Electrolyte Imbalances Flashcards
***Sodium
135-145
Main electrolyte in ecf
Major role in ecf volume/distribution in the body
Sodium imbalances
Hyponatremia <135
Hypernatremia >145
***Potassium
3.5-5
Major icf electrolyte
Transmission of nerve impulses
Skeletal and cardiac muscle contractility
Potassium imbalances
Hypokalemia <3.5
Hyperkalemia >5
***Calcium
8.8-10.4
99% of calcium is stored in bones
The rest is bound to plasma proteins (albumin) or free/ionized (active form)
Transmits nerves impulses
Muscle contraction (skeletal and cardiac)
Calcium imbalances
Hypocalcemia <8.8
Hypercalcemia >10.4
***Magnesium
1.8-2.6
Regulates muscle contraction
Metabolizes carbs and proteins
Magnesium imbalances
Hypomagnesemia <1.8
Hypermagnesemia >2.6
***Phosphorous
2.7-4.5
Most phosphorus is in bones/teeth
Involved in acid/base balance, metabolism
Phosphate imbalances
Hypophosphatemia: <2.7
Hyperphosphatemia: >4.5
***Hyponatremia
Sodium loss (GI,Renal,skin)
Water gained (excessive hypotonic ivf, psych issues, tumors/endocrine diseases)
CHF
Exercise induced
Low sodium in bv= fluid leaves and goes to cell causing edema
Hyponatremia symptoms ***
Neuro changes :
Mild:
Irritability, headache
Severe:
Confusion, seizures
Vomiting
Coma
Fatal
Severe if less than 115
Hyponatremia tx ***
NO DIURETICS (bc itll get rid of sodium too)
Sodium replacement (SLOWLY) (
*PO or LR/0.9% NS
*more sever require hypertonic saline
Fluid restriction
Strict I/O
Daily weights
Seizure precautions (edema cause seizure risk)
Hypernatremia ***
Sodium gain
Water loss or low intake
Endocrine issues (uncontrolled DM)
Sodium is high in BV (ECF) eater moves into BV (shrinks cells)
Hypernatremia s/s ***
Thirst
Sticky mucous membranes
Elevated body temp
Restlessness, irritability
Seizures
Hypernatremia tx ***
Fluid replacement: depends on cause
Slow and steady
Usually isotonic, sometimes hypotonic
Monitor neurological status
High Na diet ***
Good for hyponatremia
Processed foods
Canned
Fast foods
Chips
Chees
Lunch meat
Low Na foods ***
Good for hypernatremia
Fruits
veggies
Freshmeats, fish
Oatmeal
Hypokalemia ***
GI, Renal, Skin loss
Shift of potassium into cells
-high insulin levels
-alkalosis (ph imbalance)
Hypokalemia s/s ***
Muscle weakness
Decreased reflexes
Constipation, paralytic ileus
Weal/irregular pulse
Bradycardia
*pearl: increased risk for digoxin toxicity (it also slows down heart)
Hypokalemia tx ***
Oral replacement via diet or supplement
IV potassium if severe (but it could stop heart) (hard on veins could cause phlebitis)
Cautious replacement if kidney disease or decreased renal function
IV Potassium ***
Always dilute and must use a pump
NEVER IV push or bolus
Use largest peripheral site possible or central if available
Cardiac monitor pt
Hyperkalemia ***
Excess intake (salt substitutes, potassium in meds)
Shifts potassium out of cells because of destruction of cell membrane (burns, trauma, sepsis, intense exercise, acidosis)
Failure to eliminate extra potassium (renal disease)
Hyperkalemia s/s ***
Weakness
Flaccid paralysis
Abdominal cramps
Peaked T waves (heart getting irritable)
*can progress to cardiac arrest
Hyperkalemia tx ***
Obtain ECG
Potassium restrictions/med changes (PO intake)
May use kayexalate by mouth or enema
Loop diuretics (kidney removal)
*both too slow for severe
IVP insulin with IVP dextrose solution then use other methods
May require dialysis for removal
Why do you give IVP insulin and IVP dextrose for hyperkalemia? ***
Ivp insulin will push K into cells
Dextrose prevents low glucose
Hyperkalemia interventions ***
Monitor I/O
Monitor cardiac rhythm
Apical pulse (bc of heart arrhythmias)
Pt education diet
Hypocalcemia ***
Loss thru:
Hypoparapthyroidism
Chronic kidney disease
Chronic alcohol abuse
Diarrhea
Get large amounts of citrated blood
Med SEs
Hypocalcemia s/s ***
Increased nerve excitability tetany
*tetany=constant muscle contractions
Chvosteks sign=contraction of facial muscles in response to tap over facial nerve
Trousseaus sign=carpal spams when BP cuff inflated above systolic pressure
CATS: Convulsion, Arrhythmias, Tetany, Stridor and spasms
Hypocalcemia tx ***
Mild: PO calcium/ vit d
Symptomatic: IV calcium gluconate
Cardiac monitor (can cause hypotension), and seizure precautions
Hypercalcemia ***
Hyperparathyroidism
PTH moves calcium into plasma
Cancers
Dietary intake
Rare: prolonged immobilization
Hypercalcemia s/s ***
BACKME:
Bone pain
Arrhythmia
Cardiac Arrest
Kidney stones
Muscle weakness
Excessive urination
Hypercalcemia interventions ***
Mild: decrease intake of calcium
Severe:
Isotonic IVF to dilute it
Bisphosphonate(causes bone absorption of calcium moves from plasma)
*gold standard, 2-4 days for max effect
HD if life threatening
Hypomagnesemia ***
GI loss
Chronic ETOH
Long term PPI use
Hypomagnesemia s/s ***
Muscle cramps
Hyperactive DTR
Arrhythmia (tachycardia)
Tremors, seizures, confusion
Hypomagnesemia management ***
Oral replacement
Iv replacement with: magnesium sulfate
*must use pump, rapid administration can cause hypotension and cardia/resp arrest
Hypermagnesemia ***
Renal failure
IV magnesium use
Antiacids
Laxatives
Hypermagnesemia S/S ***
Initial:
Hypertension
Facial flushing
Lethargy
Urinary retention
As levels increase:
Loss of DTR
Muscle paralysis
Coma
Hypermagnesemia management ***
Decrease po intake
Po fluids/diuretics
HD
IV calcium gluconate (cardio protective)
*prevents heart from freaking out while removing magnesium
Hypophosphatemia***
Malabsorption
Chronic diarrhea
Chronic ETOH
CKD
Hypophosphatemia s/s ***
Mild to moderate often asymptomatic
Severe: CNS depression, resp/heart failure, muscle weakness
Chronic will cause osteomalacia/rickets
Hypophosphatemia management ***
Mild: oral replacement
Severe: IV phosphate replacement
*any electrolyte replacement needs cardiac monitoring
Hyperphosphatemia***
Renal failure
Excess intake (laxatives/enemas)
Rhabdomyolysis
Hypoparathyroidism
Hyperphosphatemia s/s ***
May be asymptomatic
If calcium binds to ectra phosphate in blood=s/s of HYPOCALCEMIA
Long term can cause calcified deposits in soft tissue
Hyperphosphatemia management ***
Phosphate binders (calcium carbonate)
HD
Can be chronic in pt with renal failur, managed by nephrologist
