Republic of the Philippines

Bicol University
POLANGUI CAMPUS
NURSING DEPARTMENT
Polangui, Albay
www.bupolangui.com
Email: bupc.nursing@gmail.com

NCM106: Pharmacology
1st Semester, SY2022-2023

MAINTENANCE OF HEMEOSTASIS

HEMEOSTATIS:

 normal blood clotting in response to an injury

 your body can also have too much clotting, known as hypercoagulability.
That can cause many blood clots to form spontaneously and block normal blood flow.
When blood clots form inside your blood vessels, this is known as thrombosis.

Study Guide No. 1

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 Republic of the Philippines
Bicol University
POLANGUI CAMPUS
NURSING DEPARTMENT
Polangui, Albay
www.bupolangui.com
Email: bupc.nursing@gmail.com
==========================================================================

FLUID & ELECTROLYTE balance in necessary to maintain HEMEOSTASIS

 fluid and electrolyte balance is the foundation on which nurses make important decisions
concerning patient care
 for body to function normally – body cells must have fluid and electrolyte in the RIGHT
COMPARTMENTS and in the RIGHT AMOUNTS

Study Guide No. 1

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 Republic of the Philippines
Bicol University
POLANGUI CAMPUS
NURSING DEPARTMENT
Polangui, Albay
www.bupolangui.com
Email: bupc.nursing@gmail.com
===========================================================================

Principles in Homeostasis:
I. Anions and Cations must be balanced within each compartment and remain electrically neutral
II. Fluid compartment remain in osmotic equilibrium except for transient changes
Osmolality: number of particles dissolved in the serum primarily sodium, urea (blood urea nitrogen),
and glucose.
Fluid concentration are based on the osmolality of body fluids:
a. Iso-osmolar fluid: same weight proportion of particles (eq. sodium, glucose) and water
b. Hypo-osmolar fluid: contains fewer particles than water
c. Hyper-osmolar fluid: contains more particles than water

FLUID REPLACEMENT

General Considerations:

 Recommended water intake for a healthy adult is about 2300 to 2900 mL per day oral intake
accounts for 1200 to 1500 mL of urine daily
 Patients lose water through different routes: kidneys, skin, lungs, GI tract
 Daily water requirements differ according to the patient’s age, and medical problems

TYPES OF INTRAVENOUS SOLUTION

Study Guide No. 1

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 Republic of the Philippines
Bicol University
POLANGUI CAMPUS
NURSING DEPARTMENT
Polangui, Albay
www.bupolangui.com
Email: bupc.nursing@gmail.com

===========================================================================

Study Guide No. 1

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 Republic of the Philippines
Bicol University
POLANGUI CAMPUS
NURSING DEPARTMENT
Polangui, Albay
www.bupolangui.com
Email: bupc.nursing@gmail.com
==========================================================================

ELECTROLYTES

Potassium (K+): primary intracellular cation, and 98% of the body’s potassium is found within the cells

 Potassium moves in and out of the cells under the influence of the potassium-sodium pump

Function:

 Necessary for transmission and conduction of nerve impulses and for contraction of skeletal,
cardiac and smooth muscles
 Necessary for normal kidney function and for the enzyme action used to change
carbohydrates to energy (glycolysis) and amino acids to protein

Hypokalemia: (potassium deficit) – serum potassium concentration of less than 3.5 mEq/L

 Caused by excessive loss rather than deficient intake

 Earliest sign: muscle weakness
 Other early signs: fatigue, muscle weakness, anorexia, nausea, and vomiting
 Severe signs and symptoms: paresthesia, leg cramps, decreased bowel motility and paralytic
ileus, confusion, rhabdomyolysis, myoglobinuria, atrial and ventricular dysrhythmias, cardiac
arrest

Treatment: (potassium replacement)

Oral and Intravenous Potassium Preparations:

Potassium Acetate: IV administration – used for acute treatment of hypokalemia

Potassium Bicarbonate: oral dose and solution for injection – for potassium concentration less
than 4mg/dL; sodium phosphate for potassium serum concentration more than 4 mg/dL

Potassium Gluconate: elixir or tablet – dietary supplement used to maintain potassium balance

Potassium Chloride: liquid, powder, tablet, capsule, controlled-release microencapsulated tablet,

enteric-coated tablet, and effervescent table and parenteral use; used for treatment of hypokalemia
and to main acid-based balance

Hyperkalemia: serum potassium level above 5.0 mEq/L

Causes: excessive intake, impaired renal excretion, or a shift from intracellular to extracellular

Most common causes: renal failure and medication that interfere with potassium excretion

Effects of Drugs on Potassium Balance: potassium wasting diuretics are a major cause of hypokalemia

Two Categories of Diuretics:

1. potassium wasting: cause excretion of potassium and other electrolytes (sodium and chloride in
the urine

2. potassium sparing: cause retention of potassium, but sodium and chloride are excreted in the
urine

Sodium. Major cation; normal serum sodium level is 135-145 mEq/L

Functions:

- Plays major role in lfuid volum balance and is the primary determinant of plasma
oslolality.
Study Guide No. 1
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 Republic of the Philippines
Bicol University
POLANGUI CAMPUS
NURSING DEPARTMENT
Polangui, Albay
www.bupolangui.com
Email: bupc.nursing@gmail.com
===========================================================================

- Important for the maintenance of neuromuscular irritability and for conduction of

nerve impulses
- For neural and hormonal mediators, kidney maintains normal serum sodium
concentrations through renal tubular reabsorption
- Serum level reflects the ratio of sodium to water, not necessarily the loss or gain of
sodium

Hyponatremia. Caused by a loss of sodium-containing fluids, deficient intake or water gain

- Sodium loss. Can result to vomiting, diarrhea, nasogastric suctioning, burns,

wound drainage, trauma, renal failure, nasogastric suctioning, burns, wound
drainage, trauma, renal failure, heart failure, third spacing, syndrome or
inappropriate anti-diuretic home (SIADH), excessive hypertonic IVF, surgery, and
thiazide diuretics
- Hyponatremia may occur with hypovolemia and hypervolemia, and thirst is usually
the first symptom of sodium deficit

Signs and Symptoms: (first symptom of sodium deficit)

- Muscle weakness
- Decreased deep tendon reflexes
- Headaches
- Lethargy
- Confusion
- Seizures
- Coma
- Abdominal cramps
- Nausea and vomiting
- Tachycardia and hypotension
- Pale skin
- Dry mucus membrane

Signs of Hyponatremia (associated with decreased ECP (Hypovolemia)

- Tachycardia
- Weak, thread pulse
- Decreased blood pressure progressing to orthostatic hypotension

Hypernatremia: sodium gain, sodium retention, or water loss

Causes:

- Excessive oral sodium intake

- Deficient water intake
- Hypertonic
- Tube feedings
- Hypertonic IVF
- Hyperaldosteronism
- Cushing syndrome
- Corticosteroid use
- Acute kidney failure

Study Guide No. 1

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 Republic of the Philippines
Bicol University
POLANGUI CAMPUS
NURSING DEPARTMENT
Polangui, Albay
www.bupolangui.com
Email: bupc.nursing@gmail.com
=======================================================================

Other Causes:

- Vomiting, diarrhea, burns, diabetes insipidus,

- Mineralocorticoid excess

Signs of Fluid imbalance depends on the cause:

- Water loss presents with symptoms of fluid volume deficit (FVD) whereas sodium
gain presents with symptoms of fluid volume excess (FVE)

Signs and Symptoms of hypernatremia:

- Dry
- Sticky mucus membranes
- Flushed dry skin
- Agitation
- Elevated body temperature
- Rough edematous
- Dry tongue
- Nausea and vomiting
- Anorexia
- Tachycardia
- Hypertension
- Muscle twitching
- Hyperreflexia
- Seizures
- Coma

Calcium. Most abundant mineral in the body (40% of all body minerals and 2% of body weight

- Necessary for transmission of nerve impulses and normal contraction of skeletal and
heart muscles
- Regulation of the heart and blood pressure
- Hormone segregation
- Maintenance of muscle tone
- Formation of blood clots
- Total serum calcium range (8.6-10.2 mg/dL)

Function of Calcium:
- Promotes normal nerve and muscle contraction and plays a role in cardiac excitability
- Cations maintains normal permeability and promotes blood clotting by converting
prothrombin into thrombin
- Needed in the formation of bone and teeth

Hypocalcemia. Inadequate calcium intake causes calcium to leave bone to maintain a normal
serum calcium level

- Calcium loss from bones (bone demineralization) , pathologic fractures may occur if
calcium deficit persist
Common Causes:
- Hypocalcemia include hyperphosphatemia
- Acute pancreatitis
- Widespread bony metastases

Study Guide No. 1

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 Republic of the Philippines
Bicol University
POLANGUI CAMPUS
NURSING DEPARTMENT
Polangui, Albay
www.bupolangui.com
Email: bupc.nursing@gmail.com
===========================================================================

- Hypoparathyroidism
- Alkalosis
- Diarrhea
- Alcoholism
- Malnutrition
- Use of loop diuretics
- Vitamin D deficiency
- Multiple blood transfusions

Signs and Symptoms of Hypocalcemia:

- Reflect calcium’s role in nerve transmission and heart and muscle function
- Neurologic and neuromuscular symptoms: anxiety, irritability and tetany; twitching;
hyperactive deep tendon reflexes; spasms of hands, wrist, feet and ankles; spasmodic
contractions; laryngeal spasm; seizures
- Cardiovascular manifestations: decreased cardiac output, dysrhythmias, ECG
changes

Hypercalcemia. Elevated serum calcium may be a result of hyperparathyroidism,

malignancy, hypophossphatemia, excessive calcium intake, prolonged immobilization,
multiple fractures, drugs such as thiazide diuretics and steroid.

Signs and Symptoms:

- Fatigue
- Muscle weakness
- Depressed deep tendon reflexes
- Confusion
- Impaired memory
- Anorexia
- Nausea
- Vomiting
- Constipation
- Kidney stones of calcium composition
- Patient may experience ECG changes and exhibit decreased heart rate and
dysrhythmias

Effects of drugs on calcium balance

- Phosphate preparations, corticosteroids, look diuretics, aspirin, anti-convulsants,

magnesium sulfate and plicamycin (antineoplastic antibiotic) – can lower serum
calcium levels
- Excess calcium salt ingestions or infusion and thiazide diuretics can all contribute to
an increase serum calcium level

Chloride. Principal anion of extracellular fluid (ECF).

- Chloride ion is a major contributor to acid-base balance, gastric juice acidity and
osmolality of extracellular fluid (ECF)
- Normal serum chloride (96-106 mEq/L

Phosphorous. Primary anion in intracellular fluid (ICF) and is the second most abundant
element in the body

Study Guide No. 1

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 Republic of the Philippines
Bicol University
POLANGUI CAMPUS
NURSING DEPARTMENT
Polangui, Albay
www.bupolangui.com
Email: bupc.nursing@gmail.com
==========================================================================

- Majority of the body’s phosphorous is found as phosphate – two terms are used
interchangeably
- Both phosphorus and calcium levels are regulated by parathyroid (PTH) and need
vitamin D for absorption from the GI tract
- Normal serum phosphorus level (2.4-4.4 mEq/L)

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Instructions:

In your own notebook, make your own study notes/guide on the topic discussed earlier Maintenance
of Homeostasis (Fluid and Electrolytes). You can use your textbooks as reference for more information.

In connection with this, make a presentation in a table of the respective medications/treatment

recommended for the following:

1. Fluid replacements
Different types of intravenous fluids
Solutions Indications Nursing
(Type of IVF) Considerations/ Side Effect Adverse Effects
Management

2. Electrolytes
a. Hypokalemia
b. Hyperkalemia
c. Hyponatremia
d. Hypernatremia
e. Hypocalcemia
f. Hypercalcemia

Name of Drug
Generic Name Brand Name Indications Nursing Side Effects Adverse Effects
Preparation & considerations/
Management

This should be handwritten in your own notebook to be submitted Nov. 8, 2022 after the class.

Study Guide No. 1

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 Republic of the Philippines
Bicol University
POLANGUI CAMPUS
NURSING DEPARTMENT
Polangui, Albay
www.bupolangui.com
Email: bupc.nursing@gmail.com

Study Guide No. 1

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