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Table 11-1. Fluid and Electrolyte Imbalances
Imbalance
Definition
Contributing Factors
Clinical Manifestations
Diagnostic Test Findings
Hypovolemia
Fluid volume
Vomiting, diarrhea, fever,
Weak. rapid pulse;
Increased hematocrit, BUN,
deficit
blood loss, and uncon-
decreased BP; dizziness;
serum sodium levels
trolled diabetes mellitus
thirst; confusion; and
muscle cramps
Hypervolemia
Fluid volume
Renal failure. congestive
Shorrness of breath,
Decreased hematocrit,
>
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excess
heart failure. blood
increased BP. bounding
BUN, and serum sodium
�
'"
Z
transfusions, and
pulse, and presence of
levels
"
prolonged corticosteroid
cough
x
therapy
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Hyponatremia
Sodium deficit
Diuretic therapy, renal
Lethargy, nausea, apathy,
Decreased urine and serum
r
c:
;:;
(serum
disease, excessive
muscle cramps, muscular
sodium levels
>-
sodium level
sweating, hyperglycemia,
twitching, and confusion
z
"
of <135
NPO status. congestive
in severe states
'"
r
mEqniter)
heart failure, and SIADH
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Hypernatremia
Sodium excess
Diabetes insipidus, diarrhea,
Elevated body tcmperaturc;
Increased serum sodium
'"
0
(serum
hyperventilation, and
lethargy or restlessness;
and decreased urine
r
::j
sodium level
excessive corricosteroid,
thirst; dry, flushed skin;
sodium levels
'"
01>145
sodium bicarbonate, or
weakness; irritability;
f<
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mEqniter)
sodium chloride
tachycardia; hyper- or
>
administration
hypotension; oliguria;
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z
and pulmonary edema
n
lii
"
'"
Vo
Table 0-1. Continued
�
'"
Imbalance
Definition
Conrribudng Factors
Clinical Manifestations
Diagnostic Test Findings
>
Ilypokalemia
Potassium defi-
Diarrhea, vomiting, chronic
Fatigue; muscle weakness;
ST depression or pro·
§
cit (serum
renal disease, gastric sue-
slow, weak pulse; ven-
longed PR interval on
�
'"
potassium
tion, polyuria, corrico-
[Ticular fibrillation; par-
ECG
m
level of
J:
d.5
steroid therapy, and
esrhesias; leg cramps;
>
mEqniter)
digoxin therapy
and decreased blood
S
pressure
8
Hyperkalemia
Potassium
Renal failure. Addison's dis-
Vague muscle weakness,
ST depression; rail, rented
"
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excess (serum
ease, burns, use of potas-
nausea, initial tachycardia
T waves; or absent P
o
'"
potassium
sium-conserving diuretics,
followed by bradycardIa,
waves on ECG
Of
level of >5
and chronic heparin ther-
dysrhythmia, flaccid
V\
mEqniter)
apy
paralysis, paresthesia,
n
�
irritability, and anxiety
BP = blood pressure; BUN = blood urea nurogel1; ECG = elearocardiogram; NPQ = nothmg by mouth; SIADH = syndrome of mappropriate
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amidluretlc hormone secretion.
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Sources: Data from M Mulvey. Fluid and Electrolytes: Balance and Disorders. In SC Smeltzer, BG Bare (cds), Srunner and Suddanh's Textbook
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of �1edical·Surgical Nursing (8th cd), Philadelphia: Lippincott, 1996;231; CC Goodman, TE Kelly Snyder. Problems Affecting Multiple Sys·
terns. In CC Goodman, WG Boissonnauh. Pathology: Implications for the PhYSical Therapist. Philadelphia: Saunders, 1998;72-82; and PJ Fall.
Hyponatremia and hypernatremia: a systemarit: approach to causes and their correction. Posrgrad l\ted 2000; I 07(5):75-82,