i bc27f85be50b71b1 (238 page)

Table 11-1. Fluid and Electrolyte Imbalances

Imbalance

Definition

Contributing Factors

Clinical Manifestations

Diagnostic Test Findings

Hypovolemia

Fluid volume

Vomiting, diarrhea, fever,

Weak. rapid pulse;

Increased hematocrit, BUN,

deficit

blood loss, and uncon-

decreased BP; dizziness;

serum sodium levels

trolled diabetes mellitus

thirst; confusion; and

muscle cramps

Hypervolemia

Fluid volume

Renal failure. congestive

Shorrness of breath,

Decreased hematocrit,

>

�

excess

heart failure. blood

increased BP. bounding

BUN, and serum sodium

�

'"

Z

transfusions, and

pulse, and presence of

levels

"

prolonged corticosteroid

cough

x

therapy

�

Hyponatremia

Sodium deficit

Diuretic therapy, renal

Lethargy, nausea, apathy,

Decreased urine and serum

r

c:

;:;

(serum

disease, excessive

muscle cramps, muscular

sodium levels

>-

sodium level

sweating, hyperglycemia,

twitching, and confusion

z

"

of <135

NPO status. congestive

in severe states

'"

r

mEqniter)

heart failure, and SIADH

�

Hypernatremia

Sodium excess

Diabetes insipidus, diarrhea,

Elevated body tcmperaturc;

Increased serum sodium

'"

0

(serum

hyperventilation, and

lethargy or restlessness;

and decreased urine

r

::j

sodium level

excessive corricosteroid,

thirst; dry, flushed skin;

sodium levels

'"

01>145

sodium bicarbonate, or

weakness; irritability;

f<

�

mEqniter)

sodium chloride

tachycardia; hyper- or

>

administration

hypotension; oliguria;

�

z

and pulmonary edema

n

lii

"

'"

Vo

Table 0-1. Continued

�

'"

Imbalance

Definition

Conrribudng Factors

Clinical Manifestations

Diagnostic Test Findings

>

Ilypokalemia

Potassium defi-

Diarrhea, vomiting, chronic

Fatigue; muscle weakness;

ST depression or pro·

§

cit (serum

renal disease, gastric sue-

slow, weak pulse; ven-

longed PR interval on

�

'"

potassium

tion, polyuria, corrico-

[Ticular fibrillation; par-

ECG

m

level of

J:

d.5

steroid therapy, and

esrhesias; leg cramps;

>

mEqniter)

digoxin therapy

and decreased blood

S

pressure

8

Hyperkalemia

Potassium

Renal failure. Addison's dis-

Vague muscle weakness,

ST depression; rail, rented

"

�

excess (serum

ease, burns, use of potas-

nausea, initial tachycardia

T waves; or absent P

o

'"

potassium

sium-conserving diuretics,

followed by bradycardIa,

waves on ECG

Of

level of >5

and chronic heparin ther-

dysrhythmia, flaccid

V\

mEqniter)

apy

paralysis, paresthesia,

n

�

irritability, and anxiety

BP = blood pressure; BUN = blood urea nurogel1; ECG = elearocardiogram; NPQ = nothmg by mouth; SIADH = syndrome of mappropriate

�

amidluretlc hormone secretion.

�

Sources: Data from M Mulvey. Fluid and Electrolytes: Balance and Disorders. In SC Smeltzer, BG Bare (cds), Srunner and Suddanh's Textbook

�

of �1edical·Surgical Nursing (8th cd), Philadelphia: Lippincott, 1996;231; CC Goodman, TE Kelly Snyder. Problems Affecting Multiple Sys·

terns. In CC Goodman, WG Boissonnauh. Pathology: Implications for the PhYSical Therapist. Philadelphia: Saunders, 1998;72-82; and PJ Fall.

Hyponatremia and hypernatremia: a systemarit: approach to causes and their correction. Posrgrad l\ted 2000; I 07(5):75-82,