Introduction
Sodium/Chloride

Serum Lab Values/Electrolytes

Yevette Harrell
588-3399

 References: Electrolyte Lectures

n    Corbett, J. (2000). Laboratory tests and diagnostic procedures with nursing diagnosis (5th ed.). New Jersey: Prentice Hall.
n      Guyton, A, & Hall, J (1996). Textbook of medical physiology (9th ed.). Philadelphia: WB Saunders.
n    Bennett, C. & Plum, F. (1996). Cecil textbook of medicine (20th ed.). WB Saunders: Philadelphia

Interpreting Serum Reports  

Fluid: Intake/Output

n    Intake
n   Output
n   Insensible Fluid Loss
n   Fluid Loss in Sweat
n   Water Loss in Feces
n   Water Loss by the Kidneys

Daily intake and output of H20

n    Intake

Ingested              2100
Metabolism          200
Total                  2300

n    Output

Insensible (skin)       350
Insensible (lungs)     350
Sweat                     100
Feces                      100
Urine                     1400
 Total                     2300

 Body Fluid Compartments

Extracellular Fluid
Intracellular Fluid
Interstitial Fluid

 Volume Depletion

Four Major Factors

  1. Magnitude of volume loss

  2. Rate of Loss

  3. Nature of fluid loss  - water? Na+water? Blood?

  4. Responsiveness of vasculature to volume depletion

Volume excess

Definition- Rate(amount) of salt or water exceeds rate of renal or extrarenal losses

Contributing factors for changes in Starling forces

Increased systemic venous pressure
R & L sided heart failure, portal hypertension, pulmonary hypertension, constrictive pericard.
Decreased plasma oncotic pressure
Combination

Sodium

FUNCTIONS

Active transport (Na pump)
Neuromuscular Activity
Enzymatic Reactions
Acid / Base Balance

Hyponatremia <135mEq/L
n    Hypotonic/Hyposomolar

CAUSES

n    Excess water in body in relation to Na+ loss

n    Increased production of ADH

Common conditions with Na+ loss

n    Renal failure (salt wasting)
n    Polyuria (DKA)
n    Vomiting/Diarrhea
n    NGT’s
n    Vigorous exercise

Symptoms

n    Lethargy
n    Weakness
n    Somnolence
n    Seizures
n    Coma
n    Death

Who is at risk??

Nursing goals

Hypernatremia >145mEq/L
Hypertonic/Hyperosmolar

n    Most common cause

DEHYDRATION
Decreased water balance in relation to sodium

Conditions that increase Na+concentration

n    Decreased thirst
n    Osmotic Diuresis
n    Excess Water Loss
n    Combination with Hypertonic solution administration

Symptoms

n    Somnolence
n    Confusion
n    Coma
n    Respiratory paralysis
n    Death

Who is at risk???

Nursing goals

Chloride 100-108 mEq/L

n    MOST frequently combined with Na+
n    Associated with changes with other electrolytes
n    Ingested with Na+

Chloride Functions

n    Body fluid osmolality (with Na)
n    Body water balance (with Na)
n    Acid-base balance
n    Acidity of body fluids

Hyperchloremia (rarely used term)

n    Related to increase in Na+
n    Related to decrease in HC03 levels

Hypochloremia

n    Relate to K+ loss
n    Related to HCO3 increase

Nursing goals

n    Relate Cl- rises and falls with other assessments

 

Anion gap

n    Unmeasured anions
n    Serum anion gap=10-12mEq/L
n   Albumin accounts for About half of the anion gap

Increase Serum Anion Gap   >12 mEq/L

n    Metabolic Acidosis
n    Exogenous
   Uremic acidosis, Lactic acidosis, Ketoacidosis
n    Endogenous
         Poisonings
      Salicylates, Paraldehyde, Methanol, Ethylene glycol

Decreased Anion Gap   <10 (8)mEq/L

n    Other disorders
n    Most common-- Hypoalbuminemia

Normal Anion Gap - Metabolic Acidosis

n    Renal Causes
n   Bicarbonate loss
n    GI causes
n   Diarrheal states
n   Small bowel drainage
n    Acidyfing Salts
n   Parental hyperalmentation