NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*

MIDWIFERY*MEDTECH LET*PSYCHOMET*RESPIRATORY
THERAPY*CIVIL SERVICE*NAPOLCOM NCLEX*DHA*HAAD*
PROMETRIC* UK-CBT

HANDOUTS
GI HepatoBiliary
Prepared By: Prof: Orlan Balanon

FLUIDS AND ELECTROLYTES:

ISOTONIC
When the concentration of particles (solutes) in the IV fluid similar to that of
plasma
Do not enter the cells because no osmotic force exists to shift the Fluids

Example:
Plain solutions
D5Water: within a short time after administration

VOLUME EXPANDER
1st line solution to treat shock or any fluid deficit DKA and HHNK.

HYPOTONIC
Are more dilute solutions and have a lower osmolality than body fluids
Cause the movement of water into cells by osmosis.

Example:
Any Solution Less than 0.90 %
D5Water: dextrose is metabolized and the tonicity decreases

Use to treat cellular dehydration

Secondary solution to treat DKA and HHNK
 NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*
MIDWIFERY*MEDTECH LET*PSYCHOMET*RESPIRATORY
THERAPY*CIVIL SERVICE*NAPOLCOM NCLEX*DHA*HAAD*
PROMETRIC* UK-CBT

HYPERTONIC
Are more concentrated solutions and have a higher osmolality than body
fluids
Cause movement of water from cells into the extracellular fluid by osmosis

Example:
5, D10, D50, Solutions
(except D5Water)
D5LR, D10Water, D50Water

VOLUME EXPANDER
Use to treat edema accompanied by diuretics.
Maintenance solution to treat shock
Contraindicated with DKA and HHNK

FLUID VOLUME DEFICIT FLUID IMBALANCE FLUID VOLUME EXCESS

(HYPOVOLEMIA) (HYPERVOLEMIA)
Vomiting, Excess Sweating, CAUSES Congestive heart failure, liver
Diarrhea, burns, diuretic use, failure, kidney failure, fluid
high fever, shock shifting.
MANIFESTATION

_____________ Fontanels _____________

_____________Eyeballs _________Intracranial
_____________ LOC Pressure
_____________ Neck Veins _____________
_______Cardiac Output _____________
_________Urine Output ______________Heart
_____________ GIT ______________Lungs
_____________ BUN _____________
_____________ Creatinine _____________
_____________ Weight _____________
_____________ BP _____________
_____________ Temperature _____________
_____________ HR _____________
_____________ RR _____________
_____________ Pulse pressure _____________
_____________ CVP _____________
_____________ hematocrit _____________
_____________
_________________Edema
(UKCBT: oedema)
 NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*
MIDWIFERY*MEDTECH LET*PSYCHOMET*RESPIRATORY
THERAPY*CIVIL SERVICE*NAPOLCOM NCLEX*DHA*HAAD*
PROMETRIC* UK-CBT

Intravenous MANAGEMENT Limit

Fluids:____________ fluids____________________
Increase OFI (If applicable) Goal: (+) Fluid Balance Limit Sodium Intake
Monitor I & O _____________
_____________ Monitor I &
Weight Patient o__________________
_____________ Weight patient
________________
Drug:__________________
_________________

HYPONATREMIA ELECTROLYTE IMBALANCE HYPERNATREMIA

< 135 mEq/ L 135 to 145 mEq/ L > 145 mEq/ L
Hypovolemic: Excessive CAUSES Hypovolemic: Hypotonic
diaphoresis, Diuretics, Vomiting Water loss (Diarrhea, NG
, Diarrhea, Wound drainage, secretions, excessive sweating,
especially gastrointestinal, Osmotic Diuresis, Loop Diuretic
Addison disease Euvolemic: Renal Loss (DI)
Euvolemic: SIADH Diabetes Insipidus, Extra Renal
(Syndrome of inappropriate Loss (insensible Losses,
antidiuretic hormone Respiratory, skin)
Secretion) Hypervolemic: Sodium Gain
Hypervolemic: Heart Failure, (Primary Aldosteronism,
Cirrhosis, Nephrotic Syndrome Sodium Bicarbonate infusion,
Cushing’s syndrome salt
tablets.
SIADH MANIFESTATION DI

_____________ Fluid _____________

_____________ Weight _____________
_____________ Urine _____________
_____________ Urine Specific Gravity _____________
_____________ Hemo _____________

1. Demeclocycline MANAGEMENT 1. Desmopressin

2. Diuretics (for SIADH) 2. IVF Isotonic
3. Monitor Weight 3. Monitor Weight
___________ ___________
4. Monitor I&O 4. Monitor I&O
______________ ______________

HYPOKALEMIA ELECTROLYTE IMBALANCE HYPERKALEMIA

< 3.5 mEq/L 3.5 to 5.1 mEq/L > 5.1 mEq/L
 NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*
MIDWIFERY*MEDTECH LET*PSYCHOMET*RESPIRATORY
THERAPY*CIVIL SERVICE*NAPOLCOM NCLEX*DHA*HAAD*
PROMETRIC* UK-CBT

Chronic Kidney Disease, CAUSES ACE Inhibitors (-Pril),

Diarrhea, Excessive Sweating, Angiotensin II Receptor
excessive laxative. K-wasting Blocker/ARBs (-sartan),
diuretics (F-B-Ma-D) excessive K supplements,
K-sparing diuretic (S-E-A-T)
F-
B- S-
Ma - E-
D A-
T-
MANIFESTATION

_____________ Impulses _____________

_____________ CNS _____________
_____________ ECG _____________
_____________ T Wave _____________
____________Wave __________PR Interval
_____________ ST Segment _____________
_____________ GIT _____________
_____________ Muscle _____________

PUSH PULL EFFECT

OF POTASSIUM
ON ECG

MANAGEMENT
1. KCL (Kalume Durule) 1. Kayexalate
2. Give K+ Rich Foods 2. IV Glucose + Insuline

AVOID: AVOID:
___________________ ___________________
AVOID:___________________
AVOID:___________________ _
_ AVOID:___________________
_

HYPOCALCEMIA ELECTROLYTE IMBALANCE HYPERCALCEMIA

< 4.5 mEq/L 4.5 - 5.5 mEq/L > 5.5 mEq/L
< 8.5 mg/dl 8.5 - 10.5 mg/dl > 10.5 mg/dl
Hypoparathyroidism, deficiency CAUSES Hyperparathyroidism, Cancer
of Vitamin D, Pancreatitis due
to lipolysis
 NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*
MIDWIFERY*MEDTECH LET*PSYCHOMET*RESPIRATORY
THERAPY*CIVIL SERVICE*NAPOLCOM NCLEX*DHA*HAAD*
PROMETRIC* UK-CBT

MANIFESTATIONS

Impulses / Neuromascular
_____________ excitability _____________
_____________ Muscle _____________
ECG ECG
1. Prolonged ST 1. Shortened ST
2. Prolonged QT 2. Widened T wave

SIGNS: SIGNS AND SYMPTOMS

1. CHVOSTEK
__________BONES
__________STONES
__________GROANS

2. TROUSSEAU

MANAGEMENT

HYPOMAGNESEMIA ELECTROLYTE IMBALANCE HYPERMAGNESEMIA

< 1.5 mEq/L 1.5 to 2.5 mEq/ L > 2.5 mEq/L
Alcoholism, burns, chronic CAUSES Excessive intake of magnesium,
diarrhea, excessive urination magnesium sulfate, toxicity,
renal failure
MANIFESTATIONS

Impulses / Neuromascular
_____________ excitability _____________
 NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*
MIDWIFERY*MEDTECH LET*PSYCHOMET*RESPIRATORY
THERAPY*CIVIL SERVICE*NAPOLCOM NCLEX*DHA*HAAD*
PROMETRIC* UK-CBT

__________CNS __________D - eep tendon

________HEART Reflex
__________R - espiratory Rate
__________O - utput (Urine)
_____________ Muscle __________P - ressure (BP)
_____________

ECG: ECG:
1. Torsades de Pointes 1. Prolonged PR
2. Widen QRS

2. Tall T wave
3. Depressed ST
MANAGEMENT

HYPOPHOSPHATEMIA ELECTROLYTE IMBALANCE HYPERPHOSPHATEMIA

< 2.5 mg/dl 2.5 to 4.5 mg/dl > 4.5 mg/dl
An intracellular anion
Inhibits absorption of calcium. Calcium and phosphate are inversely proportional.
Causes: HYPERCALCEMIA Causes: HYPOCALCEMIA
MANIFESTATIONS

Impulses / Neuromascular
_____________ excitability _____________