Disturbances of Fluid and Electrolyte Balance

Disturbances of Fluid and Electrolyte Balance
Mechanisms and Situations Manifestations Management and Nursing Care
Water Excess
Water intake in excess of output: Edema: Limit fluid intake.

 Excessive oral intake  Generalized Administer diuretics.
 Hypotonic fluid overload  Pulmonary (moist rales or crackles) Monitor vital signs.
 Plain water enemas  Intracutaneous (noted especially in Monitor neurologic signs as
Failure to excrete water in loose areolar tissue) necessary.
presence of normal intake: Elevated central venous pressure Determine and treat cause of water
 Kidney disease Hepatomegaly excess.
 Congestive heart failure Slow, bounding pulse Analyze serum electrolytes
Malnutrition Weight gain frequently.
Lethargy Implement seizure precautions.
Increased spinal fluid pressure
Central nervous system manifestations
(seizures, coma)
Laboratory findings:
 Low urine specific gravity
 Decreased serum electrolytes
 Decreased hematocrit
 Variable urine volume
Sodium Depletion
Prolonged low-sodium diet Associated with water loss: Determine and treat cause of sodium
Decreased sodium intake  Same as with water loss—dehydration, deficit.
Fever weakness, dizziness, nausea, Administer IV fluids with appropriate
Excess sweating abdominal cramps, apprehension saline concentration.
Increased water intake without  Mild—apathy, weakness, nausea, Monitor fluid intake and output.
electrolytes weak pulse
Tachypnea (infants)  Moderate—decreased blood pressure,
Cystic fibrosis (lethargy)
Burns and wounds
Vomiting, diarrhea, nasogastric Laboratory findings:
suction, fistulas  Sodium concentration <130 mEq/L
Adrenal insufficiency (may be normal if volume loss)
Renal disease  Urine specific gravity depends on
Diabetic ketoacidosis (DKA) water deficit or excess
Malnutrition
Sodium Excess
Sodium Excess (Hypernatremia) Intense thirst Determine and treat cause of sodium
High salt intake—enteral or IV Dry, sticky mucous membranes excess.
Renal disease Flushed skin Administer IV fluids as prescribed.
Fever Temperature possibly increased Measure fluid intake and output.
Insufficient breast milk intake in Hoarseness Monitor laboratory data.
neonate Oliguria Monitor neurologic status.
(dehydration Nausea and vomiting Ensure adequate intake of breast
hypernatremia) Possible progression to disorientation, milk and provide lactation
High insensible water loss: convulsions, muscle twitching, nuchal assistance with new mother-
 Increased temperature rigidity, lethargy at rest, baby pair before hospital
 Increased humidity hyperirritability when aroused discharge.
 Hyperventilation Laboratory findings:
 Diabetes insipidus  Serum sodium concentration ≤150
 Hyperglycemia mEq/L
 High plasma volume
 Alkalosis
Potassium Depletion
(Hypokalemia)
Muscle weakness, cramping, stiffness, paralysis, Determine and treat cause of
Starvation hyporeflexia potassium deficit.
Clinical conditions associated Hypotension Monitor vital signs, including ECG.
with poor food Cardiac arrhythmias, gallop rhythm Administer supplemental potassium.
intake Tachycardia or bradycardia Assess for
Malabsorption Ileus adequate renal output before
IV fluid without added potassium Apathy, drowsiness administration.
Gastrointestinal losses—diarrhea, Irritability For IV replacement, administer
vomiting, fistulas, Fatigue potassium slowly.
nasogastric suction Laboratory findings: Always monitor ECG for IV bolus
Diuresis  Decreased serum potassium potassium
Administration of diuretics concentration replacement.
Administration of corticosteroids ≥3.5 mEq/L For oral intake, offer high-potassium
Diuretic phase of nephrotic  Abnormal ECG—notched or flattened fluids and foods.
syndrome T waves, decreased ST segment, Evaluate acid-base status.
Healing stage of burns premature ventricular contractions
Potassium-losing nephritis
Hyperglycemic diuresis (e.g.,
diabetes mellitus)
Familial periodic paralysis
IV administration of insulin in
DKA
Alkalosis
Potassium Excess
(Hyperkalemia)
Muscle weakness, flaccid paralysis Determine and treat cause of
Renal disease Twitching potassium excess.
Renal failure Hyperreflexia Monitor vital signs, including ECG.
Adrenal insufficiency (Addison Bradycardia Administer exchange resin, if
disease) Ventricular fibrillation and cardiac arrest prescribed.
Associated with metabolic Oliguria Administer IV fluids as prescribed.
acidosis Apnea—respiratory arrest Administer IV insulin (if ordered) to
Too-rapid administration of IV Laboratory findings: facilitate movement of
potassium chloride  High serum potassium concentration potassium into cells.
Transfusion with old donor blood ≤5.5 mEq/L Monitor potassium levels.
Severe dehydration  Variable urine volume Evaluate acid-base status.
Crushing injuries  Flat P wave on ECG, peaked T waves,
Burns widened QRS complex, increased PR
Hemolysis interval
Dehydration
Potassium-sparing diuretics
Increased intake of potassium
(e.g., salt substitutes)
Calcium Depletion
(Hypocalcemia)
2
Neuromuscular irritability Determine and treat cause of
Inadequate dietary calcium Tingling of nose, ears, fingertips, toes calcium deficit.
Vitamin D deficiency Tetany Administer oral calcium supplements
Rapid transit through Laryngospasm as prescribed;
gastrointestinal tract Generalized convulsions administer IV slowly and
Advanced renal insufficiency May be changes in clotting diluted.
Administration of diuretics Positive Chvostek and Trousseau signs Monitor IV site; calcium may cause
Hypoparathyroidism Hypotension vascular irritation.
Alkalosis Cardiac arrest Monitor serum calcium, vitamin D,
Calcium trapped in diseased Laboratory findings: and parathyroid
tissues  Decreased serum calcium levels.
Increased serum protein concentration Monitor serum protein levels.
(albumin) (8.8-10.8 mEq/L) or increased serum Avoid cow’s milk in infants you
Cow’s milk—tetany of the protein levels
newborn (inappropriate  Prolonged QT interval
calcium/phosphorus ratio in
whole milk for newborn)
Exchange transfusion with
citrated blood
Inadequate parenteral
administration in diseased status
Calcium Excess (Hypercalcemia)
Acidosis Constipation Determine and treat cause of

Prolonged immobilization Weakness, fatigue calcium excess.
Conditions associated with Nausea, vomiting Monitor serum calcium levels.
increased bone Anorexia Monitor ECG.
catabolism Dry mouth (thirst)
Hypoproteinemia Muscle hypotonicity
Kidney disease Bradycardia or cardiac arrest
Hypervitaminosis D Increased calcium concentration in urine,
Hyperparathyroidism causing
Hyperthyroidism formation of kidney stones
Excessive IV or oral Laboratory findings:
administration  Increased serum calcium levels or
decreased
serum protein levels
 Prolonged QRS complex or PR interval,
shortened QT interval

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Disturbances of Fluid and Electrolyte Balance

Mechanisms and Situations Manifestations Management and Nursing Care

Water intake in excess of output: Edema: Limit fluid intake.

Calcium Excess (Hypercalcemia)

Acidosis Constipation Determine and treat cause of

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