Fluids and Electrolytes

Diagnosis and alleviation of the cause, if possible, is of primary importance. Often, however, this is not possible and therapy is used to alleviate the inconvenience and pain of diarrhea. These compounds usually only mask the underlying factors producing the problem. Diarrhea may cause significant dehydration and loss of electrolytes and is a particularly serious problem in infants. Antidiarrheals do not usually prevent the loss of fluids and electrolytes into the large bowel and, although these may prevent frequent defecation, often the serious imbalance of body electrolytes and fluids is not significantly affected. 

If the patient is acutely ill or has vomiting and diarrhea, the nurse measures the fluid intake and output and observes the patient closely for signs of dehydration. If dehydration is apparent, the nurse notifies the primary health care provider. If the patient is or becomes dehydrated, oral or IV fluid and electrolyte replacement may be necessary. The nurse takes vital signs every 4 hours or as ordered by the primary health care provider. 

As part of the preadministration assessment for a patient receiving a drug for nausea and vomiting, the nurse documents the number of times the patient has vomited and the approximate amount of fluid lost. Before starting therapy, the nurse takes vital signs and assesses for signs of fluid and electrolyte imbalances (see Chap. 58). 

Observations for fluid and electrolyte disturbances are particularly important in the aged or chronically ill patient in whom severe dehydration may develop in a short time. The nurse must immediately report symptoms of dehydration, such as dry mucous membranes decreased urinary output, concentrated urine, restlessness or confusion in the older adult. 

Edema, fluid and electrolyte imbalance, headache, blurred vision, nausea, vomiting, diarrhea, urinary retention Headache, nausea, vomiting, fluid and electrolyte imbalance, syncope... 

The osmotic diuretics urea and mannitol are administered intravenously (IV), whereas glycerin and isosorbide are administered orally Administration by the IV route may result in a rapid fluid and electrolyte imbalance, especially when these drugs are administered before surgery with the patient in a fasting state ... 

ELECTROLYTE IMBALANCE The most common adverse reaction associated with the administration of a diuretic is the loss of fluid and electrolytes (see Display 46-1), especially during initial therapy with the drug. In some patients, the diuretic effect is moderate, whereas in others a large volume of fluid is lost. Regardless of the amount of fluid lost, there is always the possibility of excessive electrolyte loss, which is potentially serious. 

DISPLAY 46-1 Signs and Symptoms of Cbmmon Fluid and Electrolyte Imbalances Associated With Diuretic Therapy... 

Whether a fluid or electrolyte imbalance occurs depends on the amount of fluid and electrolytes lost and the ability of the individual to replace them. For example, if a patient receiving a diuretic eats poorly and does not drink extra fluids, an electrolyte and water imbalance is likely to occur, especially during initial therapy with the drug. However, even when a patient drinks adequate amounts of fluid and eats a balanced diet, an electrolyte imbalance may still occur and require electrolyte replacement (see Chapter 58 and Display 58-2 for additional discussion of fluid and electrolyte imbalances). 

Warning sgns of a fluid and electrolyte imbalance include dry mouth, thirst, weakness lethargy, drowsiness restlessness muscle pains or cramps confuson, gastrointestinal disturbances hypotenson, oliguria, tachycardia, and seizures... 

ANTIDIARRHEALS. The nurse notifies the primary health care provider if an elevation in temperature occurs or if severe abdominal pain or abdominal rigidity or distention occurs because this may indicate a complication of the disorder, such as infection or intestinal perforation. If diarrhea is severe, additional treatment measures, such as IV fluids and electrolyte replacement, may be necessary. 

MANAGING FLUID AND ELECTROLYTE IMBALANCES. Fluid and electrolyte imbalances, particularly excess fluid volume, are common with corticosteroid therapy. The nurse checks the patient for visible edema, keeps... 

In men, administration of an androgen may result in breast enlargement (gynecomastia), testicular atrophy, inhibition of testicular function, impotence, enlargement of the penis, nausea, jaundice, headache, anxiety, male pattern baldness, acne, and depression. Fluid and electrolyte imbalances, which include sodium, water, chloride, potassium, calcium, and phosphate retention, may also be seen. 

Virilization in the woman is the most common reaction associated with anabolic steroids, especially when higher doses are used. Acne occurs frequently in all age groups and both sexes. Nausea, vomiting, diarrhea, fluid and electrolyte imbalances (the same as for the androgens, discussed previously), testicular atrophy,... 

ANDROGENS In most instances, androgens are administered to the man on an outpatient basis. Before and during therapy, the primary health care provider may order electrolyte studies because use of these drugs can result in fluid and electrolyte imbalances. 

The nurse observes the patient each day for adverse drug reactions especially signs of fluid and electrolyte imbalance, jaundice (which may indicate hepatotoxicity), and virilization. The primary health care provider must be alerted to any sgns of fluid and electrolyte imbalance or jaundice. 

Sodium and water retention may also occur with androgen or anabolic steroid administration, causing die patient to become edematous, hi addition, otiier electrolyte imbalances, such as hypercalcemia, may occur. The nurse monitors the patient for fluid and electrolyte disturbances (see Chap. 58 for signs and symptoms of electrolyte disturbance). 

Antineoplastic drugs are potentially toxic and their administration is often associated with many serious adverse reactions. At times, some of these adverse effects are allowed because the only alternative is to stop treatment of the malignancy. A treatment plan is developed that will prevent, lessen, or treat most or all of the symptoms of a specific adverse reaction. An example of prevention is giving an antiemetic before administering an antineoplastic drug known to cause severe nausea and vomiting. An example of treatment of the symptoms of an adverse reaction is the administration of an antiemetic and intravenous (IV) fluids and electrolytes when severe vomiting occurs. 

Combined electrolyte solutions are available for oral and IV administration. The IV solutions contain various electrolytes and dextrose. The amount of electrolytes, given as milliequivalents per liter (mEq/L), also varies. The IV solutions are used to replace fluid and electrolytes that have been lost and to provide calories by means of their carbohydrate content. Examples of IV electrolyte solutions are dextrose 5% with 0.9% NaCl, lactated Ringer s injection, Plasma-Lyte, and 10% Travert (invert sugar—a combination of equal parts of fructose and dextrose) and Electrolyte No. 2. 

Unit XI consists of three chapters that discusses types of drugs not previously discussed or that are not members of a particular class or group. Chapters in this unit include topical drugs used in the treatment of skin disorders, otic and ophthalmic preparations, and fluids and electrolytes. 

Saltin, B. Costill, D.L. (1988). Fluid and electrolyte balance during prolonged exercise. In Exercise, Nutrition, and Energy Metabolism (Horton, E.S. Teijung, R.L., ed), pp. 150-158, MacMillan. New York. 

The identification of co-occurring medical problems is an important element in detoxification (Naranjo and Sellers 1986). Good supportive care and treatment of concurrent illness, including fluid and electrolyte repletion, are essential (Naranjo and Sellers 1986). Administration of thiamine (50—100 mg/day po or im) and multivitamins is a low-cost, low-risk intervention for the prophylaxis and treatment of alcohol-related neurological disturbances. 

Those associated with the acute and chronic treatment of ne d>orns for respiratory, fluid and electrolyte problems. 

Bacteria cause disease of the gut as a result of either mucosal invasion or toxin produchon or a combinahon of the two mechanisms as summarized in Table 6.4. Treatment is largely directed at replacing and maintaining an adequate intake of fluid and electrolytes. Anhbiohcs are generally not recommended for infechve gastroenterihs. 

Cholera is a serious infection causing epidemics throughout Asia. Although a toxin-mediated disease, largely controlled with replacement of fluid and electrolyte losses, tetracycline has proved effective in eliminating the causative vibrio from the bowel, thereby abbreviating the course of the illness and reducing the total fluid and electrolyte losses. 

Adjunctive therapy with fluid and electrolyte replacement should be initiated. Nutritional support with enteral or parenteral nutrition may be indicated for patients unable to eat for more than 5 to 7 days.2 Some evidence suggests that enteral nutrition provides anti-inflammatory effects in patients with active CD.40,41... 

The primary treatment of acute diarrhea includes fluid and electrolyte replacement, dietary modifications, and drug therapy. 

Because many elderly persons experience constipation, laxative use is sometimes viewed as a normal part of daily life. However, mineral oil can be a special hazard in bedridden elderly persons because it can lead to pneumonia through inhalation of oil droplets into the lungs. Lactulose may be a better choice in this situation. Regular use of any laxative that affects fluid and electrolytes may result in significant unwanted adverse effects. 

The goals of treatment for diarrhea are to relieve symptoms, maintain hydration, treat the underlying cause(s), and maintain nutrition. The primary treatment of acute diarrhea includes fluid and electrolyte replacement, dietary modifications, and drug therapy. 

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