Fluids and Electrolytes
Conduction system: The pace maker of the
heart is the SA node. The one that receives
the action potential, then travel to the AV
nodes, impluse will be received by the Right
and left bundle of His.
Waht is happening to the heart during
conduction system?
The atrium are already contructing
Atrioventricular valves will open- Tricuspid
and Mitral
Semilunar valve will close- Pulmonic and
Aortic
Valve: to flow blood in one direction
Atrial depolarization--giving blood to
ventricles; open for 0.5 seconds more or less
120cc blood
If atrium that are contructing, you will see
the P wave
Impulse will travel to AV node seen in the PR
interval; 0.3 seconds; trying to open the AV
valve for a longer time so more blood will be
filled in ventricles.
AV valve will close and Semilunar Valve will
open then, another ways:
QRS-- ventricles are contracting;
Ventricular depolarization/ contraction
What's happening?
Right ventricle contracting and pushing
unoxygenated blood towards the pulomic
valve entering the pulmonary artery that
goes to the lungs for oxygenation
- at the same time the left ventricle is also
contracting and pushing blood against the
aortic vavle so the oxygenated blood will be
distributed to the system/ body(QRS)
ST segment at the level of the PR
(significant)
Early ventricular repolarization/ relaxation
Then immediately followed by positive wave
T -- complete ventricular repolarization.
Pulmonic valve will open for 0.3 seconds
Complete cardiac cycle is .8 seconds
Na (Sodium)
main cation
Intravascular- inside the blood vessels
Intracellullar- inside the cells (40%)
extracellullar- (20%)
15% - 10.5 liters find in intertitial
compartment
5%- 5 litere intravascular (least amount of
h2o)
Fluid in the body 60%
How does the bodymaintain the fluid
normally?
1. Thirst mechanism
2. bleeding- hypothalamus alert the posterior
pituitary gland and order ADH- absorb by the
blood go to renal tubules and order to
reabsorb water and not make urine
3. Aldosterone from adrenal cortex (outside)
produce cortisol and aldosterone and
testosterone
Aldosterone will go to kidney to reabsorb
sodium
Adrenal medulla -will release cathecolamines
the Epinephrine and Norepinephrine
4. RAAS
Oliguria-- body's compensation when body is
loosing blood or hypovolemic shock
Na++function-- transmission and conduction
of the impulse
- help reserve extra fluid volume task
- control the fluid distribution in the body
- When combine with chloride and
bicarbonate will maintain the acid base
balance
Sodium- potassium pump
Major Cation- potassium in the cell 98%
Sodium is at interstitial
-Whenever sodium enters potassium has to
go out
- When potassium goes out of cell it will
immediately closes the sodium channel
- if
- ATP forces the potassium out of the cell
- this will maintain the sodium balance
-if K will not be sent out the doors of Na will
be open and plenty of Na will enter the cell
the effect is
- too much sodium will make the cells to
swell because sodium attract h2o
-to limit he fluid that will enter the cells so
the cells will not swell and will not rapture
* The calcium- phosphate exchange have
opposing effect same with sodium -
potassium
*Na+ is 40x greater outside (interstitial) than
inside
k+ is 35x bigger inside (intracellular)than
outside
Normal Na+ level-- 135-145 mEq/L
Osmosis-- Water moving from lesser to
greater concentrated solution
Diffusion-- Particles (gasses, electrolytes)
HYPONATREMIA-- LESS SODIUM
* When blood vessel (artery, vein)
Intravascular, contains more water and less
sodium
*fluid will move by osmosis from
extracellular into a more concentrated and
that is ICS (Intra Cellular Compartment)
-- Cell will cell--cerebral edema, increase ICP
Hypovolemia means less water
CAUSES:
1. GIT losses- Vomitting, diarrhea, GI surgery
2. Renal losses- prolong diuretic therapy
3. SIADH (symptoms of Anti diuretic
hormone)- hypersecretion of ADH
Plentry of ADH is being released
(reabsorb plenty of water) dilute sodium
- FAll
-Lung cancer
4. Altered cellular function- heart failure
like MI, cardiomyopathy(cant give out
adequate amount of blood)
Normal cardiac output- 5k to 8k L
Altered cellular when you destroyed the liver
like drinking too much alcohol
liver is responsible for the production of
albumin
how can heart failure can lead to
hyponatremia?
- the heart cant pump anymore then there
will be plenty of fluid to lung peritoneal
cavity that will dilute the sodium
tx: remove the excess fluid-- diuretics
diuretics will flush the Na also that leads to
hyponatremia
- Liver chirrosis (production of albumin-
plasma protein)
5. Burns-- destroy blood vessel- edema
6. Excessive diaphoresis
7. Fever- hyperventilate because of high
temp, lose Na via evaporation
above 1245 mEg/L - no signs and symptoms
- If the Na level drops to 110 mEq/L then the
brain cells will immediately be affected to
stupurous to commatose
Assessment:
Dry skin- went to third space
Crack lips, crack tongue
muscle twitching
muscle cramps
N/V- increase gastric motility
Increase cardiac rate
BP decreased
Siezures
Management:
hyponatremia associated with hypovolemia
- plenty of fluids in the body that diluted the
sodium (hF, SIADH, liver Cirrhsis)
1. REstrict the fluid intake
2.restrict Na in the diet
3. Hypovolemia- give isotonic (d5water and
PNSS) no movement of fluid
replacing fluid loss
* do not give hyper and hypo
Serum Na level below 110
- give high saline solution -- Hypertonic
causes the water to shift out of the cell--
High sodium food:
-instant soup
-use of bullion
-pickeled food
-soy souce
-gravy
-pizza
HYPERNATREMIA: Excess sodium in the
3rd space
remove the fluids from inside the cells out
thirst (hypothalamus) if the bodys defence in
hypernatremia
- Brain cells will shrink
-Unconscouis patient- then give osteorize
feeding which is hypertonic
 When there is metabolic acidosis, plenty of
- Confused elderly patient Hydregen ion (H+) in echange of hydregen
- Infant ion potassium will go out..hyperkalemia

cells become dehydrated esp to the brain Insulin makes the potassium goes to the cell
CAUSES: too- hyperkalemic
H- hypercorticolism (when body make too
much cortisol on its own) Medication:
I-ncresed intake of sodium Diuretics
G- GI feeding wthout adequate water
supplement CAUSES:
H- ypertonic solution -TPN, D10 water Hypokalemia
(plenty of glucose) Malnutrition- no albumin- edematous
S-odium excretion is decreased- (renal Vomiting, laxatice
failure) , Steroids - prednisone(reabsorb hemiodialysis
plenty of sodium) Cellular damage- burns- massive fluid
Side effects of sterioids: shifting
the immediate adverse effect is GI irritant- When cellular activity is catabolic
peptic ulcer (breakdown)
if taking more than 2 weeks- lowers the Injury- less blood- less o2- metabolism inside
immune system prone to infection anaerobic- lactic acid- metabolic acidosis
more than 3 months- soften the bones Stress- increses the production of sterioids in
reabsord sodium that's why there is mooning the body
of the face Steroid- adrenal cortex- cortisol
become voracious eater
Thins the skin ECG
causes hyperglycemia- DM Depressed ST
Flat Inverted T wave
Aldosterone insuffeciency Increased U wave
(hyperaldosteronism)- reabsord sodium
L-oss of body fluids (Diarrhea, Diabetes Hypokalemia- decreases cerebral function
insipidus)
SIADH posterior pituitary is releasing plenty
of ADH, it can reabsorb plenty of water- there
will be water intoxication. if there is
insipidus there is less ADH. loosing plenty of
water but sodium can be retain
- you can loose 30L of urine in 1 day

ASSESSMENT FINDINGS:
longcoatchihuahua00
-Restlessness ghieneldeguzmanflores@gmail.com
-Seizure for moderate to severe ghienelrementilla@gmail.com
hypernatremia
-brain swell if correcting hypernatremia very
quickly
isotonic- .9%
Hypotonic- .45% Na cl
Hypertonic- 3-5% na cl

POTASSIUM: Normal serum 3.5-5.3

Plenty in GI tract
Hyperkalemia and hypokalemia will both
cause cardiac dysrhythmia
7-8 or below 2.5%
Calcium gluconate
ECG--
Afterload (pressure)--the pressure inside is
high
if BP is 150 /100
left ventricle is having a hard time pushing
because of the high pressure-- the muscle
will increase
but the blood supply given by the coronary
artery is the same--contractility will slow
down
not all the blood will be ejected--increasing
the preload (filling)
casue left ventricular hypertrophy

CArdiac output- (CO) amount of blood that is

ejected by the heart in 1 minute (5-8L)

Stroke volume (SV)- amount of blood that is

ejected per contraction -- 70cc

CRxSV= CO
eg: 80x 70=

Diastole-