Electrolyte Information

Question 1

Hypocalcemia Levels

Answer 1

(Serum < 8.9 mg/dL or Ionized < 4.5 mg/dL)

Question 2

Hypocalcemia Causes

Answer 2

Inadequate vitamin D
Decreased estrogen production 
Hypoparathyroidism
Renal disease
Low albumin levels
Stimulant laxatives
Chronic steroid use
Proton pump inhibitors
Inhibits H+ absorptions

Question 3

Hypocalcemia S/S

Answer 3

Chest pain
Dysrhythmias
Renal calculi
Numbness and tingling
Muscle cramping
Confusion
Osteopenia 
Dental problems

Chcostek/Trosseau Signs

Question 4

Calcium, Serum vs. Ionized

Answer 4

Serum calcium accounts for all calcium, whether it is in the free ionized form or if it is bound to proteins.

Ionized detects the active or unbound form of calcium in the body

Question 5

Hypocalcemia Treatment

Answer 5

Calcium and vitamin D supplementation

Increased dietary intake

Calcium injections

Question 6

Hypercalcemia Levels

Answer 6

(Serum >10.5 mg/dL or ionized > 5.6 mg/dL)

Question 7

Hypercalcemia Causes

Answer 7

Cancer
Hyperparathyroidism
Vitamin D toxicity
TUMS, too much can contribute to hypercalcemia

Question 8

Hypercalcemia S/S

Answer 8

Mild symptoms - GI Issues
Constipation
Abdominal pain
Nausea
Vomiting 

Severe symptoms
Confusion
Renal failure
Arrhythmias
Coma
Death

Question 9

Hypercalcemia Treatment

Answer 9

Administer phosphate, why?
Ca and Phosphorous have an inverse relationship

Intravenous saline bolus

Loop diuretic

Hemodialysis in severe cases

Question 10

Hypomagnesemia Levels

Answer 10

(< 1.8 mg/dL or 1.3 mEq/L)

Question 11

Hypomagnesemia Causes

Answer 11

Crohn’s disease or celiac disease
Diarrhea or pancreatitis
Type 2 diabetes
In the presence of hypokalemia and hypocalcemia
Decreased intake 
Increased renal excretion

Question 12

Hypomagnesemia Symptoms

Answer 12

Mild symptoms
Decreased appetite, fatigue, nausea, weakness

Severe
Muscle cramps, numbness and tingling, seizures, tetany, and personality changes

Question 13

Hypomagnesemia Treatment

Answer 13

Oral or intravenous magnesium

What might have to be treated first before magnesium can be given?
Restore calcium or potassium balance

Educate clients on foods high in magnesium

Question 14

Hypermagnesemia Levels

Answer 14

(> 2.3 mg/dL or 2.1 mEq/L)

Question 15

Hypermagnesemia Causes

Answer 15

Kidney disease
Acidosis
Hypothyroidism
Trauma
Medications that increase dwell time of food in the intestines (opioids or anticholinergics)
Laxatives or antacids that contain magnesium

Question 16

Hypermagnesemia Symptoms

Answer 16

Mild symptoms
Dizziness, nausea, weakness, confusion

Severe symptoms
Confusion, blurred vision, headache, bladder paralysis, bradycardia, reduced respiratory rate, loss of deep tendon reflexes, death

Question 17

Hypermagnesemia Treatment

Answer 17

Something given to prevent cardiac problems…similar to hyperkalemia?
Calcium chloride and calcium gluconate (EKGS covered in NUR 410)

Intravenous saline with diuretics

Severe cases may require?
Hemodialysis

Question 18

Dietary Sources for Electrolytes

Answer 18

Finish here

Question 19

Hypokalemia Levels

Answer 19

(K < 3.5 mEq/L)

Question 20

Hypokalemia Causes

Answer 20

Diuretics 
Metabolic alkalosis
Folic acid deficiency
Gastrointestinal losses
Decreased intake of potassium

Question 21

Hypokalemia S/S

Answer 21

Mild
Cardiac arrythmias, constipation, fatigue

Severe
Respiratory paralysis, paralytic ileus, tetany, hypotension, rhabdomyolysis, life threatening arrythmias

Question 22

Hypokalemia Treatment

Answer 22

Priority is determining underlying cause

Potassium supplementation

Switch to a potassium sparing diuretic like spironolactone

Making dietary changes

Intravenous Potassium
ONLY given IV through a slow infusion

Question 23

Hyperkalemia Levels

Answer 23

(K > 5.0 mEq/L)

Question 24

Hyperkalemia Causes

Answer 24

Acute renal failure
Dehydration
Diabetes
Burns
Acidosis 
Blood transfusion
K in packed red blood cells

CPR can damage cells and release potassium

Question 25

Hyperkalemia S/S

Answer 25

Mild
Nausea, vomiting, muscle aches, weakness, dysrhythmias

Severe
Paralysis, heart failure, death

Question 26

Hyperkalemia Treatment

Answer 26

Hemodialysis if the cause is acute renal failure

To reduce the effects of hyperkalemia on the heart
Calcium gluconate or calcium chloride (more on that in NUR 410)

If renal failure is not present
Loop diuretics like furosemide

Sodium polystyrene sulfonate (Kayexalate)
Bind to potassium and excrete it in feces

Intravenous insulin
Insulin helps to push potassium into the cell
Must have glucose monitored to prevent hypoglycemia

Question 27

Hyponatremia Levels

Answer 27

(Na < 135 mEq/L)

Question 28

Hyponatremia Causes

Answer 28

Severe vomiting or diarrhea - prolonged
Drinking excess water
Excess alcohol intake
Thiazide diuretics
Liver or Heart disease

Question 29

Hyponatremia S/S

Answer 29

Mild
Nausea, feeling unwell

Severe
Cerebral edema, lethargy, confusion, irritability, seizure, coma

Question 30

Hyponatremia Treatment

Answer 30

Sodium levels must be raised slowly to prevent rapid fluid shifts in neurologic cells
remember tonicity
Cells can shrink up

Fluid restriction

If the cause is due to thiazide diuretics
Isotonic IV fluids
Hypertonic is only used
in extreme situations of
cerebral edema.
Due to underlying liver or cardiac problems
Alter treatment for these problems

Question 31

Hypernatremia Levels

Answer 31

(Na > 145 mEq/L)

Question 32

Hypernatremia Causes

Answer 32

Causes
Dehydration and things that cause a state of dehydration
Vomiting 
Chronic kidney disease
Diabetes
Impaired thirst response
Consumption of high sodium items

Question 33

Hypernatremia S/S

Answer 33

Think neurological

Question 34

Hypernatremia Treatment

Answer 34

Restore fluid status

Hypotonic, but if there is shock or low blood pressure then isotonic.

What can cause cerebral edema with treatment?
If the sodium is lowered too quickly
This is the reason that water is not used for hypernatremia treatment

Educate clients on dietary measures to reduce sodium intake