Fluid and Electrolyte Management

Abstract

Fluid and electrolyte management is challenging for clinicians, as electrolytes shift in a variety of settings and disease states and are dependent on osmotic changes and fluid balance. The development of a plan for managing fluid and electrolyte abnormalities should start with correcting the underlying condition. In most cases, this is followed by an assessment of fluid balance with the goal of achieving euvolemia. After fluid status is understood and/or corrected, electrolyte imbalances are simplified. Many equations are available to aid clinicians in providing safe recommendations or at least to give a starting point for correcting the abnormalities. However, these equations do not take into consideration the vast differences between clinical scenarios, thus making electrolyte management more challenging. The supplementation plan, whether delivered intravenously or orally, must include an assessment of renal and gastrointestinal function, as most guidelines are established under the assumption of normal digestion, absorption and excretion. After the plan is developed, frequent monitoring is vital to regain homeostasis. A fluid and electrolyte management plan developed by a multidisciplinary team is advantageous in promoting continuity of care and producing safe outcomes.

Metabolic Complications of Home Parenteral Nutrition

“…Patients should be given parameters of when to contact their HPN provider based on trends from I/O data. Weight loss or gain of 1 kg for 2 consecutive days, urine output <1 L in 24 hours, negative fluid balance for 48 hours, positive fluid balance of >1 L for 2 consecutive days, and changes in GI losses from baseline are a few examples 12 , 16 . Monitoring blood pressure and heart rate is another option if a blood pressure cuff is available.…”

“…A repeat measurement should be completed to obtain an accurate value prior to providing any treatment. Symptoms of hyperkalemia include muscle cramping, numbness or tingling in the extremities, unusual nausea or vomiting, weakness, chest pain, electrocardiogram (ECG) changes, and arrhythmias 12 . Patients symptomatic of hyperkalemia should be treated in a clinical setting where they can be constantly monitored and may require emergency department or intensive care unit (ICU) admission.…”

“…Other medications, including loop diuretics, glucocorticoids, immunosuppressants, phenolphthalein, theophylline, verapamil, sorbitol, caffeine, and those related to magnesium depletion, are associated with hypokalemia. Symptoms vary in severity and range from generalized weakness, apathy, unusual nausea or vomiting, and anorexia to muscle necrosis, paralysis, cardiac arrhythmias, and death 12 . Hypokalemia is corrected either with oral or IV supplementation depending on medical history and severity.…”

“…Symptoms typically do not occur until serum levels reach almost twice the upper normal limit of the reference range 10 . Physical symptoms include unusual nausea or vomiting, headache, flushing of the skin, diaphoresis, stumbling, decreased mental awareness, hypotension, bradycardia, and respiratory paralysis 12 . Treatment includes decreasing magnesium intake via the oral and IV routes, providing loop diuretics, and infusing IV calcium in a monitored, clinical setting in instances of severe hypermagnesemia 32…”

The Impact of Rate of Feeding Advancement after Early Initiation of Enteral Nutrition in Critically Ill, Underweight Patients: A Single-Center Retrospective Chart Review

“…Target glucose level was set as 100 to 180 mg/dL. 13) Number of patients exhibiting hypophosphatemia, defined as a serum phosphorus (P) concentration < 2.7 mg/d [23], during the first week and 28 days after EICU admission. However, serum P concentration was not examined in all patients, because the frequency of laboratory testing was not standardized between physicians.…”