Altered Electrolyte States

Question 1

Hyponatremia: common causes

Answer 1

diuretics, GI fluid oss, hypotonic tube feeding, D5W or hypotonic Iv fluids, diaphoresis

Question 2

Hypernatremia: common causes

Answer 2

water deprivation, hypertonic tube feeding, diabetes insipidus, heat stroke, hyperventilation, watery diarrhea, renal failure, Cushing syndrome (cortisol)

Question 3

Hypokalemia: common causes

Answer 3

diuretics, diarrhea, vomiting, gastric suction, steroid administration, hyperaldosteronism, amphotericin B, bulimia, Cushing syndrome (cortisol)

Question 4

Hyperkalemia: common causes

Answer 4

hemolyzed serum sample –> produces pseudohyperkalemia, oliguria, acidosis, renal failure, Addison disease (adrenal glands), multiple blood transfusions

Question 5

hypocalcemia: common causes

Answer 5

renal failure, hypoparathyroidism, malabsorption, pancreatitis, alkalosis

Question 6

hypercalcemia: common causes

Answer 6

hyperparathyroidism, malignant bone disease, prolonged immobilization, excess calcium supplementation

Question 7

hypomagnesemia: common causes

Answer 7

alcoholism, malabsorption, diabetic ketoacidosis, gastric suction, diuretics

Question 8

hypermagnesemia: common causes

Answer 8

renal failure, adrenal insufficiency, excess replacement

Question 9

hypophosphatemia: common causes

Answer 9

refeeding after starvation, alcohol withdrawal, diabetic ketoacidosis, respiratory alkalosis

Question 10

hyperphosphatemia: common causes

Answer 10

renal failure, excss intake of phosphorus

Question 11

hyponatremia: s/s and treatment

Answer 11

anorexia, n/v, weakness, lethargy, confusion, muscle cramps, twitching, seizures, Na < 135;
restrict fluids (safer), If IV saline solutions prescribed administer very slowly; use if fluid restriction not effective

Question 12

hypernatremia: s/s + treatment

Answer 12

thirst, hyperpyrexia, sticky mucous membranes, dry mouth, hallucinations, lethargy, irritability, seizures, Na >145;
restrict sodium in the diet, beware of hidden sodium in foods and medications, increase water intake

Question 13

hypokalemia: s/s + tx

Answer 13

fatigue, anorexia, n/v, muscle weakness, decreased GI motility, dysrhythmias, paresthesia, Flat T waves on EKG, K < 3.5;
give K supplements (don’t give oral supplements to empty stomach - can be irritating; dilute) and never give IV bolus - must always be diluted. Assess renal status prior to administering, encourage foods high in potassium

Question 14

hyperkalemia: s/s + tx

Answer 14

muscle weakness, bradycardia, dysrhythmias, flaccid paralysis, intestinal colic, tall t waves on EKG, K > 5;
Eliminate parenteral potassium from IV infusions and medications. Administer 50% glucose with regular insulin, adminster Kayexalate, monitor EKg, administer calcium gluconate to protect the heart, possibly need IV loop diuretics or renal dialysis

Question 15

hypercalcemia: s/s, tx

Answer 15

muscle weakness, constipation, anorexia, n/v, polyuria, polydipsia, neurosis, dysrhythmias, Ca >10.5;
eliminate parenteral calcium, administer agents to reduce calcium such as calcitonin, avoid calcium-based antacids, renal dialysis may be required

Question 16

hypomagnesemia: s/s, tx

Answer 16

anorexia, distention, neuromuscular irritability, depression, disorientation, Mg 1.5;
administer MgSO4, IV. Encourage foods high in magnesium: meats, nuts, legumes, fish, vegetables

Question 17

hypermagnesemia: s/s, tx

Answer 17

flushing, hypotension, drowsiness, lethargy, hypoactive reflexes, depressed respirations, bradycardia, Mg 2.5;
Avoid magnesium-based antacids and laxatives, restrict dietary intake of foods high in magnesium

Question 18

hypophosphatemia: s/s, tx

Answer 18

paresthesias, muscle weakness, muscle pain , mental changes, cardiomyopathy, respiratory failure, pH >4.5;
Correct underlying cause, administer oral replacement of phosphates with vitamin D.

Question 19

hyperphosphatemia: s/s, tx

Answer 19

short term: tetany symptoms. long-term: phosphorus precipitation in nonosseous sites, pH >4.5 ;
administer aluminum hydroxide with meals to bind phosphorus, dialysis may be required if renal failure is underlying cause

Question 20

Respiratory Acidosis: causes

Answer 20

hypoventilation; COPD/pulm disease, drugs, obesity, mechanical asphyxia, sleep apnea.

Question 21

Metabolic Acidosis: causes

Answer 21

Addition of large amounts of fixed acids to body fluids; lactic acidosis (circulatory failure), ketoacidosis (diabetes/starvation), phosphates and sulfates (renal disease), acid ingestion (salicylates), secondary to respiratory alkalosis, adrenal insufficiency

Question 22

Respiratory alkalosis: causes

Answer 22

Hyperventilation - too much CO2 expired; overventilation on a vent, response to acidosis, bacteremia, thyrotoxicosis, fever, hepatic failure, response to hypoxia, hysteria.

Question 23

Metabolic alkalosis: causes

Answer 23

retention of base or removal of acid from body fluids; excess gastric drainage, potassium depletion (diuretics), burns, excessive NaHCO3 administration