Dr. Jhason John J.

Cabigon
Philippine Integrated
Nurse Licensure
Examination

Fluids and Electrolytes

Outline

3 concepts

Fluids
Electrolytes
Acids and Bases

THE BODY FLUIDS

A solution of solvent and solutes
Our body is made up of fluids and solids
About 50-60% of the body weight is WATER
In a 70 Kg adult male: 60% X 70= 40-42

Liters
Note that 1 kg body weight= 1 liter of water
The body has two major compartments:
1 Intracellular
2. Extracellular

The Proportion of Body Fluids

Intersti
Intracellul tial
ar
fluid
15%
40%

Intravas
cular
5%
4

The Intracellular Fluid

Found inside the cell surrounded by a

membrane
This is the compartment with the highest

percentage of water in adults

The Extracellular Fluid

Fluid found outside the cells

1. INTERSTITIAL FLUID

Found in between the cells

2. INTRAVASCULAR FLUID

Found inside the blood vessels and

lymphatic vessels

3. TRANSCELLULAR FLUID

Found inside body cavities like pleura,

peritoneum, CSF

Sample question
1. A client with CHF is assessed by the
nurse. Upon reviewing the chart, it is
determined that his weight increased by
4.5 pounds. The nurse estimates that
client has gained how many liters of
fluid?
A. 3
B. 1
C. 2
D. 0.5

Sources of Fluids:
Fluid Input
(~2,500 ml/day)
1. Exogenous sources
Fluid intake- water from foodstuffs
IVF
Medications
Blood products
2. Endogenous sources
By products of metabolism
secretions
8

Fluid Losses
(~2,500 ml/day)
Routes of Fluid output
Urine (1,500 ml/day)
Fecal losses (~200 ml) Sensible losses
Sweat
Insensible losses though the skin and
lungs as water vapor

Sample question
2. A nurse reads a doctors progress
notes in the clients chart which states
insensible fluid loss approximately 800
ml. The nurse understands that this
fluid loss may occur through:
A. The Gastrointestinal tract
B. Urinary output
C. Wound drainage
D. The skin

10

Sample question
A nurse is administering IVF as ordered to
a patient who sustained second-degree
burns. In evaluating the adequacy of
fluid resuscitation, the nurse
understands that the most reliable
indicator for fluid adequacy is the:
A. Blood pressure
B. Mental status
C. Urine output
D. Peripheral pulses

11

Sample question
The nurse receives the following

endorsements. She is certain that which

patient is at most risk for the development of
fluid volume deficit?
A. The client who came from the OR after a
hemorroidectomy
B. The client who has Renal failure
undergoing dialysis
C. The client with AIDS taking corticosteroids
D. The client with Rheumatic fever taking
diuretics

12

Fluid Dynamics
The movement of fluids (solutes and
solvents) in the body compartment
Diffusion
Osmosis
Filtration
Active transport

13

DIFFUSION

The movement of SOLUTES or particles

in a solution from a higher concentration

to a lower concentration
If a sugar is placed in plain water, the
glucose molecules will dissolve and
diffuse/distribute in the solution

14

OSMOSIS
Diffusion of WATER
OSMOTIC PRESSURE the power of a

solution to draw water across a semipermeable membrane is called (water

diffuses into a more concentrated
solution)
A special type of osmotic pressure is
exerted by the proteins in the plasma. It
is called Oncotic pressure.
HYDROSTATIC PRESSURE pressure
exerted by the fluids within the closed
system in the walls of the container
15

The Concept of TONICITY

This is the concentration of solutes in a

solution
A solution with high solute concentration
is considered as HYPERTONIC
A solution with low solute concentration
is considered as HYPOTONIC
A solution having the same tonicity as
that of body fluid or plasma is
considered ISOTONIC

16

Helpful Hints
In a HYPERTONIC solution, fluid will go

out from the cell, the cell will shrink

(crenation)
In a HYPOTONIC solution, fluid will enter
the cell, the cell will swell and burst
(lysis)
In an ISOTONIC solution, there will be no
movement of fluid.

17

Sample question
The nurse is caring for a psychiatric

patient who ingested high-sodium

containing foods. She suspects
hypernatremia in this patient and expect
to note:
A. Hyperactive deep tendon reflex
B. Chovsteks Sign
C. Dry skin and sticky mucous
membrane
D. Decreased muscle tone

18

FILTRATION

The movement of both solute and

solvent by hydrostatic pressure, ie, from

an area of a higher pressure to an area
of a lower pressure
An example of this process is urine
formation
Increased hydrostatic pressure is one
mechanism producing edema

19

Active transport
This is the movement of

solutes across a membrane

from a lower concentration to
a higher concentration with
utilization of energy
Example is the SodiumPotassium pump- a primarily
active transport process
20

Sample question
The nurse reviews the laboratory report

of a patient with fluid volume deficit.

Which of the following laboratory
findings will support this condition?
A. WBC count of 9,000 (normal 5,00010,000/hpf)
B. Creatinine of 1 mg/dl (normal 0.5-0.9
mg/dl)
C. Sodium of 140 mEq/L (normal 135-145
mEq/L)
D. Hematocrit of 58% (normal 35.444.4%)
21

Sample question
The client is taking a high dose of

Furosemide. To determine the progress

of the therapy, the nurse performs which
of the following important action?
A. Monitor urinary pH
B. Check the temperature periodically
C. Weigh the patient daily
D. Obtain a serial serum Sodium level

22

Regulation of Body fluid

balance
1. The Kidney
Regulates primarily fluid output by urine
formation
Releases RENIN
Regulates sodium and water balance

23

Regulation of Body fluid

balance
2. Endocrine regulation
Regulates primarily fluid intake by thirst
mechanism
Antidiuretic Hormone increase water
reabsorption on collecting duct
Aldosterone increases Sodium
retention in the distal nephron
Atrial Natriuretic Factor Promotes
Sodium excretion and inhibits thirst
mechanism

24

Regulation of Body fluid

balance
3. Gastro-intestinal regulation
The GIT digests food and absorbs water
Only about 200 ml of water is excreted

in the fecal material per day

25

FLUID VOLUME DEFICIT:

HYPOVOLEMIA
Risk Factors:
Diabetes Insipidus
Adrenal insufficiency
Osmotic diuresis
Hemorrhage
Coma
Third-spacing conditions like ascites,
pancreatitis and burns

FLUID VOLUME DEFICIT or

HYPOVOLEMIA
PATHOPHYSIOLOGY:
Factors inadequate fluids in the body
decreased blood volume decreased cellular
hydration cellular shrinkage weight loss,
decreased turgor, oliguria, hypotension, weak
pulse, etc.

Assessment
Physical examination
Weight loss, tented skin turgor, dry mucus
membrane
Hypotension
Tachycardia
Cool skin, acute weight loss
Flat neck veins
Decreased CVP
Subjective cues
Thirst
Nausea, anorexia
Muscle weakness and cramps

Assessment
Laboratory findings
Elevated BUN due to depletion of fluids or
decreased renal perfusion (Normal = 7-20
mg/dl)
Hemoconcentration (Normal Hct = 35.4 - 44.4)
Possible Electrolyte imbalances: Hypokalemia,
Hyperkalemia, Hyponatremia, hypernatremia
Urine specific gravity is increased (concentrated
urine) above 1.020

Nursing Diagnosis
Fluid volume deficit

Planning
To restore body fluids

Implementation
ASSIST IN MEDICAL INTERVENTION
Provide intravenous fluid as ordered
Provide fluid challenge test as ordered

Implementation
NURSING MANAGEMENT
Assess the ongoing status of the patient by
doing an accurate input and output monitoring
Monitor daily weights. Approximate weight loss
1 kilogram = 1 liter!
Monitor Vital signs, skin and tongue turgor,
urinary concentration, mental function and
peripheral circulation
Prevent Fluid Volume Deficit from occurring by
identifying risk patients and implement fluid
replacement therapy as needed promptly

Implementation
NURSING MANAGEMENT
Correct fluid Volume Deficit by offering fluids
orally if tolerated, anti-emetics if with vomiting,
and foods with adequate electrolytes
Maintain skin integrity
Provide frequent oral care
Teach patient to change position slowly to avoid
sudden postural hypotension

FLUID VOLUME EXCESS:

HYPERVOLEMIA
Etiologic conditions and Risks factors
Congestive heart failure
Renal failure
Excessive fluid intake
Impaired ability to excrete fluid as in renal
disease
Cirrhosis of the liver
Consumption of excessive table salts
Administration of excessive IVF
Abnormal fluid retention

FLUID VOLUME EXCESS:

HYPERVOLEMIA
Pathophysiology
Excessive fluid expansion of blood volume
edema, increased neck vein distention,
tachycardia, hypertension

Assessment
Physical Examination
Increased weight gain
Increased urine output
Moist crackles in the lungs
Increased CVP
Distended neck veins
Wheezing
Dependent edema

Assessment
Subjective cue/s
Shortness of breath
Change in mental state
Laboratory findings
BUN and Creatinine levels are LOW because of
dilution
Urine sodium and osmolality decreased (urine
becomes diluted)
CXR may show pulmonary congestion

Nursing Diagnosis
Fluid Volume excess

Implementation
ASSIST IN MEDICAL INTERVENTION
Administer diuretics as prescribed
Assist in hemodialysis
Provide dietary restriction of sodium and water

Implementation
NURSING MANAGEMENT
Continually assess the patients condition by
measuring intake and output, daily weight
monitoring, edema assessment and breath
sounds
Prevent Fluid Volume Excess by adhering to diet
prescription of low salt- foods.

Implementation
NURSING MANAGEMENT
Detect and Control Fluid Volume Excess by
closely monitoring IVF therapy, administering
medications, providing rest periods, placing in
semi-fowlers position for lung expansion and
providing frequent skin care for the edema
Teach patient about edema, ascites, and fluid
therapy. Advise elevation of the extremities,
restriction of fluids, necessity of paracentesis,
dialysis and diuretic therapy.
Instruct patient to avoid over-the-counter
medications without first checking with the

The ELECTROLYTES
Electrolytes are charged ions capable of

conducting electricity and are solutes in

all compartment
ANIONS are Negatively charged ions:
Bicarbonate, chloride, PO4CATIONS are positively charged ions:
Sodium, Potassium, magnesium, calcium

43

Helpful mnemonics
PI-SO
Potassium is inside
Phosphate is inside
Sodium is outside
Chloride is outside

44

Regulation of Electrolyte
Balance
1. Renal regulation
Occurs by the process of glomerular
filtration, tubular reabsorption and
tubular secretion
Urine formation
If there is little water in the body, it is

conserved
If there is water excess, it will be
eliminated

45

Regulation of
Electrolyte Balance

2. Endocrinal regulation
Hormones play a role in electrolyte
regulation
Aldosterone promotes Sodium
retention and Potassium excretion
Atrial Natriuretic Factor promotes
Sodium excretion
Parathormone promotes Calcium
retention and Phosphate excretion
Calcitonin promotes Calcium
excretion and Phosphate excretion

46

THE CATIONS
SODIUM
POTASSIUM
CALCIUM
MAGNESIUM

47

SODIUM

The MOST ABUNDANT cation in the ECF

Normal range is 135-145 mEq/L
Major contributor of plasma osmolarity

FUNCTIONS
1. participates in the Na-K pump
2. assists in maintaining blood volume
3. assists in nerve transmission and
muscle contraction
Aldosterone increases sodium
retention
ANF increases sodium excretion
48

IMBALANCE : DEFICIENCY
HYPONATREMIA
Na level is less than 135 mEq/L
Water is drawn into the cell cell swelling
Etiology: vomiting, diarrhea, NGT

suctioning, prolonged diuretic therapy,

excessive burns, excessive sweating,
dilutional (SIADH and water intoxication)
S/SX: nausea, VOMITING, anorexia,
cramps, CEREBRAL EDEMA 2o cellular
swelling (signs of ICP: headache, altered
mental status, muscle twitching, focal

49

IMBALANCE: EXCESS
HYPERNATREMIA
More than 145 mEq/L
Fluid moves out of cell
Etiology: sodium intake, IVF (hypertonic), water
loss (from watery diarrhea, fever and
hyperventilation), Diapedes insipidus, heat stroke,
dialysis malfunction
S/SX: THIRST, signs of DHN, neurologic
symptoms 2o to cellular dehydration
(restlessness, weakness, behavioral
changes, disorientation, delusions,
hallucinations, permanent brain damage)

50

POTASSIUM
MOST ABUNDANT cation in the ICF
Normal range is 3.5-5.3 mEq/L
Major electrolyte maintaining ICVF

balance
FUNCTIONS
1. maintains ICF Osmolality
2. nerve conduction and muscle
contraction
3. metabolism of carbohydrates, fats and
proteins
Aldosterone promotes renal excretion of
K+
Acidosis promotes exchange of K+ for H+
in the cell
51

IMBALANCE : DEFICIENCY
HYPOKALEMIA
K+ level less than 3.5 mEq/L
Etiology: use of diuretic (potassium-losing),
vomiting, suctioning, diarrhea, diaphoresis,
starvation, heart failure, ileostomy, insulin
therapy, alcoholism, hyperaldosteronism,
nephrotic syndrome, metabolic alkalosis
S/Sx: nausea, vomiting, anorexia, cramps,
nerve and muscle function (muscle
WEAKNESS, DYSRHYTHMIA, peristalsis,
paresthesia, increased sensitivity to digitalis)
ECG: flat or inverted T waves, presence of
U waves, prolonged PR interval

52

IMBALANCE : DEFICIENCY
HYPOKALEMIA
Provide oral or IV replacement of potassium
NEVER administer K by IV bolus or IM
Infuse parenteral potassium supplement. Always
dilute the K in the IVF solution and administer with
a pump. IVF with potassium should be given no
faster than 10-20-mEq/ hour and hook the patient
on a cardiac monitor
Watch out for digitalis toxicity (muscle weakness,
visual disturbances, diarrhea, arrhythmia, confusion
and delirium)
53

IMBALANCE: EXCESS
HYPERKALEMIA
K+ more than 5.3 mEq/L
Etiology: Iatrogenic (IVF with K+,
hyperalimentation and K+ replacement), renal
failure, acidosis, hypoaldosteronism and
addisons disease, severe trauma, transfusion of
old blood product, pseudo- (tight tourniquet,
hemolysis of blood sample)
S/Sx: nausea, diarrhea, ascending weakness,
intestinal colic, ventricular DYSRRYTHMIA,
CARDIAC ARREST
ECG: peaked T waves , shortened QT interval,
prolonged PR interval, disappearance of P wave,
54
wide QRS complex

IMBALANCE: EXCESS
HYPERKALEMIA
Monitor the cardiac status with cardiac
machine
Institute emergency therapy to lower potassium
level by:
Administering IV calcium gluconate- antagonizes

action of K on cardiac conduction

Administering Insulin with dextrose-causes
temporary shift of K into cells
Administering sodium bicarbonate-alkalinizes
plasma to cause temporary shift
Administer beta-agonist
Administering Kayexalate (cation-exchange resin)- 55

CALCIUM

Majority of calcium is in the bones and

teeth
Normal range 4.5-5.5 mEq/L (8.5-10
mg/dL)
FUNCTIONS
1. formation and mineralization of
bones/teeth
2. muscular contraction and relaxation
3. cardiac function
4. blood clotting
5. enzyme activation
56

CALCIUM

Regulation:
GIT absorbs Ca+ in the intestine with
the help of Vitamin D
Kidney Ca+ is filtered in the
glomerulus and reabsorbed in the
tubules
PTH increases Ca+ by bone
resorption, Ca+ retention and activation
of Vitamin D
Calcitonin released when Ca+ is high,
it decreases Ca+ by excretion in the
kidney

57

IMBALANCE : DEFICIENCY
HYPOCALCEMIA
Calcium level of less than 8.5 mg/dL
Etiology: removal of parathyroid gland
during thyroid surgery, Vit. D deficiency,
Furosemide, infusion of citrated blood,
diet, drugs (aminoglycosides, caffeine,
steroids), hyperphosphatemia
S/SX: neuromuscular
irritability/excitability : tingling
sensation, spasms, TETANY, (+)
Chovsteks (+) Trousseaus, seizures,
mental changes, impaired memory
ECG: prolonged QT interval

58

IMBALANCE: EXCESS
HYPERCALCEMIA
Serum calcium more than 10.5 mg/dL
Etiology: Overuse of calcium supplements,
excessive Vitamin D, malignancy, prolonged
immobilization, thiazide diuretic, renal
failure, hyparathyroidism
S/Sx: anorexia, nausea, vomiting, bone pain,
polyuria and thirst, ulcer-like symptoms,
neuromuscular depression (weakness,
constipation, mental changes, HYPOACTIVE
DTRs, coma, cardiac arrest), digitalis toxicity
ECG: Shortened QT interval
Meds: D5NSS (to dilute), IV phosphate, furosemide,

59

MAGNESIUM
Second to K+ in the ICF
Normal range is 1.3-2.1 mEq/L

FUNCTIONS
1. intracellular production and utilization
of ATP
2. protein and DNA synthesis
3. neuromuscular irritability
Very similar to calcium disturbances

60

IMBALANCE: EXCESS
HYPERMAGNESEMIA
Serum magnesium more than 2.1 mEq/L
Etiology: Renal failure, Mg medications
(antacids for ulcer, magnesium sulfate
for pre-eclampsia), untreated DM (severe
DHN in DKA)
S/SX: similar to hypercalcemia
(neuromuscular depression), DEPRESSED
DTRS, oliguria, RR
Meds: Ca gluconate, furosemide and
0.45% saline
61

THE ANIONS
CHLORIDE
PHOSPHATES
BICARBONATES

62

CHLORIDE

The MAJOR Anion in the ECF

Normal range is 95-108 mEq/L

FUNCTIONS
1. major component of gastric juice
aside from H+
2. together with Na+, regulates plasma
osmolality
3. participates in the chloride shift
4. acts as chemical buffer

63

PHOSPHATES

The MAJOR Anion in the ICF

Normal range is 2.5-4.5 mg/L

FUNCTIONS
1. component of bones
2. needed to generate ATP
3. components of DNA and RNA
PTH decreases PO4 in blood by
renal excretion
Calcitonin increases renal
excretion of PO4
64

BICARBONATES
Present both in ICF and ECF
Normal range- 22-26 mEq/L

FUNCTION
1. regulates acid-base balance
2. component of the bicarbonatecarbonic acid buffer system

65

ACID-BASE CONCEPTS
Acid- substance that can donate or release

hydrogen ions

Carbonic acid, Hydrochloric

acid

Base- substance that can accept hydrogen

ions

Bicarbonate
Buffer- substance that can accept or donate

hydrogen

Hemoglobin buffer
Bicarbonate : carbonic acid

66

Helpful Hints
Carbon dioxide is considered to be

ACID because of its relationship with

carbonic acid
pH measures the degree of acidity and
alkalinity. It is inversely related to
Hydrogen. Normal ph 7.35-7.45
Decreased pH- ACIDIC-increased
HydrogenpH below 7.35
Increased pH- ALKALOSIS-decreased
hydrogenpH above 7.45

67

remember
a high hydrogen acidic pH is low
a low hydrogen alkalosis pH is high
a high CO2may mean acidic
a low CO2 may mean alkalosis

68

Dynamics of Acid and bases

Acids and bases are constantly produced in

the body
They must be constantly regulated
CO2 and HCO3 are crucial in the balance
A ratio of 20:1 is maintained
(HCO3:H2CO3)
Respiratory and renal system are active in
regulation

69

Ways to balance the acids and

bases
Excretion
Acid can be excreted, and Hydrogen can
be excreted in ACIDOTIC condition
Bicarbonate can be excreted in
ALKALOTIC condition

70

Ways to balance the acids and

bases
Production
Bicarbonate can be produced in
ACIDOTIC condition
Hydrogen can be produced in ALKALOTIC
condition

71

Ways to balance the acids and

bases
Chemical buffers participate in
the balance of acid-base
1. Carbonic acid- bicarbonate
buffer
2. Phosphate buffer
3. protein buffer- ICF and
hemoglobin
The action is immediate but
very limited
72

Ways to balance the acids

and bases

The respiratory system

compensates for metabolic
problems
CO2 (acid) can be exhaled
from the body to normalize
the pH in ACIDOSIS
CO2 (acid) can be retained
in the body to normalize the
73

Ways to balance the acids and

bases
The kidney can compensate for problems in
the respiratory system
The Kidney reabsorbs and generates
Bicarbonate (alkaline) in ACIDOSIS
The Kidney can excrete H+ excess
(Acidosis) to normalize the pH in ACIDOSIS

74

Ways to balance the acids and

bases
The kidney can excrete bicarbonate

(alkali) in conditions of ALKALOSIS

The kidney can retain H+ (acid) in
conditions of ALKALOSIS

75

Normal Arterial Blood

Gas values
pH- 7.35 7.45
pO2- 80-100 mmHg
pCO2- 35 45 mmHg
HCO3- 22- 26 mEq/L
Base deficit/excess (+/-) 2
O2 saturation- 98-100 %

ABG Interpretation
1. The pH is the first value that you must
look at:
Normal 7.35-7.45
If pH is 7.46 and above ALKALOSIS is

the problem
If pH is 7.34 and below ACIDOSIS is the
problem

ABG Interpretation
2. Second, look at the pCO2
Normal is 35-45 mmHg
If more than 45 (46 and above) Carbon

Dioxide is retained in the body

respiratory problem
If less than 35 (34 and below) Carbon
dioxide is exhaled more outside of the
body respiratory problem

ABG Interpretation
3. Try to determine the relationship of the
pH and pCO2 to determine compatibility
and respiratory problem
If pH is less than 7.35 (ACIDOSIS) and

pCO2 is greater than 45, retained carbon

dioxide is causing the problem
RESPIRATORY ACIDOSIS
If ph is greater than 7.45 (ALKALOSIS)
and pCO2 is less than 35, excess
excretion or lack of carbon dioxide in the
body is causing the problem
RESPIRATORY ALKALOSIS

ABG Interpretation
4. Look at the HCO3 (Bicarbonate)
Normal is 22-26 mEq/L
If the HCO3 is less than 22, bicarbonate

is less or the level is lower than normal

METABOLIC problem
If HCO3 is more than 26, bicarbonate is
retained in the body more than the
normal level Metabolic problem

ABG Interpretation
5. Determine now the relationship of pH
and Bicarbonate with the use of base
excess
If pH is less than 7.35 (ACIDOSIS) and

Bicarbonate is less than 22 and the base

Excess is (-) 2 Meq/L, this low
bicarbonate is causing the problem
METABOLIC ACIDOSIS
If the pH is greater than 7.45
(ALKALOSIS) and bicarbonate is
more
than 26, and the base excess is (+) 2,
this high bicarbonate is causing the

ABG Interpretation
6. Determine the evidence of compensation
In respiratory acidosis, the kidneys will respond
by retaining or producing bicarbonate to
minimize the acidosis. Bicarbonate is expected to
be more than 26 if there is renal compensation
In respiratory alkalosis, the kidney will respond
by excreting bicarbonate to minimize alkalosis,
bicarbonate is expected to be below 22 if there is
renal compensation
In metabolic acidosis, the lungs respond by
blowing off carbon dioxide to minimize the
acidosis, thus pCO2 is expected to be below 35 if
there is respiratory compensation
In metabolic alkalosis, the lungs compensate by
retaining carbon dioxide to minimize the
alkalosis, thus pCO2 is expected to be more than
45 if there is respiratory compensation

ABG Interpretation
7. Compensated imbalances are present if
the pH becomes normal after the
compensatory mechanisms affect the
acid-base problem.

Acid-Base Imbalances
Metabolic acidosis: low pH, low HCO3,

low pCO2 (if lung compensation)

Metabolic alkalosis: high pH, high HCO3,
high pCO2 (if lung compensation)
Respiratory acidosis: low pH, high pCO2,
high HCO3 (if renal compensation)
Respiratory alkalosis: high pH, low pCO2,
low HCO3 (if renal compensation)

Metabolic Acidosis
Two forms exist: HIGH anion gap and NORMAL

anion gap acidosis

Anion Gap: Sodium (Chloride +
bicarbonate); normal 8-12 mEq/L
Low anion gap occurs in hypoproteinemia

Causes of Metabolic
Acidosis
High Anion Gap
Direct loss of bicarbonates- surgery, drains, severe
diarrhea
Use of diuretics
Excessive administration of chloride
Prolonged fasting
Normal Anion Gap
Excessive accumulation of fixed acids
Salicylic poisoning
Oliguric renal disease

Assessment Findings
Headache, confusion and drowsiness
Weakness, nausea and vomiting
Increased respiratory rate and depth
Diminished cardiac output, cold clammy skin
and hypotension
Laboratory results of ABG:

pH is below 7.35
Bicarbonate is Below 22 mEq/L
Hyperkalemia
Decreased pCO2

Implementation
Assist in the correction of the acidosis by

administering sodium bicarbonate in the IV

line
Assist in eliminating the source of chloride
Monitor ABG values
Monitor the level of K closely
Treat chronic metabolic acidosis by
administering calcium to avoid tetany, use of
alkalinizing agents and hemodialysis
Institute safety measures
Administer oxygen as prescribed

Metabolic Alkalosis
Most common causes are:
Vomiting
Gastric suctioning
Loss of potassium
Diuretic therapy
Hyperaldosteronism
Excessive alkali ingestion

Assessment Findings
Tingling of fingers and toes; symptoms of

hypocalcemia
Hypokalemic symptoms
LABORATORY FINDINGS:
Decreased ionized calcium
pH of above 7.45
Bicarbonate of above 26 mEq/L
pCO2 is increased above 45 mmHg

Implementation
Assist in the correction of alkalosis by

supplying chloride
Restore blood volume
Administer K+ supplements
Administer carbonic anhydrase inhibitors

Respiratory Acidosis
This disorder may be due to inadequate

excretion of CARBON DIOXIDE

Causes: COPD, airway obstruction, CNS
depression, atelectasis, overdose of sedatives,
administration of O2 to COPD patients,
respiratory muscle paralysis

Respiratory Acidosis
ASSESSMENT
Increased HR and RR, increased BP
Mental cloudiness
Ventricular fibrillation
IMPLEMENTATION
Improve ventilation
Administer low flow O2 to COPD patients
Pulmonary hygiene or pulmonary toilet
Mechanical ventilation

Respiratory Alkalosis
Usually, this is attributed to

HYPERVENTILATION
Causes:
Anxiety
Hypoxemia
Early Aspirin poisoning
Septicemia
Inappropriate ventilator settings

Respiratory Alkalosis
ASSESSMENT
Lightheadedness due to vasoconstriction and
decreased cerebral blood flow!
Loss of mental concentration
Loss of consciousness
Tachycardia
IMPLEMENTATION
Assist the patient during the periods of anxiety
Utilize a paper bag for the patient to breath in a
closed system to recover the lost CO2
Administer sedatives
Treat any underlying cause

End of Fluids and

Electrolytes