes in blood pressure.

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 Chemoreceptor
 Chemoreceptor detect the levels of carbon dioxide in the blood
by monitoring the concentrations of hydrogen ions in the blood.

 Central chemoreceptors, located on the

ventral surface of medulla oblongata,
detect changes in pH of cerebrospinal fluid.
 Peripheral chemoreceptors act mostly to
detect variation of the oxygen in the arterial
blood, in addition to detecting arterial carbon
dioxide and Ph.

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 Regulation of Body Fluid Volume

Hypervolemia excess Hypovolemia Deficient

fluid volume fluid volume

Inhibit Stimulation

ADH Aldosterone Thirst Thirst ADH release Aldosterone

release release Stimulated Stimulated release
Inhibited Inhibited Inhibited Stimulated

Contribute to Contribute to

Increased urination of Decreased urination of

dilute urine concentrated urine

Normal fluid volume restored

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 Regulation of Fluids in
Compartments
 Osmosis
 Movement of water through a selectively permeable
membrane from an area of low solute concentration to
a higher concentration until equilibrium occurs.

 Movement occurs until near equal concentration found

 Passive process

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Fluid and Electrolytes 2

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Regulation of Fluids

Diffusion

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 Osmosis versus Diffusion
 Osmosis
 Low to high

 Water potential

 Diffusion
 High to low

 Movement of particles

 Both can occur at the same time

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 Isotonic Solution
Isotonic: The concentration of solutes in the solution
is equal to the concentration of solutes inside the cell.

Result: Water moves equally in both directions and the

cell remains same size! (Dynamic Equilibrium)

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 Hypotonic Solution
Hypotonic: The solution has a lower concentration
of solutes and a higher concentration of water
than inside the cell. (Low solute; High water)

Result: Water moves from the solution to inside the cell):

Cell Swells and bursts open (cytolysis)!

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 Hypertonic Solution
Hypertonic: The solution has a higher concentration of
solutes and a lower concentration of water than inside the
cell. (High solute; Low water)

Shrinks
Result: Water moves from inside the cell into the
solution: Cell shrinks (Plasmolysis)!
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 Regulation of Fluids

 Active Transport
 Allows molecules to move against
concentration and osmotic pressure to areas of
higher concentration
 Active process – energy is expended

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 Active Transport
 Na / K pump
 Exchange of Na ions for K ions
 More Na ions move out of cell
 More water pulled into cell
 ECF / ICF balance is maintained

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 Fluid Volume Shifts
 Fluid normally shifts between intracellular
and extracellular compartments to maintain
equilibrium between spaces.

 Fluid not lost from body but not available for

use in either compartment – considered third-
space fluid shift (“third-spacing”) are called
(transcellular fluid).

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 Causes of Third-Spacing
 Burns
 Peritonitis
 Bowel obstruction
 Massive bleeding into joint or cavity
 Liver or renal failure
 Lowered plasma proteins
 Increased capillary permeability
 Lymphatic blockage

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 Fluid volume deficit
 Hypovolemia
 Abnormally low volume of body fluid in
intravascular and/or interstitial compartments.

 Causes
o Vomiting
o Diarrhea
o Fever
o Excess sweating
o Burns
o Diabetes insipidus
o Uncontrolled diabetes mellitus

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 Fluid volume deficit

 What happens
 Output > Intake -> Water extracted from ECF
 ECF hypertonic (water moves out of cell - cell

dehydration) + osmotic pressure increased

(stimulates thirst preceptor in hypothalamus)
 ICF hypotonic with decreased osmotic

pressure = posterior pituitary secretes more

ADH
 Decreased ECF volume= adrenal glands

secrete Aldosterone

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 Signs and Symptoms
 Acute weight loss
 Decreased skin turgor
 Oliguria
 Concentrated urine
 Weak, rapid pulse
 Capillary filling time elongated
 Decreased BP
 Increased pulse
 Sensations of thirst, weakness, dizziness,
muscle cramps

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 Significant Points
 Dehydration – one of most common
disturbances in infants and children

 Additional S/S
 Sunken eyeballs
 Depressed fontanels
 Significant wt loss

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 Significant Points

 Older Adult
 Vein filling better indicator than skin turgor
 Have additional health problems
 Take various medications
 May intake to prevent incontinence

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 Labs
 Increased HCT Normal 35 – 45
25% means that there are 25 milliliters of red blood
cells in 100 milliliters of blood.
 Increased BUN
 High serum osmolality
 Increased urine osmolality
 Increased specific gravity
 Decreased urine volume, dark color

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 Interventions
 Major goal prevent or correct abnormal fluid
volume status before ARF occurs

 Encourage fluids

 IV fluids
 Isotonic solutions (0.9% NS or LR) until BP

back to normal, then hypotonic (0.45% NS)

 Monitor I & O, urine specific gravity, daily

weights

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 Cont…

 Monitor skin turgor

 Monitor vital sing and mental status
 Evaluation
 Normal skin turgor, increased UOP with

normal specific gravity, normal VS, clear

sensory stimuli , good oral intake of fluids,
labs WNL

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 Fluid Volume Excess (FVE)

 Hypervolemia
 Isotonic expansion of ECF caused by
abnormal retention of water and sodium
 Fluid moves out of ECF into cells and cells
swell

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 Causes
 Cardiovascular – Heart failure
 Urinary – Renal failure
 Hepatic – Liver failure, cirrhosis
 Other – Cancer, thrombus, PVD, drug therapy
(i.e., corticosteroids), high sodium intake,
protein malnutrition.

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 Signs/Symptoms
 Physical assessment
 Weight gain
 Distended neck veins
 Periorbital edema, pitting edema
 Adventitious lung sounds (mainly crackles)
 Dyspnea
 Mental status changes
 Generalized or dependent edema

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 Signs / Symptoms
 VS
 High CVP/PAWP
 ↑ cardiac output
 Lab data
 ↓ Hct (dilutional)
 Low serum osmolality
 Low specific gravity
 ↓ BUN (dilutional)

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 Signs / Symptoms

 Radiography
 Pulmonary vascular congestion
 Pleural effusion
 Pericardial effusion
 Ascites

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 Interventions
 Sodium restriction (foods/water high in sodium)
 Fluid restriction, if necessary
 Closely monitor IVF
 If dyspnea or provide Semi-Fowler’s sitting
orthopnea
 Strict I & O, lung sounds, daily weight, degree
of edema, reposition 2 hr
 Promote rest and diuresis.

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54
 Sources of Water
 Oral liquids: 1300ml/day
 Water in foods: 1000ml/day
 Meats and vegetables: 60-90% water
 Water from oxidation: 300ml/day
 10ml/cal of food metabolized

 Parenteral fluids
 Enteral feedings

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 “Normal” Water Loss
 Skin:
 Perspiration: 0-1000 ml/day

 Lungs: 300-400 ml/day

 Increases with increased respiratory rate

or depth or dry climate

 GI Tract: 100-200 ml/day

 Kidneys: 1-2 L/day
 Insensible loss: 600 ml/day (evaporation)
1ml/kg of body wt/hr in all ages

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Other Causes of Water Loss
 Fever
 Burns
 Diarrhea
 Vomiting
 N-G Suction
 Fistulas
 Wound drainage

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 IV Fluid Replacement
 IV Fluid to manage fluid volume imbalances
 Isotonic fluids (approximate normal serum
plasma)
 Rapid ECF expansion needed

 D W, NS, LR
5
 Hypotonic fluids
 Treatment of cellular dehydration

 .45% NS, NS, 2.5% dextrose

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 Cont…

 Hypertonic
 Treatment of water intoxication
 D5 ½ NS, D10W, 3% NS
 Shifts fluids from ICF & ECF to
intravascular component – expands
blood volume
 Now can be removed by kidneys

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 Sodium
 Normal 135-145 mEq/L
 Major cation in ECF
 Regulates voltage of action potential;
transmission of impulses in nerve and
muscle fibers, one of main factors in
determining ECF volume
 Elderly at risk
 Helps maintain acid-base balance

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 Electrolyte Imbalances

Hyponatremia (Na+ < 135 mEq/L; Normal = 135-

145 mEq/L)
 Causes:
  Na+ intake
  Na+ excretion (diaphoresis, GI suctioning)
 Adrenal insufficiency

 Assessment:
 N & V, abdominal cramps, weight loss
 Cold, clammy skin,  skin turgor
 Apprehension, head ache, convulsions, focal
neurologic deficit, coma (cerebral edema)
 Fatigue, postural hypotension
 Rapid thready pulse
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 Assessment

 Labs
 Increased HCT, K
 Decreased Na, Cl, Bicarbonate, UOP
with low Na and Cl concentration
 Urine specific gravity ↓ 1.010

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 Electrolyte Imbalances

Hyponatremia (Na+ < 135 mEq/L; Normal = 135-

145 mEq/L)

 Management:
 Provide foods high in sodium
 Administer NSS IV
 Assess blood pressure frequently
measure lying down, sitting &
standing)

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 Electrolyte Imbalances
Hypernatremia (Na+ >145 mEq/L; Normal = 135-
145 mEq/L)
 Causes:
 Excessive, rapid IV administration of NSS
 Inadequate water intake
 Kidney disease

 Assessment:
 Dry, sticky mucus membranes
 Flushed skin
 Rough dry tongue, solid skin turgor
 Intense thirst
 Edema, oliguria to anuria
 Restlessness, irritability .

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 Signs/Symptoms
Early:
 Generalized muscle weakness, faintness, muscle

fatigue, head ache.

Moderate:
 Confusion, thirst

Late:
 Edema, restlessness, thirst, hyperreflexia,

muscle twitching, irritability, seizures, possible

coma
Severe:
 Permanent brain damage, hypertension,

tachycardia, N & V

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 Labs
 Increased serum Na
 Increased serum osmolality
 Increased urine specific gravity

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 Fluid & electrolytes imbalances
Hypernatremia (Na+ >145 mEq/L; Normal = 135-145 mEq/L)

 Nursing Intervention:
 Weigh daily
 Assess degree of edema frequently
 Measure I & O
 Assess skin frequently & institute nursing
measures to prevent breakdown
 Encourage sodium-restricted diet.

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 Evaluation

 Normal serum Na levels

 Resolution of symptoms

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 Fluid & electrolytes imbalances
Potassium
 Normal 3.5-5.5 mEq/L
 Major ICF cation
 Vital in maintaining normal cardiac and
neuromuscular function, influences nerve
impulse conduction, important in CHO
metabolism, helps maintain acid-base
balance, control fluid movement in and out of
cells by osmosis.

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Fluid & Electrolytes Imbalance
Hypokalemia (K+ < 3.5 mEq/L; Normal = 3.5-5.5 mEq/L)
 Causes:
 Renal insufficiency
 Adrenocortical insufficiency
 Cellulose damage (burns)
 Infection
 Acidotic states
 Rapid infusion of IV sol’n w/ potassium-
releasing diuretics.

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 Fluid & Electrolytes Imbalance
Hypokalemia (K+ < 3.5 mEq/L; Normal = 3.5-5.5 mEq/L)

 Assessment:
 Thready, rapid, weak pulse
 Faint heart sounds
  BP
 Skeletal muscle weakness
  or absent reflexes
 Shallow respirations
 Malaise, apathy, lethargy
 Loss of orientation
 Anorexia, vomiting, weight loss
 Gaseous intestinal distention.

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72
Fluid & Electrolytes Imbalance

Nursing Interventions

 Administer K+ supplements to replace

losses
 Be cautious in administering drugs that
are potassium-sparing
 Monitor acid-base balance
 Monitor pulse, BP and ECG

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Fluid & electrolytes imbalances
 Hyperkalemia (K+ > 5.5 mEq/L; Normal = 3.5-5.5
mEq/L)

 Causes:
 Renal insufficiency
 Massive cellular trauma
 Insulin deficiency
 Addison’s disease
 Potassium sparing diuretics
 Decreased blood pH
 Exercise causes K+ to move out of cells

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 Signs/Symptoms
 ECG changes – tachycardia to Bradycardia to
possible cardiac arrest
 Tall, tented T waves

 Cardiac arrhythmias

 Muscle weakness, paralysis, paresthesia of

tongue, face, hands, and feet, N/V, cramping,
diarrhea, metabolic acidosis

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 Fluid & Electrolytes Imbalance
Hyperkalemia (K+ > 5.5 mEq/L; Normal = 3.5-5.5
mEq/L)
Nursing Interventions
 Administer kayexalate as ordered
 Administer/monitor IV infusion of
glucose & insulin
 Control infection

 Provide adequate calories &

carbohydrates
 Discontinue IV or oral sources of K+

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 Evaluation

 Normal serum K values

 Resolution of symptoms
 Treat underlying cause if possible

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 Calcium

 Required for blood coagulation, neuromuscular

contraction, enzymatic activity, and strength
and durability of bones and teeth.
 Nerve cell membranes less excitable with
enough calcium

 Ca absorption and concentration influenced by

Vit D, calcitriol (active form of Vitamin D), PTH,
calcitonin, serum concentration of Ca and Phos.

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Vitamin D Synthesis

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 Fluid & Electrolytes Imbalance
Hypocalcemia (Ca < 4.5 mEq/L; Normal = 4.5-5.8
mEq/L)

 Causes:
 Acute pancreatitis
 Diarrhea
 Hypoparathyroidism
 Lack of vitamin D in the diet
 Long-term steroid therapy
 Assessment
 Painful tonic muscle & facial spasms
 Fatigue, dyspnea
 Laryngospasm, convulsions

80
 Signs/Symptoms
 Abdominal cramping
 Tingling and numbness
 Tetany; hyperactive reflexes
 Irritability,
 Reduced cognitive ability,
 Seizures
 Prolonged QT on ECG,
 Hypotension,
 Decreased myocardial contractility
 Abnormal clotting

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Sources of Calcium Intake

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Dietary Sources of Calcium

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Fluid & Electrolytes Imbalance

Nursing Interventions

 Administer oral Ca lactate or IV CaCl2 or

gluconate
 Providing safety by padding side rails
 Administer dietary sources of calcium
 Vitamin D
 Provide quiet environment

84
Fluid & Electrolytes Imbalance
Hypercalcemia (Ca > 5.8 mEq/L; Normal = 4.5-5.8
mEq/L)
 Causes:
 Hyperparathyroidism
 Immobility
 Increased vitamin D intake
 Osteoporosis & osteomalacia

 Assessment:
 N & V, anorexia, constipation
 Headache, confusion
 Lethargy, stupor
 Decreased muscle tone
 Deep bone / flank pain

85
Fluid & Electrolytes Imbalance
Nursing Interventions
 Encourage mobilization
 Limit vitamin D intake
 Limit calcium intake
 Normal saline
 Administer diuretics
 Calcitonin

86
 Sources of Vitamin D Intake
Age Male Female Pregnancy Lactation

0-6 months 1,000 IU 1,000 IU    

7-12 months 1,500 IU 1,500 IU    

1-3 years 2,500 IU 2,500 IU    

4-8 years 3,000 IU 3,000 IU    

≥9 years 4,000 IU 4,000 IU 4,000 IU 4,000 IU

87
 Evaluation

 Normal serum calcium levels

 Improvement of signs and symptoms

88
 Magnesium

 Ensures K and Na transport across cell

membrane.
 Important in CHO and protein metabolism
 Plays significant role in nerve cell conduction
 Important in transmitting CNS messages and
maintaining neuromuscular activity.

89
 Fluid & Electrolytes Imbalance
Hypomagnesemia (Mg < 1.50 mEq/L; Normal = 1.5-
3.0 mEq/L)
 Causes:
 Low intake of Mg in the diet
 Prolonged diarrhea
 Massive diuresis
 Hypoparathyroidism

 Assessment:
 Paresthesia, muscle spasm
 Confusion, hallucination, convulsions
 Ataxia, tremors, hyperactive deep reflexes
 Flushing of the face, diaphoresis

 Nursing Intervention:
 Provide good dietary sources of Mg.

90
 Treatment
 Mild
 Diet – Best sources are unprocessed cereal
grains, nuts, legumes, green leafy
vegetables, dairy products, dried fruits,
meat, fish
 Magnesium salts

 More severe
 MgSO4 IM
 MgSO4 IV slowly

91
Daily requirement of MgSo4

92
 Fluid & Electrolytes Imbalance
Hypermagnesemia (Mg > 3.0 mEq/L; Normal = 1.5-
3.0 mEq/L)
 Causes:
 Renal insufficiency, dehydration
 Excessive use of Mg-containing antacids or
laxatives
 Assessment:
 Lethargy, somnolence, confusion
 N&V
 Muscle weakness, depressed reflexes
  pulse and respirations
 Nursing Intervention:
 Withhold Mg drugs/foods
  fluid intake

93
 Hypermagnesemia
 Most common cause is renal failure, especially
if taking large amounts of Mg-containing
antacids; DKA with severe water loss.

 Signs and symptoms

 Hypotension, drowsiness, respiratory
depression, coma, cardiac arrest
 ECG – Bradycardia, cardiac arrest & tall T
waves

94
 Treatment

 Withhold Mg-containing products

 Calcium chloride or gluconate IV for acute
symptoms
 IV hydration and diuretics
 Monitor VS, LOC
 Check patellar reflexes

95
 Evaluation
 Serum magnesium levels WNL
 Improvement of symptoms

96
 Phosphorous
 Phosphorus. A major mineral in the body's bone
crystal, phosphorus is found in dairy products
and meat. Vitamin D improves phosphorus
absorption in the intestine and kidney.

 Normal 2.5-4.5 mg/dl

 Intracellular mineral
 Essential to tissue oxygenation, normal CNS
function and movement of glucose into cells,
assists in regulation of Ca and maintenance of
acid-base balance
 Influenced by parathyroid hormone and has
inverse relationship to Calcium

97
 Hypophosphotemia

 Causes
 Malnutrition
 Hyperparathyroidism
 Certain renal tubular defects
 Metabolic acidosis (esp. DKA)
 Disorders causing Hypercalcemia

98
 Signs/Symptoms
 Impaired cardiac function
 Poor tissue oxygenation
 Muscle fatigue and weakness
 N/V, anorexia
 Disorientation, seizures, coma

99
 Treatment
 Closely monitor and correct imbalances
 Adequate amounts of Phos

 Recommended dietary allowance for formula-

fed infants 300 mg Phos/day for 1st 6 mos. and

500 mg per day for latter ½ of first year
 1:1 ratio Phos and Ca recommended dietary

allowance. Exception is infants, whose Ca

requirements is 400 mg/day for 1st 6 mos and
500 mg/day for next 6 months

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 Treatment

 Treatment of moderate to severe deficiency

 Oral or IV phosphate (do not exceed rate of

10 mEq/h)
 Identify clients at risk for disorder and

monitor
 Prevent infections
 Monitor levels during treatment

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 Hyperphosphatemia

 Causes
 Chronic renal failure (most common)
 Hyperthyroidism, Hypoparathyroidism
 Severe catabolic states
 Conditions causing Hypocalcemia

102
 Signs/Symptoms

 Muscle cramping and weakness

 ↑ HR
 Diarrhea, abdominal cramping, and nausea

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 Treatment
 Prevention is the goal
 Restrict phosphate-containing foods
 Administer phosphate-binding agents
 Diuretics
 Treat cause
 Treatment may need to focus on correcting
calcium levels

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 Evaluation
 Lab values within normal limits
 Improvement of symptoms

105
 References
 Helen Giannakopoulos, LEE Carrasco. Jason
Alabakoff, peter D. Quinn. Fluid and electrolyte
management and blood product usage.

 Fluid, Electrolyte, and Acid-base Balance Heitz, Horne-

Mosby, 4th edition IV Therapy made incredibly Easy!

 McCann, Lippincott, 3rd edition

 Fluid & Electrolytes Chernecky, Macklin, Murphy-

ende, Saunders 2002

 Fluids, Electrolytes & Acid-Base Balance Hogan,

Wane, Prentice Hall nursing

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