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] |
to\tthirst\tis\tdecreased\tin\tolder\tindividuals,\tchronically\n\tor\tacutely\till\tpatients,\tinfants,\tand\tathletes\nleading\tto\ta\thigher\tpotential\tfor\twater\tdeficits.\tSources\tof\twater\tinclude\tfluids\t(oral,\tenteral\ttube\nfeeding,\tparenteral\tfluids),\tfood,\tand\toxidative\tmetabolism\t(\nTables\t3.1\n,\t\n3.2\n,\tand\t\n3.3\n).\tThe\toxidation\tof\nfoods\tin\tthe\tbody\tproduces | [
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] |
,\t\n3.2\n,\tand\t\n3.3\n).\tThe\toxidation\tof\nfoods\tin\tthe\tbody\tproduces\t\nmetabolic\twater\n\tas\tan\tend\tproduct.\tThe\toxidation\tof\t100\tg\tof\tfat,\ncarbohydrate,\tor\tprotein\tyields\t107,\t55,\tor\t41\tg\n\tof\twater,\trespectively,\tfor\ta\ttotal\tof\tapproximately\n200\tto\t300\tmL/day\t(\nWhitmire,\t2008\n;\t\nCanada,\t2015\n).\nTABLE\t3.1\nContent\tof\tCommon\tIntravenous\tFluids\nFluid | [
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] |
Canada,\t2015\n).\nTABLE\t3.1\nContent\tof\tCommon\tIntravenous\tFluids\nFluid\nDextrose\n(g/L)\nSodium\n(mEq/L)\nChloride\n(mEq/L)\nAdditional\tComponents\n(mEq/L)\n0.45%\tNaCl\n0\n77\n77\nn/a\n0.9%\tNaCl\n0\n154\n154\nn/a\n3%\tSaline\n0\n513\n513\nn/a\n5%\tDextrose\tin\nwater\n50\n0\n0\nn/a\nD\n5\n0.45%\tNaCl\n50\n77\n77\nn/a\nD\n5\n0.9%\tNaCl\n50\n154\n154\nn/a\n10%\tDextrose\n100\n0\n0\nn/a\nLactated\tRinger’s | [
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] |
5\n0.9%\tNaCl\n50\n154\n154\nn/a\n10%\tDextrose\n100\n0\n0\nn/a\nLactated\tRinger’s\n(LR)\n0\n130\n109\nPotassium\t4\nCalcium\t3\nLactate\t28\nD\n5\nLR\n50\n130\n109\nPotassium\n\t4\nCalcium\t3\nLactate\t28 | [
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] |
TABLE\t3.2\nPercentage\tof\tWater\tin\tCommon\tFoods\nFood\nPercentage\nLettuce,\ticeberg\n96\nCelery\n95\nCucumbers\n95\nCabbage,\traw\n92\nWatermelon\n92\nBroccoli,\tboiled\n91\nMilk,\tnonfat\n91\nSpinach\n91\nGreen\tbeans,\tboiled\n89\nCarrots,\traw\n88\nOranges\n87\nCereals,\tcooked\n85\nApples,\traw,\twithout\tskin\n84\nGrapes\n81\nPotatoes,\tboiled\n77\nEggs\n75\nBananas\n74\nFish,\thaddock,\tbaked | [
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Grapes\n81\nPotatoes,\tboiled\n77\nEggs\n75\nBananas\n74\nFish,\thaddock,\tbaked\n74\nChicken,\troasted,\twhite\tmeat\n70\nCorn,\tboiled\n65\nBeef,\tsirloin\n59\nCheese,\tSwiss\n38\nBread,\twhite\n37\nCake,\tangel\tfood\n34\nButter\n16\nAlmonds,\tblanched\n5\nSaltines\n3\nSugar,\twhite\n1\nOils\n0 | [
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-0.038039833307266235,
-0.028392244130373,
0.09533429145812988,
0.06268396973609924,
-0.02926020137965679,
0.009027885273098946,
0.03607911616563797,
0.026258792728185654,
-0.036152396351099014,
0.02544489875435829,
0.03085094504058361,
0.015663156285881996,
0.005326856393367052,
0.06131334230303764,
-0.0030760702211409807
] |
34\nButter\n16\nAlmonds,\tblanched\n5\nSaltines\n3\nSugar,\twhite\n1\nOils\n0\nFrom\tU.S.\tDepartment\tof\tAgriculture\t(USDA),\tAgricultural\tResearch\tService\t(ARS):\tNutrient\tdatabase\tfor\tstandard\treference.\nhttp://ndb.nal.usda.gov\n.\nTABLE\n\t3.3\nWater\tContent\tof\tEnteral\tNutrition\tFormulations\nEnteral\tFormula\tConcentration\nPercentage\tof\tFree\tWater\n1.0\tkcal/mL\n84% | [
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0.05303463339805603,
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0.00011944270227104425,
0.08630072325468063,
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0.0509914793074131,
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] |
Percentage\tof\tFree\tWater\n1.0\tkcal/mL\n84%\n1.2\tkcal/mL\n81%\n1.5\tkcal/mL\n76%\n2.0\tkcal/mL\n69%\nTonicity\tof\tbody\tfluids\tcan\tbe\tmeasured\t(serum\tosmolality)\tor\testimated\tfrom\tthe\tfollowing\nformula:\nCLINICAL\tINSIGHT\nOsmotic\tForces\nOsmotic\tpressure\n\tis\tdirectly\tproportional\tto\t\nthe\tnumber\tof\tparticles\tin\tsolution\tand\tusually | [
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proteins\tin\tthe\tplasma\tand\tinterstitial\tfluids.\tOncotic\tpressure\thelps\tretain\twater\twithin\tblood\nvessels,\tpreventing\tits\tleakage\tfrom\tplasma\tinto\tthe\tinterstitial\tspaces.\n\tIn\tpatients\twith\tan\nexceptionally\tlow\tplasma\tprotein\tcontent,\tsuch\tas\tthose\twho\tare\tunder\tphysiologic\tstress\tor\thave | [
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certain\tdiseases,\twater\tleaks\tinto\tthe\tinterstitial\tspaces,\tcausing\tedema\tor\tthird\tspacing;\tthus\tthe\nfluid\tis\tcalled\t\n“third\tspace”\tfluid\n.\nOsmoles\tand\tmilliosmoles\nConcentrations\tof\tindividual\tionic\tconstituents\tof\textracellular\tor\tintracellular\tfluids\tare\nexpressed\tin\tterms\tof\n\tmilliosmoles\tper\tliter\t(mOsm/L).\tOne\tmole\tequals\tthe\tgram\tmolecular | [
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the\tparticles\tare\tdispersed.\tIt\tis\texpressed\tas\tmilliosmoles\tof\tsolute\tper\tkilogram\tof\tsolvent\n(mOsm/kg).\t\nOsmolarity\n\tis\tthe\tterm\tformerly\tused\tto\tdescribe\tconcentration—milliosmoles\tper\nliter\tof\tthe\tentire\tsolution—but\tosmolality\tis\tnow\tthe\tmeasurement\tfor\tmost\tclinical\twork. | [
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However,\tin\treference\tto\tcertain\tconditions\tsuch\tas\thyperlipidemia,\tit\tmakes\ta\tdifference\twhether\nosmolality\tis\tstated\tas\tmilliosmoles\tper\tkilogram\tof\tsolvent\tor\tper\tliter\tof\tsolution.\nThe\taverage\tsum\tof\tthe\tconcentration\n\tof\tall\tthe\tcations\tin\tserum\tis\tabout\t150\tmEq/L.\tThe\tcation | [
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activity\tfluid\tloss\tand\tconsume\t1\tto\t1.25\tL\tof\tfluid\tfor\teach\t1\tkg\tof\tbody\twater\tlost\tduring\texercise\n(Binkley,\t2002).\nThe\tGI\ttract\tcan\tbe\ta\tmajor\tsource\tof\twater\tloss\t(\nFig.\t3.3\n).\tUnder\tnormal\tconditions\tthe\twater\ncontained\tin\tthe\t7\tto\t9\tL\tof\tdigestive\tjuices\tand\tother\tECFs\n\tsecreted\tdaily\tinto\tthe\tGI\ttract\tis | [
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FIG.\t3.3\nContent\tof\tGastrointestinal\tSecretions\nCholeric\tdiarrhea,\tacute\tdiarrhea\tcaused\tby\tcontaminated\tfood\tor\twater\tcontaining\tthe\tbacteria\nvibrio\tcholera\n,\tis\tresponsible\tfor\tthe\tloss\tof\tmany\tlives\tin\tdeveloping\tcountries\tand\thydration\tcan\tbe\ncorrected\twithout\tintravenous\tfluids.\tOral\trehydration\tsolution,\tan\tisotonic\tfluid,\tis\ta\tsimple\tmixture | [
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data\tfrom\ta\tvariety\tof\tsources,\tincluding\tphysical\texamination\tby\tthe\tmedical\tteam,\tnutrition-focused\nphysical\texaminations,\timaging\treports\t(e.g.,\tidentifying\tabnormal\tfluid\tcollections\twithin\tthe\tlungs,\nascites),\tlaboratory\tstudies\t(i.e.,\tserum\n\tsodium),\tsubjective\treport\tof\tsymptoms\tfrom\tpatients, | [
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urine,\tdiuretic\tmedications,\tand\tGI\tsecretions\t(e.g.,\n\temesis,\tgastric\tsecretions,\tsurgical\tdrains,\tstool,\nfistulas)\t(\nPopkin\tet\tal,\t2010\n).\nOf\tnote,\tthirst\tis\tnot\tan\teffective\tsignal\tto\tconsume\tfluids\tin\tinfants,\theavily\texercising\tathletes\n(\nCasa,\t2015\n),\tindividuals\tin\textreme\theat,\tsick\tindividuals,\tand\tolder\tadults\twho\tmay\thave\ta | [
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diminished\tthirst\tsensation.\tHospitalized\tpatients,\tregardless\tof\tthe\tdiagnosis,\tare\tat\trisk\tfor\twater\nand\telectrolyte\n\timbalance.\tOlder\tadults\tare\tparticularly\tsusceptible\tbecause\tof\tfactors\tsuch\tas\nimpaired\trenal\tconcentrating\tability,\tfever,\tdiarrhea,\tvomiting,\tand\ta\tdecreased\tability\tto\tcare\tfor\nthemselves.\nCLINICAL\tINSIGHT | [
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themselves.\nCLINICAL\tINSIGHT\nWater\tRequirements:\tWhen\tEight\tIs\tNot\tEnough\nThere\tis\tno\tstorage\tform\tof\twater,\tand\ttherefore\tfluid\trequirements\tand\tfluid\tlosses\tmust\tbe\nmaintained\tat\tequilibrium.\tOften\tclinicians\n\tquickly\testimate\tfluid\trequirements\tbased\ton\tenergy | [
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quickly\testimate\tfluid\trequirements\tbased\ton\tenergy\nrequirements\t(1\tmL/kcal\tfor\tadults\tand\t1.5\tmL/kcal\tfor\tinfants)\tor\tapproximately\t35\tmL/kg\tof\nusual\tbody\tweight\tin\tnonobese\tadults,\t50\tto\t60\tmL/kg\tin\tchildren,\tand\t150\tmL/kg\tin\tinfants.\nAt\tcertain\tpoints\twithin\tthe\tlifecycle,\tthe\tbody\twill\tnaturally\trequire\tmore\tfluid.\tInfants\tneed | [
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throughout\tthe\tday\tand\tseparating\tfluids\tfrom\tmeals\tcan\tbe\thelpful\tstrategies\tfor\thelping\tSBS\npatients\tmaintain\ttheir\thydration\n\tstatus.\tWhen\toral\tintake\talone\tis\tnot\tsufficient\tto\tprevent\ndehydration,\tparenteral\tfluids\tmay\tbe\tneeded.\tUse\tof\tparental\tfluids\tcan\tbe\ttemporary\t(e.g.,\tdue | [
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to\tan\tacute\tevent\tsuch\tas\ta\turinary\ttract\tinfection\tin\tan\telderly\tadult)\tor\tchronic\tfor\tcertain\ndisease\tstates\t(e.g.,\tSBS\tor\tgastrointestinal\tfistula).\nFluid\tneeds\tof\thospitalized\tpatients\tshould\tbe\tindividualized\tand\tadequacy\tof\tfluid\tintake\nassessed\tfrom\tphysical\texamination\tby\tthe\tmedical\tteam,\tnutrition-focused\tphysical\texaminations, | [
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imaging\treports,\tlaboratory\tstudies\t(Na,\tBUN,\tCr,\tHgb/Hct,\talbumin,\tetc.),\tsubjective\treport\tof\nsymptoms\tfrom\tpatients,\tsudden\tweight\tchanges,\tmedications,\tand\tvital\tsigns.\nElectrolytes\nElectrolytes\n\tare\tminerals\twith\telectric\tcharges\tthat\tdissociate\tin\ta\tsolution\tinto\tpositive\tor\nnegatively | [
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-0.04225224629044533,
0.040217287838459015,
0.10756440460681915,
-0.0013949364656582475,
-0.08280246704816818,
-0.0091222720220685,
0.07210604101419449,
-0.006535809952765703,
0.004093969240784645,
-0.04533015564084053,
0.045120079070329666,
0.10658562928438187,
0.015337790362536907,
-0.02596304938197136,
0.02815185859799385,
0.057177238166332245,
0.1031559482216835,
0.03212399035692215,
-0.017835119739174843
] |
negatively\n\tcharged\tions.\tElectrolytes\tcan\tbe\tsimple\tinorganic\tsalts\tof\tsodium,\tpotassium,\tor\nmagnesium,\tor\tcomplex\torganic\tmolecules;\tthey\tplay\ta\tkey\trole\tin\ta\thost\tof\tnormal\tmetabolic\nfunctions\t(\nTable\t3.4\n).\tOne\tmilliequivalent\t(mEq)\tof\tany\tsubstance\thas\tthe\tcapacity\tto\tcombine | [
-0.033031076192855835,
-0.05939001590013504,
0.008465389721095562,
-0.021265773102641106,
-0.09120778739452362,
-0.03480546921491623,
0.10962534695863724,
0.03546597808599472,
0.03372002765536308,
0.05594291910529137,
0.11014746129512787,
-0.04268175736069679,
0.045368824154138565,
0.07257258147001266,
0.01360504049807787,
-0.030065229162573814,
0.027622338384389877,
0.005785536020994186,
-0.0754534900188446,
0.00771760568022728,
0.0199134424328804,
0.031794287264347076,
-0.015590107068419456,
-0.01687808521091938,
0.003930560778826475,
0.024703802540898323,
-0.027237338945269585,
-0.0009892228990793228,
0.044896405190229416,
-0.10836676508188248,
-0.11813406646251678,
0.07717481255531311,
-0.049152474850416183,
-0.004002405796200037,
0.028451699763536453,
0.041368912905454636,
-0.06641803681850433,
-0.014606442302465439,
0.019839229062199593,
-0.010337591171264648,
-0.029834076762199402,
-0.016872772946953773,
-0.04836232587695122,
0.027513904497027397,
0.016744179651141167,
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0.0016886290395632386,
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-0.039067342877388,
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0.04845069348812103,
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0.08278775215148926,
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0.0009454686660319567,
-0.02935531735420227,
-0.013365102931857109,
-0.03822425380349159,
-0.03353219851851463,
0.0018041078001260757,
0.017543580383062363,
-0.058453019708395004,
0.032758016139268875,
0.07763171941041946,
0.059893589466810226,
-0.02069971151649952,
-0.007956080138683319,
0.024963540956377983,
0.10236708074808121,
-0.025925789028406143,
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-0.07269152253866196,
0.07206865400075912,
0.007160588633269072,
0.10429269820451736,
0.06406036019325256,
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-0.037268076092004776,
-0.0671519786119461,
0.06097577139735222,
0.01460416242480278,
0.05314897745847702,
0.0007571452297270298,
0.0506233312189579,
-0.006355876103043556,
0.020776471123099327,
-0.041806094348430634,
0.029048167169094086,
0.02495112270116806,
-0.01706663705408573,
0.056521832942962646,
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-0.02457841858267784,
0.014949647709727287,
0.011845927685499191,
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0.02351447194814682,
0.031708184629678726,
0.005547347012907267,
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0.004063394386321306,
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0.021898409351706505,
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0.006761672906577587,
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0.039603497833013535,
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-0.009711232036352158,
0.07181393355131149,
0.08196742832660675,
0.021319475024938583,
0.017348388209939003,
-0.01980503275990486,
-0.032032422721385956,
0.07812255620956421,
-0.026718631386756897,
-0.006596744060516357,
-0.04836466535925865,
3.260890756816121e-33,
0.06279990077018738,
0.045017313212156296,
0.029015475884079933,
0.011903899721801281,
0.01035249698907137,
0.0048336791805922985,
-0.04872690141201019,
-0.041575249284505844,
-0.06547748297452927,
0.1057496890425682,
-0.08385838568210602,
0.04379982501268387,
-0.013496717438101768,
0.05174548923969269,
0.053471747785806656,
-0.05277393013238907,
-0.03147939592599869,
0.00880019273608923,
0.02584635093808174,
-0.045341454446315765,
-0.017186947166919708,
0.13710938394069672,
0.0058982796035707,
-0.0038514076732099056,
-0.02423117309808731,
-0.03602127358317375,
-0.02464110217988491,
-0.008441975340247154,
-0.05243059992790222,
0.015611113049089909,
-0.0036267382092773914,
-0.014307252131402493,
-0.03224575147032738,
0.022778978571295738,
0.04758007079362869,
0.00342852296307683,
-0.08900418877601624,
0.01513063907623291,
-0.000812136975582689,
-0.048913728445768356,
-0.08683030307292938,
0.005315952003002167,
-0.04850124567747116,
0.03070596233010292,
0.07412143051624298,
-0.03866344317793846,
0.01263517513871193,
-0.052600305527448654,
-0.014051002450287342,
-0.06065749004483223,
0.009510202333331108,
0.013019563630223274,
0.06838621199131012,
0.0026619078125804663,
0.009672312997281551,
-0.01167540717869997,
0.03878689184784889,
0.024791715666651726,
-0.0033209852408617735,
0.1046895757317543,
-0.0314340740442276,
0.06729713082313538,
0.017376486212015152,
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0.0032060977537184954,
0.009886066429316998,
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0.056129902601242065,
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0.026769552379846573,
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0.08056247979402542,
0.06097489595413208,
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-0.022828903049230576,
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0.06888599693775177,
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-0.027446767315268517,
-0.09801360964775085,
0.0006252749590203166,
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-0.07415162026882172,
-0.07282201200723648,
0.0035809141118079424,
-0.08842603862285614,
0.032121434807777405,
-0.011149917729198933,
-0.06119978800415993,
0.02455016039311886,
0.014271572232246399,
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-0.12164478003978729,
-4.2043998281356915e-33,
-0.10657257586717606,
-0.022981757298111916,
-0.04805687442421913,
0.03443009406328201,
-0.08649953454732895,
-0.0019763221498578787,
-0.006857389118522406,
0.018202336505055428,
0.09984048455953598,
-0.01638762839138508,
0.1498233526945114,
0.04677268862724304,
-0.018404271453619003,
-0.13192810118198395,
-0.024684233590960503,
0.015523189678788185,
-0.020483722910284996,
0.047612421214580536,
0.03715863823890686,
-0.02405269630253315,
-0.06845526397228241,
0.006959844846278429,
-0.10806066542863846,
0.046951476484537125,
0.002354671247303486,
0.07304258644580841,
0.008193982765078545,
-0.04115472361445427,
0.06770838797092438,
0.07991750538349152,
0.04332795739173889,
0.05676984041929245,
-0.0010996789205819368,
0.05808006972074509,
0.019986871629953384,
-0.039274733513593674,
0.05655849352478981,
0.04403887689113617,
-0.06978536397218704,
-0.05577317997813225,
0.026194948703050613,
0.05899631604552269,
0.14208544790744781,
0.024868376553058624,
0.03141899034380913,
-0.01747034303843975,
-0.08441253006458282,
-0.05804812163114548,
-0.03412375971674919,
0.008147151209414005,
0.06404009461402893,
-0.026192693039774895,
0.016779672354459763,
-0.025986140593886375,
0.012204618193209171,
0.03568631783127785,
-0.006577033083885908,
-0.09863916784524918,
0.005599773023277521,
0.03767331689596176,
0.021594874560832977,
-0.03672672435641289,
0.04977094754576683,
-0.025123072788119316,
0.05097654089331627,
-0.05579947680234909,
-0.059085674583911896,
-0.006007462274283171,
0.04619206115603447,
-0.09510380774736404,
0.05590664595365524,
0.018263673409819603,
-0.05762914568185806,
-0.12027891725301743,
0.06397145241498947,
-0.06227211281657219,
0.06000569835305214,
-0.00916069932281971,
-0.021567778661847115,
-0.013460061512887478,
0.007885490544140339,
0.058553896844387054,
0.0030865860171616077,
-0.047264400869607925,
-0.012877433560788631,
-0.00765155628323555,
-0.05283583700656891,
0.04515979811549187,
0.04423696547746658,
0.054100263863801956,
-0.0010262388968840241,
0.04618367552757263,
0.007836096920073032,
0.08282284438610077,
0.11594980955123901,
-4.8249486184204216e-8,
0.01938755437731743,
-0.03694161772727966,
0.04057572782039642,
-0.019753921777009964,
0.024163197726011276,
0.0053025586530566216,
0.09670452773571014,
0.007278818171471357,
-0.002119160955771804,
-0.024973919615149498,
0.04867120832204819,
0.07894199341535568,
-0.11474935710430145,
-0.05065372586250305,
0.07830092310905457,
0.07983085513114929,
-0.08408306539058685,
0.05768338590860367,
-0.028545362874865532,
-0.039386261254549026,
0.03827948123216629,
0.07579059898853302,
-0.03498673439025879,
0.0070533668622374535,
-0.023559201508760452,
-0.02103901468217373,
-0.007363598328083754,
-0.029365824535489082,
0.01832183636724949,
0.040897518396377563,
0.01607533171772957,
-0.03090643510222435,
0.022083045914769173,
-0.026798179373145103,
-0.07326982915401459,
0.0488424226641655,
-0.029139230027794838,
-0.029718471691012383,
-0.06177203357219696,
0.1023487001657486,
-0.02832988277077675,
0.0019707258325070143,
-0.05047130212187767,
0.05138012766838074,
0.0582054927945137,
-0.04563041403889656,
-0.046643879264593124,
0.08350306749343872,
-0.004105751868337393,
-0.030484192073345184,
0.007476785220205784,
0.14198754727840424,
-0.041584111750125885,
-0.043016403913497925,
-0.04552194103598595,
0.05751217529177666,
-0.005151076707988977,
0.0388471819460392,
-0.04835489019751549,
-0.03807857260107994,
0.04361070692539215,
0.006344395689666271,
0.0956735759973526,
-0.02990572713315487
] |
chemically\twith\t1\tmEq\tof\ta\tsubstance\twith\tan\topposite\tcharge.\tFor\tunivalent\tions\t(e.g.,\tNa\n+\n),\t1\nmillimole\t(mmol)\tequals\t1\tmEq;\tfor\n\tdivalent\tions\t(e.g.,\tCa\n++\n),\t1\tmmol\tequals\t2\tmEq\t(see\t\nAppendix\t1\nfor\tconversion\tguidelines).\nTABLE\t3.4\nElectrolyte\tClassification\nElectrolyte\nLocation\nCations\nSodium\nExtracellular\tcation\nPotassium | [
-0.034705135971307755,
-0.06876201182603836,
0.01582079939544201,
-0.021377375349402428,
-0.03772968798875809,
-0.00423551956191659,
0.059982359409332275,
0.059838179498910904,
-0.01835133507847786,
0.028309661895036697,
0.059009991586208344,
-0.03486735373735428,
0.06548744440078735,
0.09185196459293365,
-0.037907924503088,
-0.021084625273942947,
-0.0027160414028912783,
0.04657421633601189,
-0.05041228234767914,
0.0024668690748512745,
0.03910832107067108,
0.034002579748630524,
-0.026479879394173622,
-0.021878868341445923,
0.0011541504645720124,
0.022403154522180557,
-0.013872615993022919,
-0.007270406931638718,
0.03706686571240425,
-0.0684867724776268,
-0.10285840183496475,
0.06535449624061584,
-0.017763424664735794,
-0.023512139916419983,
0.07511362433433533,
-0.004416837822645903,
-0.11413702368736267,
0.03691505640745163,
-0.011552375741302967,
0.023344626650214195,
0.013928152620792389,
-0.051729630678892136,
-0.010396511293947697,
0.02136686071753502,
0.08801158517599106,
-0.053899336606264114,
0.03586341813206673,
-0.0570586621761322,
-0.03706071525812149,
-0.012636453844606876,
-0.03429894521832466,
0.049469977617263794,
-0.10071572661399841,
0.10090603679418564,
0.0335523821413517,
-0.04541923850774765,
-0.06752098351716995,
-0.012947224080562592,
-0.04344598203897476,
-0.012485156767070293,
0.014107716269791126,
-0.0521465428173542,
-0.0648479089140892,
-0.000524748582392931,
0.040017690509557724,
0.09043475240468979,
-0.0023423293605446815,
0.01654362864792347,
0.03616975247859955,
0.06295279413461685,
-0.07865399122238159,
-0.00138668657746166,
-0.06675129383802414,
0.05886426940560341,
0.008772486820816994,
0.08083759993314743,
0.1361263543367386,
0.019713502377271652,
0.0410521999001503,
-0.06004978343844414,
-0.06316279619932175,
0.1106543019413948,
0.025299999862909317,
0.024621237069368362,
0.03638690337538719,
0.06271282583475113,
-0.00905328057706356,
0.044423025101423264,
0.05818595364689827,
0.023938369005918503,
0.09001068770885468,
0.04820113629102707,
-0.038287144154310226,
-0.076158307492733,
-0.023285498842597008,
-0.010822040028870106,
-0.01575998216867447,
-0.025177953764796257,
0.033585380762815475,
-0.007669424172490835,
0.02426828444004059,
-0.019544459879398346,
-0.07180426269769669,
0.017537754029035568,
-0.03322296589612961,
-0.018380632624030113,
0.06556554138660431,
-0.04756125435233116,
0.050765976309776306,
0.016666999086737633,
-0.03981608524918556,
-0.00942434836179018,
0.020311791449785233,
-0.04387995973229408,
-0.04015922546386719,
-0.02636398747563362,
0.026395995169878006,
0.010906227864325047,
0.15897421538829803,
-0.01919914223253727,
0.0036071352660655975,
-0.028404006734490395,
0.02288743108510971,
0.03339959681034088,
0.02991430275142193,
-0.00013273960212245584,
-0.04550561681389809,
2.497564030984483e-33,
-0.00001101638645195635,
0.08737877756357193,
0.02128056436777115,
0.02725641056895256,
0.034485507756471634,
-0.0011910349130630493,
-0.026542918756604195,
-0.04773296043276787,
-0.03449654579162598,
0.05329156666994095,
-0.13167686760425568,
0.028353625908493996,
-0.02138551138341427,
0.05638277530670166,
0.05655592307448387,
-0.04573287069797516,
-0.03675004467368126,
0.017489882186055183,
0.026095930486917496,
-0.06620868295431137,
-0.03466569259762764,
0.09564083814620972,
0.0003451279771979898,
0.03645819425582886,
-0.043240346014499664,
-0.05261055752635002,
0.005338657647371292,
-0.0010704976739361882,
-0.039845339953899384,
-0.003933274187147617,
0.019790474325418472,
-0.07157336175441742,
-0.026559768244624138,
-0.007648323196917772,
-0.0181136392056942,
0.009332317858934402,
-0.06826025992631912,
0.028452245518565178,
0.06790030002593994,
-0.008332474157214165,
-0.06520038098096848,
0.0482417456805706,
0.07219353318214417,
0.0622791163623333,
0.048153918236494064,
-0.06033870205283165,
-0.07273092120885849,
0.011382327415049076,
-0.004263430833816528,
-0.034341003745794296,
-0.04967581108212471,
0.007327888160943985,
0.07430575788021088,
-0.0869661495089531,
-0.01538839004933834,
0.019544469192624092,
-0.025398319587111473,
0.044613439589738846,
-0.0018886479083448648,
0.10391911119222641,
-0.11477832496166229,
0.02384154126048088,
-0.02213633805513382,
-0.02790653705596924,
0.01465680543333292,
0.040660277009010315,
-0.19033098220825195,
-0.07687611132860184,
0.05296815186738968,
-0.045703548938035965,
-0.04020099714398384,
0.007635030429810286,
0.011965302750468254,
0.04978102445602417,
0.07097724825143814,
-0.019295990467071533,
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] |
Electrolyte\nLocation\nCations\nSodium\nExtracellular\tcation\nPotassium\nIntracellular\tcation\nCalcium\nExtracellular\tcation\nMagnesium\nIntracellular\tcation\nAnions\nChloride\nExtracellular\tAnion\nCO\n2\nExtracellular\tAnion\nPhosphorus\t(inorganic)\nIntracellular\n\tAnion\nThe\tmajor\t\nextracellular | [
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0.0429118275642395,
0.11825897544622421,
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0.042509011924266815,
0.09999372065067291,
0.0173720084130764
] |
Phosphorus\t(inorganic)\nIntracellular\n\tAnion\nThe\tmajor\t\nextracellular\n\telectrolytes\tare\tsodium,\tcalcium,\tchloride,\tand\tbicarbonate.\tPotassium, | [
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0.05055711418390274,
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magnesium,\tand\tphosphate\tare\tthe\tmajor\t\nintracellular\n\telectrolytes.\tThese\telements,\twhich\texist\tas\nions\tin\tbody\tfluids,\tare\tdistributed\tthroughout\tall\tbody\tfluids.\tElectrolytes\tare\tresponsible\tfor\nmaintenance\tof\tphysiologic\tbody\tfunctions,\tcellular\tmetabolism,\tneuromuscular\tfunction,\tand\nosmotic | [
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Calcium\nAlthough\tapproximately\t99%\tof\tthe\tbody’s\tcalcium\t(Ca\n++\n)\tis\tstored\tin\tthe\tskeleton\t(bones\tand\tteeth),\nthe\tremaining\t1%\thas\timportant\tphysiologic\tfunctions.\tIonized\tCa\n++\n\twithin\tthe\tvascular\ncompartment\tis\ta\tcation\twith\ta\tpositive\tcharge.\tApproximately\thalf\tof\tthe\tCa\n++\n\tfound\tin\tthe\nintravascular\tcompartment | [
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] |
++\n\tfound\tin\tthe\nintravascular\tcompartment\n\tis\tbound\tto\tthe\tserum\tprotein\talbumin.\tThus,\twhen\tserum\talbumin\tlevels\nare\tlow,\ttotal\tCa\n++\n\tlevels\tdecrease\tbecause\tof\thypoalbuminemia.\nThe\tbinding\tability\tof\tCa\n++\n\tand\tits\tionized\tcontent\tin\tblood\thave\timplications\tfor\tnormal\nhomeostatic\tmechanisms.\tBlood\ttests\tfor\tCa\n++ | [
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homeostatic\tmechanisms.\tBlood\ttests\tfor\tCa\n++\n\tlevels\toften\tmeasure\ttotal\tand\tionized\tCa\n++\n\tlevels.\nIonized\t(or\tfree,\tunbound)\tCa\n++\n\tis\tthe\tactive\tform\tof\tCa\n++\n\tand\tis\tnot\timpacted\n\tby\thypoalbuminemia.\nIn\thealthy\tadults,\tnormal\tlevels\tfor\tserum\ttotal\tCa\n++\n\tare\tabout\t8.5\tto\t10.5\tmg/dL,\twhereas\tnormal\nlevels\tfor\tionized\tCa\n++ | [
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] |
are\tabout\t8.5\tto\t10.5\tmg/dL,\twhereas\tnormal\nlevels\tfor\tionized\tCa\n++\n\tare\t4.5\tto\t5.5\tmEq/L\t(refer\tto\tthe\treference\tranges\tfor\teach\treporting\nlaboratory).\nFunctions\nCa\n++\n\tis\tan\textracellular\tcation\tnecessary\tfor\tblood\tclotting;\tCa\n++\n\tregulates\tnerve\ttransmission,\nmuscle\tcontraction,\tbone\tmetabolism,\tand\tblood\tpressure\tregulation.\n\tCa\n++ | [
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] |
Ca\n++\n\tis\tregulated\tby\nparathyroid\thormone\t(PTH),\tcalcitonin,\tvitamin\tD,\tand\tphosphorus.\tThrough\ta\tcomplex\tsystem\tof\nregulation\tamong\tmultiple\torgans,\tincluding\tthe\tkidney,\tGI\ttract,\tand\tbone,\tCa\n++\n\tabsorption\tcan\tbe\nenhanced\tto\tincrease\tCa\n++\n\treabsorption\tto\tmaintain\thomeostasis.\tWhen\tserum\tCa\n++\n\tlevels\tare\tlow,\nPTH\tcauses\trelease\tof\tCa\n++ | [
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++\n\tabsorption\tin\tthe\tGI\ntract.\nIn\tthe\tsetting\tof\thypoalbuminemia,\tserum\tCa\n++\n\tlevels\tare\tnot\taccurate\tbecause\tnearly\t50%\tof\nCa\n++\n\tis\tprotein\tbound.\tAn\tionized\tCa\n++\n\tlevel\tis\tthe\tmost\taccurate\tassay\tfor\tCa\n++\n\tbecause\tit\n\tis\tthe\nactive\tform\tand\tis\tnot\taffected\tby\tprotein\tlevels.\tIn\thealthy\tadults,\tnormal\tlevels\tfor\tserum\ttotal\nCa\n++ | [
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Ca\n++\n\tare\tapproximately\t8.5\tto\t10.5\tmg/dL,\twhereas\tnormal\tlevels\tfor\tionized\tCa\n++\n\tare\t4.5\tto\t5.5\nmEq/L\t(refer\tto\tthe\treference\tranges\tfor\teach\treporting\tlaboratory).\tWhen\tionized\tCa\n++\n\tlevels\tare\nnot\tavailable,\ta\tsimple\tformula\tmay\tbe\tused.\tThe\t\ncorrected\tcalcium\n\tformula\taccounts\tfor\ta\t0.8\nmg/dL\n\tdecrease\tin\tCa\n++ | [
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formula\taccounts\tfor\ta\t0.8\nmg/dL\n\tdecrease\tin\tCa\n++\n\tfor\teach\t1\tg/dL\tdecrease\tin\tserum\talbumin\tbelow\t4\tg/dL.\tThe\tcorrected\ncalcium\tformula\tis\nIonized\tCa\n++\n\tlevels\tare\taltered\tinversely\tby\tchanges\tin\tacid–base\tbalance;\tas\tserum\tpH\trises,\tCa\n++\nbinds\twith\tprotein,\n\tleading\tto\tdecreased\tionized\tCa\n++\n\tlevels.\tAs\tpH\tis\tlowered,\tthe\topposite\toccurs. | [
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++\n\tlevels.\tAs\tpH\tis\tlowered,\tthe\topposite\toccurs.\nBecause\tCa\n++\n\thas\tan\timportant\trole\tin\tcardiac,\tnervous\tsystem,\tand\tskeletal\tmuscle\tfunction,\nhypocalcemia\tand\thypercalcemia\tcan\tbecome\tlife\tthreatening.\nCommon\tcauses\tof\thypercalcemia\tare\tcancer\twith\tthe\tpresence\tof\tbone\tmetastases\tor\nhyperparathyroidism,\twhen\tthere\tis\ta\tlarge\tamount\tof\tCa\n++ | [
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hyperparathyroidism,\twhen\tthere\tis\ta\tlarge\tamount\tof\tCa\n++\n\tmoved\tinto\tthe\tECF.\tSymptoms\n\tof\nhypercalcemia\tinclude\tlethargy,\tnausea,\tvomiting,\tmuscle\tweakness,\tand\tdepression.\tTreatment\nusually\tis\tdirected\tat\ttreating\tthe\tunderlying\tcause\tof\tthe\tproblem,\tdiscontinuing\tCa\n++\n-containing\nmedications,\tand\tincreasing\tthe\texcretion\tof\tCa\n++ | [
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++\n\tregulation,\nthese\tare\tassessed\tin\tthe\tsetting\tof\ttrue\thypocalcemia.\tLow\tphosphorus\tand\tmagnesium\tlevels\tmust\nbe\treplete\tbefore\tCa\n++\n\tlevels\tcan\tbe\tcorrected\t(\nRhoda\tet\tal,\t2011\n).\nAbsorption\tand\texcretion\nApproximately\t20%\tto\t60%\tof\tdietary\tCa\n++\n\tis\tabsorbed\tand\tis\ttightly\tregulated\tbecause\tof\tthe\tneed\nto\tmaintain\tsteady\tserum\tCa\n++ | [
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Sources\nDairy\tproducts\n\tare\tthe\tmain\tsource\tof\tCa\n++\n\tin\tthe\tAmerican\tdiet,\twith\tsome\tgreen\tvegetables,\tnuts,\nlegumes,\tcanned\tfish\tincluding\tbones,\tand\tCa\n++\n-enriched\ttofu\thaving\tmoderate\tamounts\tof\tCa\n++\n.\nFood\tmanufacturers\tfortify\tmany\tfoods\twith\tadditional\tCa\n++\n,\tsuch\tas\torange\tjuice\tthat\tmay\thave\nsome\tbioavailability\t(see\t\nAppendix\t39\n). | [
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] |
some\tbioavailability\t(see\t\nAppendix\t39\n).\nRecommended\tintakes\nIn\tadults,\trecommended\tintakes\tof\tCa\n++\n\trange\tfrom\t1000\tto\t1300\n\tmg/day,\tdepending\ton\tage\tand\ngender.\tAn\tupper\tlimit\tfor\tCa\n++\n\tintake\thas\tbeen\testimated\tto\tbe\tapproximately\t2500\tto\t3000\tmg/day\n(see\tinside\tcover).\tExcessive\tintake\tof\tCa\n++ | [
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] |
(see\tinside\tcover).\tExcessive\tintake\tof\tCa\n++\n\tmay\tlead\tto\tkidney\tstones\tand\tgastrointestinal\tside\neffects\tlike\tconstipation.\nSodium\nSodium\t(Na\n+\n)\tis\tthe\tmajor\tcation\tof\tECF\twith\ta\tnormal\trange\tof\t135\tto\t145\tmEq/L\t(refer\tto\tthe\nreference\tranges\tfor\teach\treporting\tlaboratory).\n\tSecretions\tsuch\tas\tbile\tand\tpancreatic\tjuice\tcontain | [
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Secretions\tsuch\tas\tbile\tand\tpancreatic\tjuice\tcontain\nsubstantial\tamounts\tof\tNa\n+\n.\tGastric\tsecretions\tand\tdiarrhea\talso\tcontain\tNa\n+\n,\tbut\tcontrary\tto\ncommon\tbelief,\tsweat\tis\thypotonic\tand\tcontains\ta\trelatively\tsmall\tamount\tof\tNa\n+\n.\tApproximately\n35%\tto\t40%\tof\tthe\ttotal\tbody\tNa\n+\n\tis\tin\tthe\tskeleton\tand\tthe\tremainder\tis\tin\tbody\tfluids.\nFunctions | [
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+\n\tis\tin\tthe\tskeleton\tand\tthe\tremainder\tis\tin\tbody\tfluids.\nFunctions\nAs\tthe\tpredominant\tion\tof\tthe\tECF,\tNa\n+\n\tthus\tregulates\n\textracellular\tand\tplasma\tvolume.\tNa\n+\n\tis\talso\nimportant\tin\tneuromuscular\tfunction\tand\tmaintenance\tof\tacid–base\tbalance.\tMaintenance\tof\tserum\nNa\n+\n\tlevels\tis\tvital,\tbecause\tsevere\t\nhyponatremia | [
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Na\n+\n\tlevels\tis\tvital,\tbecause\tsevere\t\nhyponatremia\n\tcan\tlead\tto\tseizures,\tcoma,\tand\tdeath.\nExtracellular\tNa\n+\n\tconcentrations\tare\tmuch\thigher\tthan\tintracellular\tlevels\t(normal\tserum\tNa\n+\n\tis\naround\t135\tmEq/L,\twhereas\tintracellular\tlevels\tare\taround\t10\tmEq/L).\tThe\n\tsodium-potassium\tATP\npump\tis\tan\tactive\ttransport\tsystem\tthat\tworks\tto\tkeep\tNa\n+ | [
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pump\tis\tan\tactive\ttransport\tsystem\tthat\tworks\tto\tkeep\tNa\n+\n\toutside\tthe\tcell\tthrough\texchange\twith\npotassium.\tThe\tNa/K-ATPase\tpump\trequires\tcarriers\tfor\tNa\n+\n\tand\tpotassium\talong\twith\tenergy\tfor\nproper\tfunction.\tExportation\tof\tNa\n+\n\tfrom\tthe\tcell\tis\tthe\tdriving\tforce\tfor\tfacilitated\ttransporters, | [
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common\telectrolyte\tdisorders\tamong\thospitalized\tpatients\tand\toccurs\tin\t25%\tof\tinpatients.\tWhen\nhyponatremia\tis\tbelow\t125\tmEq/L,\tsymptoms\tgenerally\tbecome\tapparent.\tPatients\tmay\tdisplay\tsigns\nof\theadache,\n\tlethargy,\trestlessness,\tdecreased\treflexes,\tseizures,\tor\tcoma\tin\textreme\tcases.\tThere | [
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+\n\tis\tdissolved\tand\tresults\tin\ta\tfalsely\tlow\nvalue\t(this\tis\tmainly\ta\tlaboratory\tartifact\tand\tis\tnot\toften\tseen\tin\tclinical\tpractice).\tThe\tfinal\ttype\tis\nhypotonic\thyponatremia.\tEvaluation\n\tdepends\ton\tfluid\tstatus\tto\tevaluate\tthe\tthree\tsubtypes.\nIsovolemic\thyponatremia\tcan\tbe\tcaused\tby\tmalignancies,\tadrenal\tinsufficiency,\tor\tthe\tsyndrome\tof | [
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inappropriate\tantidiuretic\thormone\tsecretion\t(SIADH).\tSIADH\t(see\t\nChapter\t30\n)\tcan\tresult\tfrom\ncentral\tnervous\tsystem\tdisorders,\tpulmonary\tdisorders,\ttumors,\tand\tcertain\tmedications.\tThe\ntreatment\tis\tusually\twater\trestriction.\tHypervolemic\thypotonic\n\thyponatremia\tis\tcharacterized\tby\nexcess\tTBW\tand\tNa\n+\n\t(overall\thigher\texcess\twater\tthan\tNa\n+ | [
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diuretics\tto\taid\tin\tdecreasing\tTBW,\tand\toral\tNa\n+\n\trestriction\talso\tmay\n\tbe\tbeneficial.\tThe\tfinal\ttype\tis\nhypovolemic\thypotonic\thyponatremia,\tcharacterized\tby\ta\tdeficit\tin\tTBW\tand\tNa\n+\n\tthat\trequires\ntreatment\twith\tfluid\treplacement.\tOften\tfluid\tlosses\tleading\tto\thypovolemia\thyponatremia\tinclude | [
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+\n\tlevels\tmust\tbe\tdone\nslowly\t(max\tof\t8\tto\t12\tmEq\tin\t24\thours)\tto\tprevent\tosmotic\tdemyelinating\tsyndrome\tthat\tis\tseen\twith\nrapid\tcorrection\t(\nRhoda\tet\tal,\t2011\n).\nHypernatremia.\nA\tserum\tNa\n+\n\tlevel\tgreater\tthan\t145\tmEq/L\tis\tclassified\tas\thypernatremia,\tand\tthere\tare\tvarious\ntypes.\tHypovolemic\thypernatremia\n\tis\tcaused\tby\ta\tloss\tof\tNa\n+ | [
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types.\tHypovolemic\thypernatremia\n\tis\tcaused\tby\ta\tloss\tof\tNa\n+\n\tand\tTBW\twhen\twater\tlosses\texceed\nNa\n+\n\tlosses.\tIt\tis\timportant\tto\tidentify\tthe\tcause\tof\tthe\tfluid\tlosses\tso\tthat\tthey\tcan\tbe\tcorrected\tand\nprevented\tin\tthe\tfuture.\tThe\ttreatment\tis\tto\tslowly\treplace\tfluid\tvolume\twith\ta\thypotonic\tfluid | [
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solution.\tHypervolemic\thypernatremia\tis\tcaused\tby\texcessive\tintake\tof\tNa\n+\n\tresulting\tin\thigher\tNa\n+\ngain\tthan\twater\tgains.\tThe\ttreatment\tis\n\tto\trestrict\tNa\n+\n\t(especially\tin\tintravenous\tfluids)\tand\tpossibly\nthe\tuse\tof\tdiuretics.\tIsovolemic\thypernatremia\tis\tseen\twith\tdisease\tstates\tsuch\tas\tdiabetes\tinsipidus. | [
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] |
Signs\tof\thypernatremia\tinclude\tlethargy,\tthirst,\thyperreflexia,\tseizures,\tcoma,\tor\tdeath.\tFormulas\tfor\ncalculating\ta\twater\tdeficit\tare\thelpful\tto\tguide\tfluid\treplacement.\tFree\twater\tdeficit\tis\tcalculated\tas\nfollows\t(\nKingley,\t2005\n): | [
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Absorption\tand\texcretion\nNa\n+\n\tis\tabsorbed\treadily\tfrom\tthe\tintestine\tand\tcarried\tto\tthe\tkidneys,\twhere\tit\tis\tfiltered\tand\nreturned\tto\tthe\tblood\tto\tmaintain\tappropriate\tlevels.\tThe\tamount\tabsorbed\tis\tproportional\tto\tthe\nintake\tin\thealthy\tadults.\nAbout\t90%\tto\t95%\tof\tnormal\tbody\tNa\n+\n\tloss\tis\tthrough\tthe\turine;\tthe\trest\tis\tlost\tin\tfeces\tand\tsweat. | [
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