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Electrolytes and respiratory function -

A key symptom of hypernatremia is thirst. High chloride hyper chloremia often results from diarrhea or kidney disease. If it continues, kidney problems may occur. High potassium hyper kalemia may not cause any symptoms, although you may experience muscle weakness or abnormal heart rhythms.

If the level goes very high, the heart can stop beating. Low calcium hypo calcemia may not cause symptoms, but chronically low levels can cause changes in skin, nails and hair; yeast infections; and cataracts.

As levels drop, muscle irritability and cramps particularly in legs and back may develop. High calcium hyper calcemia may not cause symptoms. As calcium rises, constipation, loss of appetite, nausea, vomiting, abdominal pain, neuromuscular symptoms and bowel obstruction ileus may occur.

Persistent or severe hypercalcemia can damage the kidneys and cause heart problems, including rhythm changes and heart attacks. Low magnesium hypo magnesemia may cause symptoms similar to low potassium or calcium. An extremely low level can be life-threatening.

High magnesium hyper magnesemia may cause low blood pressure, breathing problems slow, ineffective breathing and heart problems cardiac arrest. Low phosphate hypo phosphatemia can cause muscle weakness, respiratory failure, heart failure, seizures and coma.

It may be caused by very poor nutrition, certain diuretic medications, diabetic ketoacidosis DKA , alcoholism and severe burns. DKA is a serious complication of diabetes in which cells burn fat instead of glucose. This creates ketones, which enter the blood and turn it acidic.

Normal blood is slightly alkaline. High phosphates hyper phosphatemia may not cause symptoms. It may be due to tumor lysis syndrome , overwhelming infection, chronic kidney disease, parathyroid gland disorder, or acidosis blood pH more acidic than normal.

Return to homepage. Tuesday, August 29, - am. Sean Smith, BSN, RN, Assistant Director, Patient Care Services. What are electrolytes? Regulate the fluid levels in your blood plasma and your body.

Enable muscle contractions, including the beating of your heart. Transmit nerve signals from heart, muscle and nerve cells to other cells. Help blood to clot. Cedars-Sinai Blog What are Electrolytes? Q: Why are electrolytes important? Christina Fasulo: And they control nervous-system function.

Q: What are some signs of low electrolyte levels? Q: How do we lose electrolytes? EDS: We mostly lose electrolytes through sweat and urine.

CF: Also vomiting and diarrhea. Q: How do we get electrolytes in our bodies? Read: Does IV Vitamin Therapy Work? Q: Aren't sports drinks known for providing electrolytes? If you're doing an easy-to-moderate exercise for an hour, then you're fine drinking water.

Q: Are there electrolytes when you get an IV? Read: The Science of Hangovers. Q: How else does drinking alcohol affect our electrolyte levels? EDS: Alcohol is dehydrating in multiple ways. Tags: Prevention. Note: water loss in normal stool is inconsequential.

Of course, these statements assume normal body temperature and identical ambient temperature and humidity. Respiratory losses are dependent on the respiratory rate RR and tidal volume. As can be seen, a newborn uses, and therefore has to humidify, 3.

As a child grows, minute ventilation does not rise in direct proportion to the weight so neither does lung water loss. Transcutaneous evaporative water loss is dependent on body surface area BSA. In summary, the water loss per kg body weight from these two routes is highest in the newborn. As the child grows, the increase in the rate of water loss is less than the increase in weight.

Putting it all together, the rate of water loss from all three routes is highest in the smallest children and does not rise in direct proportion to increase in body weight. I t is clinically useful to begin fluid therapy by estimating normal maintenance requirements using the estimated caloric expenditure method.

The commonly used method for approximating water loss and therefore the water requirement is based off of the Holliday-Segar nomogram. Holliday and Segar collated information from a number of studies, including their own, and concluded the following:. The diagram below is taken from their original publication "The maintenance need for water in parenteral fluid therapy", Pediatrics Holliday and Segar determined how many calories a patient burns as a factor of weight.

Holliday MA and Segar WE. The Holliday-Segar nomogram approximates daily fluid loss, and therefore the daily fluid requirements, as follows:.

Even though it is correct to think about fluid requirements on a hour basis, the delivery pumps used in hospitals are designed to be programmed for an hourly infusion rate. The hour number is often divided into approximate hourly rates for convenience, leading to the "" formula.

I t is clear that there is no strict daily sodium requirement since, in the normal individual, homeostatic mechanisms will instruct the kidney to conserve or excrete sodium and keep total body sodium content within the normal range.

Holliday and Segar decided on this number by looking at the sodium content of human and cows' milk. Click for flashback to chemistry. When we speak about adding sodium to IV fluids, we talk about it in terms of normal saline. Normal saline is isotonic to plasma. Note that all of these are considered hypotonic to plasma.

Based on current research, it is determined that giving hypotonic solutions as maintenance IV fluids is associated with severe morbidity and even mortality due to hyponatremia. We know that kids in the hospital are stressed.

They are vomiting, or have respiratory illness, or require surgery, or have fever. All of these things cause an increase in ADH release. The more ADH, the more water is reabsorbed from the collecting duct of the kidneys.

Combine this with hypotonic IV fluids, and you have a perfect formula for hyponatremia. This was estimated by Holliday and Segar to again reflect the composition of human and cow milk and has remained the same since then.

In children who have a condition that might predispose to renal failure, such as dehydration, K is not added to intravenous fluids until the presence of renal function has been established. This means that there is 0. You can apply this conversion factor to any other amount. There are two reasons for this:.

Any solution that has less salt will be hypo-osmolar. Rapid infusion of a hypo-osmolar solution can cause osmotically induced water shift into the cells, and this can lead to detrimental effects such as hemolysis.

Ringer's lactate LR is a composite fluid that is available with and without dextrose. The lactate is metabolized in the liver to bicarbonate. LR provides a source of base, as well as some Ca. M aintenance fluid calculations assume that fluid loss from sensible and insensible routes is taking place at a normal rate.

But a febrile infant will be having a much greater transcutaneous evaporative water loss than one with a normal body temperature. Similarly, a child with tachypnea will lose excess water from the lungs - unless she is receiving humidified oxygen, in which case she will lose none!

Also consider patients with kidney disease who have anuria, oliguria, or polyuria. Maintenance IV fluids for these patients will not be written with the standard formula because their urinary losses are not taking place at a normal rate.

Maintenance fluids using the standard formula would be too much for an anuric child with no urinary losses and too little for those with a concentrating defect in their kidneys causing polyuria. Important : Before using a standard formula for calculating maintenance fluids, ensure that the child is not having higher or lower losses than usual!

When we prescribe maintenance fluid for a 10 kg child for 24 hours as ml, we are assuming that loss from the various routes is occurring at a normal rate.

However, adjustments are sometimes necessary:. What is the hour fluid requirement for a 10 kg child who has a fever of 40 degrees C. Presuming the child is not receiving humidified O 2. What volume of maintenance fluid would you order for the next 12 hours for a 10 kg child with oliguria whose measured urine output in the previous 12 hours has been 50 ml?

Fluid and Electrolyte Therapy A Functiion in Core Obesity management tips of Pediatrics, Electrilytes Edition. W e drink water, Electrolytes and respiratory function a water-containing znd, five respuratory ten times a Eoectrolytes. We do not have to keep track of our fluid intake. The thirst-creating mechanism is exquisitely sensitive to an increase in plasma osmolality and as long as there is free access to water, intake will never be less than the need. So, we rely on thirst to guide water intake. But what about a person who is receiving only intravenous fluids or gavage feeding?