FLUID AND ELECTROLYTE IMBALANCE
Dehydration
Definition: Excessive loss of body fluids causing electrolyte imbalance.
Causes
- Diarrhea, vomiting, fever, excessive sweating, burns, inadequate fluid intake.
Signs and Symptoms
- Sunken fontanelle, dry mucous membranes, tachycardia, lethargy, decreased urine output, poor skin turgor.
Diagnostic Evaluation
- Serum Electrolytes (Na+, K+), Urine Specific Gravity, Blood Urea Nitrogen (BUN), Capillary Refill Test.
Medical Management
- Mild-Moderate: Oral Rehydration Therapy (ORS).
- Severe: IV fluids (Ringer’s lactate, Normal saline).
Nursing Management
- Monitor hydration status, vital signs, daily weight, strict I/O charting, administer fluids as prescribed.
Overhydration (Fluid Overload)
Definition: Excess retention of fluids leading to edema and circulatory overload.
Causes
- Congenital heart disease, renal failure, SIADH, excessive IV fluid administration.
Signs and Symptoms
- Peripheral/generalized edema, hypertension, bounding pulse, pulmonary congestion (dyspnea, crackles).
Diagnostic Evaluation
- Serum Electrolytes, Chest X-ray, BUN/Creatinine, Urine Output Monitoring.
Medical Management
- Fluid restriction, diuretics (furosemide), oxygen therapy (if pulmonary edema present).
Nursing Management
- Monitor weight, assess for edema, fluid balance charting, limit fluid intake, assess respiratory status.
Hyponatremia (Na+ <135 mEq/L)
Definition: Low serum sodium leading to cellular swelling.
Causes
- SIADH, excessive water intake, diarrhea, vomiting, renal disease.
Signs and Symptoms
- Lethargy, confusion, muscle weakness, seizures, coma.
Diagnostic Evaluation
- Serum Sodium, Urine Sodium and Osmolality.
Medical Management
- Fluid restriction, IV hypertonic saline (3% NaCl) if severe.
Nursing Management
- Monitor neurological status, assess fluid intake, educate parents on fluid regulation.
Hypernatremia (Na+ >145 mEq/L)
Definition: High serum sodium causing cellular dehydration.
Causes
- Inadequate water intake, diabetes insipidus, hypertonic IV fluids, excessive sweating.
Signs and Symptoms
- Intense thirst, restlessness, lethargy, seizures, dry mucosa.
Diagnostic Evaluation
- Serum Sodium, Urine Specific Gravity, Serum Osmolality.
Medical Management
- Gradual rehydration with hypotonic IV fluids (0.45% NaCl).
Nursing Management
- Monitor fluid status, prevent rapid correction to avoid cerebral edema, assess neurological function.
Hypokalemia (K+ <3.5 mEq/L)
Definition: Low serum potassium causing neuromuscular dysfunction.
Causes
- Vomiting, diarrhea, diuretics, metabolic alkalosis.
Signs and Symptoms
- Muscle weakness, arrhythmias (flattened T waves, U waves), ileus, fatigue.
Diagnostic Evaluation
Medical Management
- Oral/IV potassium supplementation (IV rate < 0.5-1 mEq/kg/hr).
Nursing Management
- Monitor cardiac rhythm, assess muscle strength, ensure proper potassium-rich diet.
Hyperkalemia (K+ >5.5 mEq/L)
Definition: High serum potassium causing cardiac instability.
Causes
- Renal failure, acidosis, tissue breakdown, potassium-sparing diuretics.
Signs and Symptoms
- Muscle weakness, arrhythmias (peaked T waves, widened QRS), bradycardia.
Diagnostic Evaluation
Medical Management
- Calcium gluconate (stabilize heart), insulin + glucose (shift K+ into cells), dialysis in severe cases.
Nursing Management
- Monitor ECG, assess muscle tone, administer prescribed medications carefully.
Hypocalcemia (Ca2+ <8.5 mg/dL)
Definition: Low calcium levels causing neuromuscular excitability.
Causes
- Vitamin D deficiency, hypoparathyroidism, neonatal hypocalcemia.
Signs and Symptoms
- Tetany (Chvostek’s and Trousseau’s signs), seizures, irritability, stridor.
Diagnostic Evaluation
- Serum Calcium, Serum Magnesium and Phosphorus, Parathyroid Hormone (PTH).
Medical Management
- IV calcium gluconate, oral calcium supplements, vitamin D therapy.
Nursing Management
- Monitor neuromuscular status, ensure adequate dietary calcium, seizure precautions.
Hypercalcemia (Ca2+ >10.5 mg/dL)
Definition: High serum calcium causing decreased neuromuscular excitability.
Causes
- Hyperparathyroidism, malignancy, excessive vitamin D intake.
Signs and Symptoms
- Constipation, nausea, confusion, muscle weakness, kidney stones.
Diagnostic Evaluation
- Serum Calcium, Parathyroid Hormone (PTH), Serum Phosphorus.
Medical Management
- IV fluids, diuretics, bisphosphonates.
Nursing Management
- Encourage hydration, monitor neurological status, assess for kidney stones.
Key Nursing Considerations for All Disorders
✅ Monitor vital signs, I/O charting, and daily weight.
✅ Assess hydration status and neurological function.
✅ Administer IV fluids/electrolytes as prescribed.
✅ Educate caregivers on dietary modifications and hydration needs.