Fluid & Electrolytes

Cheat Sheet KakaLea

Electrolyte Function HYPER “HIGH” Hypo “low”

HYPERkalemia (over 5.0) Hypokalemia (below 3.5)
Heart - TIGHT & CONTRACTED
1ST elevation and Peaked T waves HEART - LOW & SLOW
1 Flat T waves, ST depression, & prominent U wave
2 Severe = Vfib or Cardiac Standstill! MUSCULAR - LOW & SLOW
P - Potassium 3 Hypotension, Bradycardia
Potassium
1 Decreased DTR
P - Priority! Since it.. GI TRACT - TIGHT & CONTRACTED 2 Muscle cramping
1 Diarrhea 3 Flaccid paralysis (paralyzed limbs)
3.5 - 5.0 P - Pumps the heart
& muscles
2 Hyperactive bowel sounds
NEUROMUSCULAR GI - LOW & SLOW
Decreased motility, hypoactive to absent bowel
- TIGHT & CONTRACTED
Paralysis in Extremities sounds, Constipation
Increased DTR Abdominal distention
Profound Muscle Weakness, Paralytic ileus, paralyzed intestines!
(General Feeling of heaviness) *PRIORITY* for SB0 (small bowel obstruction)

HYPERnatremia (over 145) Hyponatermia (below 135)

S - Sodium HYPERNATREMIA = BIG & BLOATED HYPONATREMIA - DEPRESSED & DEFLATED
S - Swells the body 1. SKIN
Sodium to maintain:
FLUSH ‘’Red & Rosy’’
EDEMA ‘’waterbed skin’’
NEURO = Seizures & Coma
HEART = Tachycardia, & weak thready pulses

135 - 145 • Blood Pressure LOW GRADE FEVER RESPIRATORY ARREST

2. POLYDIPSIA EXCESS THIRST
• Blood Volume 3. LATE SERIOUS SIGN
• pH balance SWOLLEN dry tongue NCLEX TIP
GI = nausea & vomiting NCLEX TIP
INCREASED muscle tone NCLEX TIP

KakaLea Sodium’s sidekick HYPERchloremia (over 107) Hypochloremia (below 97) t

Chloride Maintains:
NEARLY SAME AS HIGH SODIUM NEARLY SAME AS LOW SODIUM
• Blood Pressure
97 - 107 • Blood Volume
NAUSEA & VOMITING
SWOLLEN DRY TONGUE
EXCESSIVE DIARRHEA,
VOMITING, SWEATING
• pH balance CONFUSION FEVER TEST TIP: ONLY DIFFERENCE

HYPERmagnesemia (over 2.1) Hypomagnesemia (below 1.3)

1. CARDIAC - CALM & QUIET 1. CARDIAC - BUCK WILD!

Heart block EKG: ST depression, T wave inversion
Prolonged PR intervals Torsades de pointes
Magnesium M - Magnesium
M - Mellows the
VITALS = bradycardia, hypotension
2. DEEP TENDON REFLEXES -
SEVERE = V fib
VITALS = Tachycardia

1.3 - 2.1 M - Muscles (relaxes) CALM & QUIET

Hyporeflexia - Decreased DTR
2. DEEP TENDON REFLEXES - BUCK WILD
Hyporeflexia - increased DTR
3. EYES - BUCK WILD
3. LUNGS - CALM & QUIET Abnormal eye movements (nystagmus)
Depressed shallow respirations 4. GI - BUCK WILD
3. GI - CALM & QUIET Diarhea
Hypoactive bowel sounds

HYPERcalcemia (over 10.5) Hypocalcemia (below 9.0)

SWOLLEN & SLOW - MOANS, GROANS T - Trousseau’s

Keeps the 3 Bs Strong
Calcium B - Bone
& STONES
1. CONSTIPATION
T - Twerking arm with BP cuff on
C - Chvostek’s
9.0 - 10.5 B - Blood
B - Beats (heart)
2. BONE PAIN
3. STONES Renal Calculi (kidney stones)
C - Cheek smile when touched
Diarrhea
4. DEEP TENDON REFLEXES
Decreased DTR
Circumoral tingling
Severe muscle weakness Weak bones

HYPERphosphatemia (over 4.5) Hypophosphatemia (below 3.0)

‘’LOW CALCIUM’’ BAJA CA+ Swollen & SLOW - MOAN,

1. TROUSSEAU’S SIGNS GROANS & STONES
Helps with bone & teeth 2. CHVOSTEK’S SIGNS
Phosphate formation.
Helps regulate calcium
3. DIARRHEA
4. WEAK Bs
1. CONSTIPATION
2. DECREASED DTR & SEVERE
3.0 - 4.5 Ca HIGH = Phosphate LOW Strong bones? -
WEAK! (fractures)
MUSCLE WEAKNESS
3. DECREASED HR, RR
Ca LOW = Phosphate HIGH 4. INCREASED BP
Strong blood clotting? -

KakaLea
WEAK! (risk for bleeding)
Strong heart beats? -
WEAK! (cardiac dysrhymias)

*Disclaimer: Values above are based on NCLEX standards, many books & hospitals will differ in their values.
 Cardiovascular
• Thready, increased pulse rate, decreased blood pressure and orthostatic
hypotension, flat neck and hand in veins in dependent positions, diminished

Fluid Volume peripheral pulses, decreased central venous pressure, dysrhythmias

Respiratory
Deficit • Increased rate and depth of respirations, dyspnea
Neuromuscular
• Decreased central nervous system activity, from lethargy to coma, fever,
“HypOvolemia” depending on the amount of fluid loss, skeletal muscle weakness
(Low fluid volume) Renal
• Decreased urine output
Integumentary
• Dry skin, poor turgor, tenting, dry mouth
Gastrointestinal
• Decreased motility and diminished bowel sounds, constipation, thirst,
decreased body weight
Serum Blood Lab Findings
25%
• Increased serum osmolality, increased hematocrit
• Increased blood urea nitrogen (BUN)
• Increased serum sodium level

KakaLea
• Increased urinary specific gravity
Memory Trick:
• If Osmolality is HIGH = Body is DRY
• If Specific gravity is HIGH = Body is DRY

KakaLea Cardiovascular
• Bouding, increased pulse rate, elevated blood pressure, distended neck
and hand veins, elevated central venous pressure, dysrhythmias

Fluid Volume Respiratory

• Increased respiratory rate (shallow respirations), dyspnea, moist crackles

Excess on auscultation
Neuromuscular
• Altered level of consciousness, headache, visual disturbances, skeletal
“Hypervolemia” muscle weakness, paresthesias
(High fluid volume) Renal & Urinary
• Increased urine output if kidneys cannot compensate
• Decreased urine output if kidney damage is the cause
Integumentary
• Pitting edema in independent areas, pale cool skin
Gastrointestinal
• Increased motility in gastrointestinal tract, diarrhea
• Increased body weight, liver enlargement, ascites
100%
Serum Blood Lab Findings
• Decreased serum osmolality, decreased hematocrit, decreased BUN level
• Decreased serum sodium level
• Decreased urine specific gravity
Memory Trick:

KakaLea
• If Osmolality is Low = Body is Liquidy
• If Specific gravity is Low = Body is Liquidy
 F&L Quick Notes: IV Solutions

Isotonic solutions
• Definition: when solutions on both sides of a selectively permeable membrane have
established equilibrium or are equal in concentration, they are isotonic.

• Human blood is isotonic thus very little osmosis occurs since isotonic solutions have
the same osmolality as body fluids & thus increase extracellular fluid volume.

Memory Trick:
• Iso-tonic Solutions
• I-so-Perfect (no fluid shift, “I’m so perfect” perfect balance)

• List of fluids:
• 0.9% sódio, chloride (normal saline)

KakaLea
• 5% dextrose in water (DWS)
• 5% dextrose in 0.225% saline (DSW/ 1/4 NS)
• Lactated Ringer’s (LR)

KakaLea
Hypotonic solutions
• Definition: when a solution contains a lower concentration of solute than another
more concentrated solution, then it is a hypotonic solution.

• These solutions have lower osmolality than body fluids.

• They cause the movement of water into cells by osmosis, swelling the cells like a BIG
fat hippo, and therefore should be administered slowly to prevent cellular edema

Memory Trick:
• HypO - tonic
• HippO - tonic = fluid swells the cell like a big hippo

• List of fluids:
• 0.45% sodium chloride (1/2 NS)
• 0.225% sodium chloride (1/4 NS)
• 0.33% sodium chloride (1.3 NS)

Hypertonic solutions
• Definition: when a solution contains a higher concentration of solutes than
another less concentrated solution, then it is a hypertonic solution.
• These solutions have higher osmolality than body fluids
• They cause the movement of water outside the cells by osmosis, making the
cells skinny like a hyper person.

Memory Trick: KakaLea

• Hyper - tonic
• Hyper person = very skinny cells like a hyper person is skinny

• List of fluids:
• 3% sodium chloride (3% NS)
• 5% sodium chloride (5% NS)
• 10% dextrose in water (D10W)
• 5% dextrose in 0.9% sodium chloride (D5W/NS)
• 5% dextrose in 0.45% sodium chloride (D5W/ 1/2 NS)
• 5% dextrose in Lactated Ringer’s (D5LR)