Electrolyte Embalance - A Guide - Unit 1 Flashcards
What are some of the functions of sodium?
Maintains ECF osmolality (acid-base balance)
Sodium is the ____ cation in the ECF.
Dominant!
Where sodium goes, water flows. T/F?
True!
What is the normal range for sodium?
135-145 mEq/L
Hyponatremia - due to….
Sodium loss (solute deficit)/water gain.
Hyponatremia - may result from excess fluid/water in the body. T/F?
True!
Hyponatremia -caused by excess fluid/water can be caused by…
Kidney failure, congestive failure, prolonged use of diuretics (older adults,) profuse sweating or severe vomiting or diarrhea (sodium and found are lost from the body) and excessive ingestion of hypotonic fluids.
What are some manifestations of hyponatremia?
Headache, confusion or altered mental state, seizures, decreased consciousness which can lead to coma and death.
How do we diagnose hyponatremia?
We diagnose through symptoms and labs.
What do we do to treat hyponatremia? (Chronic)
Adjustments to diet, lifestyle or medications.
How do we treat hyponatremia? (Severe or acute hyponatremia)
IV fluids, electrolytes and drugs..we give them hypertonic solutions of 2-3% saline over a slow period of time. Or, we could give them 0.9% isotonic depending on the symptoms or conditions of the patient.
Hypernatremia - results from the loss of……
Free water or gain of sodium loss in excess of water. The net result is an increase in the concentration of sodium in the blood.
Sodium is the contributor to serum osmolality - so know both - T/F?
True!
What are some symptoms of hypernatremia?
Symptoms vary - but typically the first seen involve excitable membrane activity - like cerebral, muscular, and cardiac.
How do we diagnose hypernatremia?
Levels and history of patient
How do we treat hypernatremia?
Use hypotonic solutions, diuretics that excrete sodium, monitor urine output and serum sodium levels and serum osmo, and nutritional therapy
Potassium - it is the major ___ - __% is found in the ICF
Cation - 98%
Movement of potassium is influenced by —- ?
Changes in pH, insulin, adrenal hormones, and changes in serum sodium.
What is the normal potassium level?
3.5-5.5 mEq
What are some of the functions of potassium?
Neuromuscular irritability, cardiac impulse conduction and muscle contractility, electrical impulses in nerve, skeletal and intestinal tissue, regulation of acid-base balance, influencing kidney function, intestinal absorption, etc.
What can cause hypokalemia?
Excessive fluid loss from diarrhea, tubes, diuretic drugs, draining wounds/fistulas, malabsorption syndrome, acid base imbalances, heart failure, some drugs like digoxin/ace inhibitors/laxatives, etc.
What are some cardiac changes in hypokalemia?
Weak pulse, flat or inverted t waves, irregular heartbeat, multi focal PVC’s..
Hypokalemia can not increase the chance of digitalis (digoxin) toxicity. T/F?
FALSE - it can’t be eliminated, so it can increase the risk of toxicity.
What are some manifestations of hypokalemia?
Generalized muscle weakness, muscle cramps, cardiac dysrhythmia’s, abdominal pain, vomiting, nausea, anorexia, reduced intestinal peristalsis, paralytic ileus.
What are some of the treatment options for hypokalemia?
Correct the cause, oral or intravenous administration of potassium, salt substitutes containing potassium, potassium enriched foods, Eliminate medications enhancing the symptoms and condition
What are some of the causes of hyperkalemia?
Kidney failure (chronic), cell trauma (burns, crush injuries, MI), I+sparing diuretics, acidosis state - possibly during a cardiac arrest!
What are some manifestations of hyperkalemia?
Usually vague - numbness and tingling and weakness but will continue to get worse. More serious is bradycardia and fatal dysrhythmia’s and CA, flaccid paralysis and apathy!
What are some cardiac changes in hyperkalemia?
EKG changes, distinctive tall/peaked T waves with a prolonged PR interval. The QRS widening - not good! V fib or asystole? Dead dead!
What is the treatment for hyperkalemia?
Usually individual based, but could include (calcium gluconate, regular insulin and 50% dextrose all given together), hemodialysis, kayexalate (given rectally) some bicarbonate maybe, and stop drugs that promote sparing of potassium or give diuretics to get rid of the potassium.
What is the normal value of calcium?
8.5-10 mEq
__% stored in bones and teeth. (calcium)
98%
Calcium - %__ found in the blood is bound to protein and muscle cells store calcium.
50%
Calcium - closely related to phosphorus and magnesium. T/F?
True!
Calcium - absorbed in the GI tract under the influence of vitamin D. T/F?
True!
What are some functions of calcium?
Parathyroid hormone is a part of this, muscle contractility, correct neural function, development and strength of bones and teeth, blood clotting, transmission of nerve impulses - muscle contractions and relaxation
Hypocalcemia - goes hand in hand with hypoparathyroidism, right?
Right!
Hypocalcemia - insufficient dietary intake of __ and __ __.
CA and vitamin D!
Hypocalcemia - other causes?
Impaired intestinal absorption from diarrhea, overuse of laxatives or enemas containing phosphorus, renal failure, sepsis, hypomagnesemia
What are some manifestations of hypocalcemia?
Muscle spasms, twitching, cramping, tetany, Positive Chvostek’s sign (cheek) and trousseau’s sign (BP), seizures, bradycardia, decreased cardiac contractility, altered blood clotting/bleeding.
How do we treat hypocalcemia?
oral or intravenous calcium, encourage dietary intake of calcium, careful use of laxatives and stuff, and we monitor calcium, albumin, and clotting levels.
Hypercalcemia - goes hand in hand with ____ and ____.
Hyperparathyroidism and Hypophosphatemia
What else can cause hypercalcemia?
Prolonged immobility, excess calcium or Vitamin D, bone tumors, clots.
Hypercalcemia - rare or not rare?
Rare!
Hypercalcemia - Moans, Stones, and Groans - T/F?
True!
What are some manifestations of hypercalcemia?
Confusion, personality changes, depression, pathologic fractures, heart block, constipation, renal calculi with flank pain, watch for DVT’s!
What is the treatment for hypercalcemia?
Give bolus of IV fluids, monitor cardiac function, calcium binders, loop diuretics, treat diseases, maybe dialysis, and activity!
Phosphorus - what are the normal levels?
3-4.5
Phosphorus - major __ in the ICF
__% found in bones, which need vitamin D to absorb phosphorus.
Anion!
80%
Phosphorus - a big part of ___ (think energy!)
ATP!
Functioning kidneys do not excrete phosphorus. T/F?
False - they do!
Hypophosphatemia - rare? not rare?
Goes hand in hand with hyper_____>
Rare - goes hand in hand with hyperparathyroidism.
Hypophosphatemia - what are some other causes?
Chronic alcoholism, malabsorption, over use of maalox, amphogel, etc.
What are some manifestations of Hypophosphatemia?
Mostly seen at prolonged levels, but can be…weakness (profound), shortness of breath, respiratory depression and decreased muscle movements leading to respiratory arrest, slow and difficult pulses, metabolic issues.
How do we treat hypophosphatemia?
Oral phosphate supplements, IV phosphate for severely low levels, nutritional intake, vitamin D supplements, and may give medicine to lower calcium!
What causes hyperphosphatemia?
Renal insufficiency or end stage renal failure (they can’t excrete it), hypocalcemia, excessive intake of alkali (baking soda), lymphomas, use of laxatives or enemas containing large amounts of phosphate
What are some manifestations of hyperphosphatemia?
Directly related to symptoms of hypocalcemia, cardiac dysrhytmia’s, tetany, soft tissue calcification.
How we do treat hyperphosphatemia?
We manage the hypocalcemia, restrict dietary intake of phosphorus, give drugs that bing with phosphate, monitor calcium levels, observe for tetany and cardiac dysrhythmia’s, and a new drug panel (Calcimimeic)
Magnesium - normal levels and what does it do?
1.5-2.5, absorbed from blood and lost primarily from kidney’s, also from intestinal tract, critical for skeletal muscle contractions, carb metabolism and ATP, and it has a potent vasodilation effect!
Deficiency of calcium affects magnesium - T/F?
True!
What are some functions of magnesium?
Affects skeletal muscles, mainly affects CV and Nervous Systems, vasodilation, transport of potassium and sodium across the cell membrane, etc.
Hypomagnesemia - caused by…
chronic alcoholism, starvations, renal disease, crohn’s disease, acute or chronic pancreatitis, surgeries (like CABG)
What are some manifestations of hypomagnesemia?
Hyperirritability, tetany, cramps, numbness and tingling of legs and feet, dizziness, arrhythmia’s, low serum calcium and potassium.
What is the treatment for hypomagnesemia?
Slow IV infusion of magnesium sulfate, dietary intake of magnesium, reduce external stimuli, monitor CV and NS stimulus, help with alcohol abuse, dietary management, maybe give calcium, etc.
What causes hypermagnesemia?
Chronic renal failure, excessive intake of magnesium (laxatives or antacids), hyperparathyroidism
What are some manifestations of hypermagnesemia?
Bradycardia, weak pulse, cardiac arrest (your BP can bottom out, too), tremors, hyporeflexia, hypotension (severe)
What is the treatment for hypermagnesemia?
Dialysis for renal patients, calcium gluconate IV, stop antacids and laxatives, encourage fluid intake, monitor for CV and Resp function, give loop diuretics.
Chloride - what are the functions?
Maintains fluid balance, produces hhydrochloric acid in stomach, acid-base balance, buffer, nerve transmission, excreted by kidney’s, etc.
Hypochloremia - seen in/caused by….
metabolic alkalosis, diabetic ketoacidosis, increase in serum bicarbonate, burns.
Hyperchloremia - seen in/caused by….
hypernatremia.
Chloride - Basically shifts between intracellular and extracellular compartments….T/F?
True!
