FLUID

ELECTROLYTE
IMBALANCE IN
PEDIA
PRESENTED BY GROUP 3
 Meet The Group

VHERA KARIZZA
Group Leader ALMER ANDREA PAUNLYN Member
Member Member Member
 Introduction
* Water is the most plentiful
constituent of the human body
* Total body water varies
from age to age, being
highest in the youngest, with
the preterm baby having the
highest
* Total body water is divided
into ICF and ECF.
* In the fetus and the
newborn, ECF is larger than
the ICF
 WHAT IS FLUID
ELECTROLYTE
IMBALANCE ALL ABOUT?
Electrolyte imbalance can occur
if the body has too much or too
little water. Electrolytes are
minerals in the blood, tissues,
and elsewhere throughout the
body. Their name refers to the
fact that they have an
electrical charge.
 ELECTROLYTES ARE EXAMPLES OF
MINERALS THAT THE ELECTROLYTES IN THE
BODY NEEDS TO: HUMAN BODY INCLUDE:
· BALANCE WATER LEVELS · SODIUM
· MOVE NUTRIENTS INTO CELLS · POTASSIUM
· REMOVE WASTE PRODUCTS · CALCIUM
· ALLOW NERVES TO SEND · MAGNESIUM
SIGNALS · PHOSPHATE
· ENABLE MUSCLES TO RELAX · CHLORIDE
AND CONTRACT EFFECTIVELY · BICARBONATE
· MAINTAIN BRAIN AND HEART
FUNCTIONING
 CAUSES:
AN ELECTROLYTE IMBALANCE IS CAUSED WHEN YOU LOSE A
LARGE AMOUNT OF BODY FLUIDS. FOR EXAMPLE, IF YOU ARE
SWEATING OR VOMITING TOO MUCH, IT CAN LOWER THE
LEVELS OF SOME ELECTROLYTES IN THE BODY.
IN FACT, WHEN YOU'RE SWEATING, YOU LOSE 2% TO 6% OF
YOUR BODY WEIGHT. IF YOU DO NOT HYDRATE
SUFFICIENTLY, SWEATING CAN LOWER ELECTROLYTE
CONCENTRATION.
HERE ARE SOME OTHER CAUSES OF AN ELECTROLYTE
IMBALANCE:
· NOT EATING AND DRINKING ENOUGH
· CHRONIC RESPIRATORY DISEASES
· METABOLIC ALKALOSIS, A CONDITION IN WHICH YOUR
BLOOD PH IS HIGHER THAN NORMAL
· MEDICATIONS, SUCH AS LAXATIVES AND STEROIDS
 IN INFANTS
Compared with adults, infants have a Symptoms of electrolyte
higher risk of dehydration due to their imbalances in infants include:
smaller size and faster metabolism of · dark urine
fluids and electrolytes. · confusion
If an infant sweats excessively or gets · weakness
sick with severe vomiting or diarrhea, · cramping
they may develop an electrolyte · muscle spasms
imbalance that requires medical · dizziness
attention. Other risk factors include · difficulty breathing
having a high fever and taking · rapid heart rate
medications that increase urination.
An infant with an underlying health
condition — such as thyroid, heart, or
kidney disease — may be at a higher
risk of an electrolyte imbalance.
 LABORATORY
TESTS:
BLOOD AND URINE TESTS ARE USED TO CONFIRM AN
ELECTROLYTE IMBALANCE AND DETERMINE ITS SEVERITY.
DEPENDING ON HOW ILL YOUR INFANT/CHILD IS, THESE TESTS
CAN BE PERFORMED USING BLOOD AND URINE SAMPLES TAKEN
IN THE DOCTOR’S OFFICE OR THE HOSPITAL. LABORATORY
RESULTS ARE USUALLY AVAILABLE QUICKLY.
DEHYDRATION

PRESENTED BY GROUP 3
 Introduction
Dehydration is a condition
that can occur with excess
loss of water and other body
fluids. Dehydration results
from decreased intake,
increased output ( renal,
gastrointestinal or insensible
losses), or capillary leak fluid
( e.g. burns and sepsis)
 CAUSES:

COMMON CAUSES:
GASTROENTERITIS (MOST COMMON)
NAUSEA
VOMITING
DIARRHEA
DIABETIC KETOACIDOSIS
EXTENSIVE BURNS
 ASSESSMENT:

CLININAL ASSESSMENT OF DEHYDRATION CAN BE DIFFICULT,

ESPECIALLY IN YOUNG INFANTS, AMD RARELY PREDICTS THE EXACT
DEGREE OF DEHYDRATION ACCURATELY.
THE MOST USEFUL INDIVIDUAL SIGNS FOR PREDICTING 5%
DEHYDRATION IN CHILDREN ARE AN ABNORMAL CAPILLARY REFILL
TIME, ABNORMAL SKIN TURGOR AND ABNORMAL RESPIRATORY
PATTERN.
COMBINATION OF EXAMINATION SIGNS PROVIDE A MUCH BETTER
METHOD THAN ANY INDIVIDUAL SIGNS IN ASSESSING THE DEGREE
OF DEHYDRATION
THE HISTORY AND LABORATORY TESTS PROVIDE ONLY MODEST
BENEFIT IN ASSESSING DEHYDRATION
 CLINICAL FEATURES OF MILD – MODERATE
DEHYDRATION; 2 OR MORE OF:
RESTLESSNESS OR
IRRITABILITY
SUNKEN EYES
THISRTY AND DRINKS
EAGERLY
 PINCH TEST ( SKIN TURGOR )
NORMAL- SKIN FOLD RETRACTS IMMEDIATELY
MILD OR MODERATE DEHYDRATION: SLOW; SKIN FOLD VISIBLE FOR LESS
THAN 2 SECONDS
SEVERE DEHYDRATION: VERY SLOW; SKIN FOLD VISIBLE FOR LONGER
THAN 2 SECONDS
OTHER FEATURED OF DEHYDRATION INCLUDES: DRY MUCOUS
MEMBRANES, REDUCED TEARS, AND DECREASED URINE OUTPUT
ADDITIONAL SIGNS OF SEVER DEHYDRATION: CIRCULATORY COLLAPSE (
E.G. WEAK RAPID PULSE, COOL OR BLUE EXTREMITIES, HYPOTENSION,
RAPID BREATHING, SUNKEN ANTERIOR FONTANELS)
 NURSING RESPONSIBILITIES
- ASSESSMENT
- ACCURATE 1& O - 1 G WET DIAPER WEIGHT = 1 ML URINE
- ORAL REHYDRATION MANAGEMENT
- PARENTERAL FLUID THERAPHY
HYPONATREMIA
(SODIUM)
PRESENTED BY GROUP 3
 Introduction
Hyponatremia is usually discovered on laboratory tests as
a lower than normal sodium level in the blood. It will
appear as sodium or Na+ in your lab results. Actually,
the main problem in the vast number of situations is too
much water that dilutes the Na+ value rather than too
much sodium. As a result, water moves into body cells,
causing them to swell. This swelling causes the major
problem, which is a change in mental status that can
progress to seizures or coma. Hyponatremia can result
from multiple diseases that often are affecting the lungs,
liver or brain, heart problems like congestive heart
failure, or medications. Most people recover fully with
their doctor’s help.
 SIGNS AND
SYMPTOMS
HYPONATREMIA SIGNS AND
SYMPTOMS MAY INCLUDE:
•NAUSEA AND VOMITING.
•HEADACHE.
•CONFUSION.
•LOSS OF ENERGY, DROWSINESS
AND FATIGUE.
•RESTLESSNESS AND IRRITABILITY.
•MUSCLE WEAKNESS, SPASMS OR
CRAMPS.
•SEIZURES.
•COMA.
 LAB FINDINGS
THERE ARE THREE ESSENTIAL LABORATORY TESTS IN THE EVALUATION OF
PATIENTS WITH HYPONATREMIA THAT, TOGETHER WITH THE HISTORY AND THE
PHYSICAL EXAMINATION, HELP TO ESTABLISH THE PRIMARY UNDERLYING
ETIOLOGIC MECHANISM: URINE OSMOLALITY, SERUM OSMOLALITY, AND URINARY
SODIUM CONCENTRATION.
MEDICAL AND NURSING INTERVENTIONS
1. STRICTLY MAINTAIN FLUID INTAKE AND OUTPUT OF PATIENT HOURLY.
2. CHECK WEIGHT EVERY DAY TO MONITOR THE FLUID VOLUME STATUS.
3. MONITOR AND OBSERVE SKIN TURGOR TO IDENTIFY DEHYDRATION AND
ACCURATELY RECORD THE STATE OF HYDRATION.
4. MONITOR VITAL SIGNS CAREFULLY AND NOTE RESPIRATORY RATE AND DEPTH TO
IDENTIFY PULMONARY EDEMA.
5. CHECK AND MONITOR THE HYPONATREMIA PATIENT FOR SIGNS OF EDEMA AND
HYPERTENSION.
HYPERNATREMIA
(SODIUM)
PRESENTED BY GROUP 3
 Introduction
Hypernatremia is the medical term to
describe too much sodium in your blood.
Sodium is one of the body’s electrolytes
— found mostly in your blood — that is
important for many bodily functions.
However, when there’s too much, it is
an imbalance in your body’s electrolytes
and can cause serious problems.
 SIGNS AND
SYMPTOMS
SYMPTOMS OF
HYPERNATREMIA INCLUDE:
•MUSCLE WEAKNESS
•RESTLESSNESS
•EXTREME THIRST
•CONFUSION
•LETHARGY
•IRRITABILITY
•SEIZURES
•UNCONSCIOUSNESS
 MEDICAL AND
NURSING
INTERVENTION
•RESTRICT SODIUM INTAKE! KNOW FOODS HIGH IN SALT SUCH AS BACON,
BUTTER, CANNED FOOD, CHEESE, HOT DOGS, LUNCH MEAT, PROCESSED FOOD,
AND TABLE SALT.
•KEEP PATIENT SAFE BECAUSE THEY WILL BE CONFUSED AND AGITATED.
•DOCTOR MAY ORDER TO GIVE ISOTONIC OR HYPOTONIC SOLUTIONS SUCH AS
0.45% NS (WHICH IS HYPOTONIC AND MOST COMMONLY USED). GIVE
HYPOTONIC FLUIDS SLOWLY BECAUSE BRAIN TISSUE IS AT RISK DUE TO THE
SHIFTING OF FLUIDS BACK INTO THE CELL (REMEMBER THE CELL IS
DEHYDRATED WITH HYPERNATREMIA) AND THE PATIENT IS AT RISK FOR
CEREBRAL EDEMA. IN OTHER WORDS, THE CELL CAN LYSE IF FLUIDS ARE
ADMINISTERED TOO QUICKLY.
•EDUCATE PATIENT AND FAMILY ABOUT SIGN AND SYMPTOMS OF HIGH
SODIUM LEVEL AND PROPER FOODS TO EAT.
HYPERKALEMIA
(POTASSIUM)
PRESENTED BY GROUP 3
 Introduction
HYPERKALEMIA is a medical problem in
which you have too much potassium in
your blood. It occurs when potassium
level in the blood is greater than
5.2mmol/L.
 SIGNS AND
SYMPTOMS
YOU MAY FEEL SOME MUSCLE WEAKNESS, NUMBNESS, TINGLING, NAUSEA, OR
OTHER UNUSUAL FEELINGS. IT USUALLY DEVELOPS SLOWLY OVER MANY WEEKS
OR MONTHS AND IS OFTEN MILD. IT CAN RECUR.
IF HYPERKALEMIA COMES ON SUDDENLY AND YOU HAVE VERY HIGH LEVELS OF
POTASSIUM, YOU MAY FEEL HEART PALPITATIONS, SHORTNESS OF BREATH,
CHEST PAIN, NAUSEA, OR VOMITING. SUDDEN OR SEVERE HYPERKALEMIA IS A
LIFE-THREATENING CONDITION. IT REQUIRES IMMEDIATE MEDICAL CARE.
 NURSING
MANAGEMENT
MONITOR INS AND OUTS
CHECK SERUM POTASSIUM LEVELS
FOLLOW ECG CLOSELY TO LOOK FOR PEAKED T WAVES
EDUCATE PATIENT ON HYPERKALEMIA
ADMINISTER DIURETICS AS ORDERED
ADMINISTER INSULIN TO LOWER POTASSIUM AS ORDERED
CHECK BLOOD GLUCOSE WHEN ADMINISTERING INSULIN
CHECK BUN AND CREATININE LEVELS
EDUCATE PATIENT ON A LOW POTASSIUM DIET
ENCOURAGE PATIENT TO FOLLOW CLOSELY WITH THE CLINICIAN
EDUCATE PATIENT ON RENAL DYSFUNCTION AND HYPERKALEMIA
ENSURE PATIENT IS ON NO MEDICATIONS THAT CAN CAUSE
HYPERKALEMIA OR RENAL DYSFUNCTION
HYPOKALEMIA
(POTASSIUM)
PRESENTED BY GROUP 3
 Introduction
HYPOKALEMIA refers to a lower than
normal potassium level in your
bloodstream. It occurs when potassium
falls below 3.6mmol/L.
 SIGNS AND
SYMPTOMS
-WEAKNESS
-FATIGUE
-MUSCLE CRAMPS OR TWITCHING
-CONSTIPATION
-ARRHYTHMIA (ABNORMAL HEART RHYTHMS)
HYPOKALEMIA CAN AFFECT YOUR KIDNEYS. YOU MAY HAVE TO GO TO THE
BATHROOM MORE OFTEN. YOU MAY ALSO FEEL THIRSTY.YOU MAY NOTICE MUSCLE
PROBLEMS DURING EXERCISE. IN SEVERE CASES, MUSCLE WEAKNESS CAN LEAD TO
PARALYSIS AND POSSIBLY RESPIRATORY FAILURE.
 NURSING
MANAGEMENT
-TO REPLACE POTASSIUM LOST BY THE BODY. THE RECOMMENDED DIETARY
REPLACEMENT FOR POTASSIUM IS 40 TO 60 MEQ/L/DAY.
-ADMINISTER A SLOW INTRAVENOUS POTASSIUM SOLUTION AS PRESCRIBED.
A SLOW INTRAVENOUS POTASSIUM SOLUTION IS GIVEN TO RAISE THE
POTASSIUM LEVEL IN THE BLOOD STREAM.
HYPERCALCEMIA
(CALCIUM)
PRESENTED BY GROUP 3
 Introduction
Hypercalcemia is a condition in which the
calcium level in your blood is above
normal. Too much calcium in your blood
can weaken your bones, create kidney
stones, and interfere with how your heart
and brain work.
 SIGNS AND
SYMPTOMS
ALTHOUGH HAVING SYMPTOMS OF HYPERCALCEMIA IS UNCOMMON,
SYMPTOMS CAN INCLUDE:
MORE FREQUENT URINATION AND THIRST
FATIGUE, BONE PAIN, HEADACHES
NAUSEA, VOMITING, CONSTIPATION, DECREASE IN APPETITE
FORGETFULNESS
LETHARGY, DEPRESSION, MEMORY LOSS OR IRRITABILITY
MUSCLE ACHES, WEAKNESS, CRAMPING AND/OR TWITCHES
 NURSING
INTERVENTIONS
MILD CASES OF HYPERCALCEMIA

KEEP PATIENT HYDRATED (DECREASE CHANCE OF RENAL STONE

FORMATION)
KEEP PATIENT SAFE FROM FALLS OR INJURY
MONITOR CARDIAC, GI, RENAL, NEURO STATUS
ASSESS FOR COMPLAINTS OF FLANK OR ABDOMINAL PAIN &
STRAIN URINE TO LOOK FOR STONE FORMATION
DECREASE CALCIUM RICH FOODS AND INTAKE OF CALCIUM-
PRESERVING DRUGS LIKE THIAZIDES, SUPPLEMENTS, VITAMIN D
HYPOCALCEMIA
CALCIUM
PRESENTED BY GROUP 3
 Introduction
Hypocalcemia is a condition in which
there are lower-than-average levels of
calcium in the liquid part of the blood, or
the plasma. Hypocalcemia is defined as a
total serum calcium concentration < 8.8
mg/dL (< 2.20 mmol/L) in the presence
of normal plasma protein concentrations.
 SIGNS AND
SYMPTOMS
EARLY-STAGE CALCIUM DEFICIENCY
MAY NOT CAUSE ANY SYMPTOMS.
HOWEVER, SYMPTOMS WILL DEVELOP
AS THE CONDITION PROGRESSES.
SEVERE SYMPTOMS OF
HYPOCALCEMIA INCLUDE:
CONFUSION
MUSCLE SPASMS
NUMBNESS AND TINGLING IN
THE HANDS, FEET, AND FACE
MUSCLE CRAMPS
WEAK AND BRITTLE NAILS
EASY FRACTURING OF THE BONES
 NURSING
INTERVENTION
ENCOURAGE THE PATIENT TO MEET THE DAILY RECOMMENDED INTAKE OF
DIETARY CALCIUM AND VITAMIN D
ADMINISTER CALCIUM SUPPLEMENTS AS PRESCRIBED
EDUCATE THE PATIENT ABOUT CALCIUM INJECTIONS AND ADMINISTER IF
PRESCRIBED
ASSIST THE PATIENT IN PERFORMING ACTIVITIES OF DAILY LIVING AS
REQUIRED
ENCOURAGE INTAKE FOODS IN HIGH CALCIUM
Thank You
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