ELECTROLYTES & ACID-BASE BALANCE
Electrolytes
●Trousseau Sign: Hypocalcemia; hand arches when BP cuff is inflated
●Levels:
○Phosphate: 3 - 4.5 mEq/L
■Sickle cell anemia causes increased P levels
○Chloride: 98–106 mEq/L
○Calcium (total): 9.0–10.5 mg/dL
○Calcium (ionized): 4.5–5.6 mg/dL
■Hypercalcemia can cause HTN
○Magnesium: 1.3–2.1 mEq/L
○Potassium: 3.5–5.0 mEq/L
○Sodium: 135–145 mEq/L
■Hypernatremia PTs need to be monitored for seizures, especially
those having a drastic drop in Na
Acid-Base Balance
●Normal Arterial Blood Gas Values:
○pH: 7.35 - 7.45
○PaCO2: 35 - 45
○Bicarbonate: 22 - 26
○PaO2: 80 - 100
○SaO2: >95%
,●Compensated vs Uncompensated:
○Uncompensated: Ph is abnormal & one system (i.e. HCO3 or PaCO2 is
abnormal)
○Partially compensated: Both PH & both systems are abnormal
○Fully compensated: Ph is normal & both systems are abnormal
●Causes of Acidosis vs Alkalosis:
○Respiratory acidosis causes:
■Atelectasis
■COPD
●When COPD PT retains co2, they will experience ↓
respirations due to inhibited respiratory drive
■Pneumonia
■Pulmonary edema
■Sedative overdose
○Respiratory alkalosis causes:
■Fever
■Liver failure
■Pulmonary embolism
■Brain injury
■Aspirin poisoning
○Metabolic acidosis causes:
■Diabetic ketoacidosis
■Diarrhea
■Renal failure
■Shock
■Starvation
○Metabolic alkalosis causes:
■Diuretic therapy
■Hypokalemia
■NG suctioning
■Vomiting
, ●Symptoms of Acidosis vs Alkalosis:
○Acidosis:
■CNS depression.
■Headache
■Lethargy
■Weakness
■Confusion
■Coma
■Hypotension
■Hyponatremia
■Seizures
■Warm, flushed skin
■Eventual coma and death
○Alkalosis:
■Hypocalcemia
■Tachycardia
■Irritability
■Seizures
■Epigastric pain
■Tetany/numbness
■CNS excitability (tingling of fingers and tetany)
IV FLUIDS
●IV Solutions:
○Isotonic:
■Same concentration as blood
■Treats hypovolemia, hemorrhage, hypotension, diarrhea, vomiting
■D5W, 0.95 NS, LR
○Hypotonic:
■Less concentrated than blood
■Treats dehydration & hypernatremia
■0.33% NS (⅓ NS), 0.45% NS
, ○Hypertonic:
■Greater concentration than blood
■Used to replace electrolytes & treat shock
■Treats hyponatremia & head injuries
■Often given through central line
■D10W, D50W, D5NS, D5 ½ NS
●Needle Gauges:
○14, 16, 18: Trauma, surgery, blood transfusions
○20: Continuous infusions
○22: Children & elderly patients
○24: Fragile veins
○Butterfly needles are for short-term use
●Avoid:
○On side of mastectomy (use leg if bilateral mastectomy)
○Avoid using foot due to r/o infection
○Fistula or graft (rushing sound is heard when palpating)
○Deficient side due to stroke
○Be cautious administering dextrose in COPD PT as it is metabolized
into CO2
●Tubing should be changed every 72 - 96 hours, fluid should be changed
every 24 hours
●Piggyback solution should be hung HIGHER than the primary bag
○When accessing port, use secondary port that is closest to PT
Electrolytes
●Trousseau Sign: Hypocalcemia; hand arches when BP cuff is inflated
●Levels:
○Phosphate: 3 - 4.5 mEq/L
■Sickle cell anemia causes increased P levels
○Chloride: 98–106 mEq/L
○Calcium (total): 9.0–10.5 mg/dL
○Calcium (ionized): 4.5–5.6 mg/dL
■Hypercalcemia can cause HTN
○Magnesium: 1.3–2.1 mEq/L
○Potassium: 3.5–5.0 mEq/L
○Sodium: 135–145 mEq/L
■Hypernatremia PTs need to be monitored for seizures, especially
those having a drastic drop in Na
Acid-Base Balance
●Normal Arterial Blood Gas Values:
○pH: 7.35 - 7.45
○PaCO2: 35 - 45
○Bicarbonate: 22 - 26
○PaO2: 80 - 100
○SaO2: >95%
,●Compensated vs Uncompensated:
○Uncompensated: Ph is abnormal & one system (i.e. HCO3 or PaCO2 is
abnormal)
○Partially compensated: Both PH & both systems are abnormal
○Fully compensated: Ph is normal & both systems are abnormal
●Causes of Acidosis vs Alkalosis:
○Respiratory acidosis causes:
■Atelectasis
■COPD
●When COPD PT retains co2, they will experience ↓
respirations due to inhibited respiratory drive
■Pneumonia
■Pulmonary edema
■Sedative overdose
○Respiratory alkalosis causes:
■Fever
■Liver failure
■Pulmonary embolism
■Brain injury
■Aspirin poisoning
○Metabolic acidosis causes:
■Diabetic ketoacidosis
■Diarrhea
■Renal failure
■Shock
■Starvation
○Metabolic alkalosis causes:
■Diuretic therapy
■Hypokalemia
■NG suctioning
■Vomiting
, ●Symptoms of Acidosis vs Alkalosis:
○Acidosis:
■CNS depression.
■Headache
■Lethargy
■Weakness
■Confusion
■Coma
■Hypotension
■Hyponatremia
■Seizures
■Warm, flushed skin
■Eventual coma and death
○Alkalosis:
■Hypocalcemia
■Tachycardia
■Irritability
■Seizures
■Epigastric pain
■Tetany/numbness
■CNS excitability (tingling of fingers and tetany)
IV FLUIDS
●IV Solutions:
○Isotonic:
■Same concentration as blood
■Treats hypovolemia, hemorrhage, hypotension, diarrhea, vomiting
■D5W, 0.95 NS, LR
○Hypotonic:
■Less concentrated than blood
■Treats dehydration & hypernatremia
■0.33% NS (⅓ NS), 0.45% NS
, ○Hypertonic:
■Greater concentration than blood
■Used to replace electrolytes & treat shock
■Treats hyponatremia & head injuries
■Often given through central line
■D10W, D50W, D5NS, D5 ½ NS
●Needle Gauges:
○14, 16, 18: Trauma, surgery, blood transfusions
○20: Continuous infusions
○22: Children & elderly patients
○24: Fragile veins
○Butterfly needles are for short-term use
●Avoid:
○On side of mastectomy (use leg if bilateral mastectomy)
○Avoid using foot due to r/o infection
○Fistula or graft (rushing sound is heard when palpating)
○Deficient side due to stroke
○Be cautious administering dextrose in COPD PT as it is metabolized
into CO2
●Tubing should be changed every 72 - 96 hours, fluid should be changed
every 24 hours
●Piggyback solution should be hung HIGHER than the primary bag
○When accessing port, use secondary port that is closest to PT
