Electrolytes

Question 1

What is Hyperkalemia?

Answer 1

Hyperkalemia is excess potassium in the intravascular serum. K+ is the ion that is ranging from 3.5-5 mEq/L. It means there is excess potassium levels in the blood. Potassium is responsible for heart muscle and other muscle conduction. It is the most important cation in the blood.

Question 2

What are the S&Sx of Hyperkalemia?

Answer 2

Potassium has one of the most important cations in the blood. It controls the muscles, especially the heart muscles.

Cardio: The heart will be tight and contradicted. There will be peaked T waves, peaked ST elevations, flat P waves, widen QRS complexes, wide PR interval. Low BP and pulses. Dysrythmias, slow, weak and irregular heart beat.

Respiratory: The muscles in the lungs become paralyzed because of muscle weakness leading to respiratory failure.

Neuromuscular:

• Early signs include weakness and parathesia (tingling in extremities and pain and then numbness especially around the hands, feet and mouth).
• Late signs are tight and contracted with extreme weakness and paralysis with the head, neck and trunk. This is especially true for issues with breathing because the levels of K+ is so high that the tissues in the lungs cannot expand.

GI: At first there will be diarrhea and then constipations because there is too much contraction of the GI muscles for peristalsis.

**PROFOUND AND SEVERE ARE LATE SIGNS, CARDIAC STANDSTILL AND VFIB CAN OCCUR BECAUSE OF THIS.

Question 3

What are causes of Hyperkalemia?

Answer 3

1. Eating too much potassium intake such as strawberries, avocados, bananas and potatoes.
2. Renal failure.
3. Heart failure secondary to renal failure.
4. Medications: NSAIDs, Prils, Potassium sparing diuretics such as sprinolactone.
5. Hyperaldosteronism aka Addison’s disease.
6. Pseudohyperkalemia- when the blood is taken from the body, the cells might lyse so there is excretion of K+ in reading the blood and result as a false negative for K+ reading. Redraw!
7. Tissue damage and burns.
8. Hyperuricemia.
9. Acidosis- when acidosis causes H+ to move into the cell, there will be a plethora of K+ outside of the cell into the intravascular space.
10. Hyper - catabolism
11. DKA- insulin is required to get potassium into the cells, when there is a lack or the ability to get insulin into the cells, the K+ stays in the blood stream.

Question 4

What is Potassium?

Answer 4

Potassium is aka K+ and the most important and and abundant cation in the body. It controls conductions for muscles and the heart. It is regulated by the kidneys and aldosterone. I has a part in arterial blood gases because K+ is exchanged in the cells with hydrogen atoms, when K+ moves into the cell, hydrogen moves out.

***For every 0.1 decrease in ABG pH, there is a 0.5 increase of K+.

Question 5

Nursing Interventions for Hyperkalemia?

Answer 5

1. ALWAYS PUT ON CARDIAC MONITOR FIRST.
2. D5W with insulin to push K+ back into the cells.
3. Albuterol.
4. Kayexalate (sodium polystyrene sulfonate)- massive diarrhea.
5. IV Calicum Gluconate- it glues the K+ together.
6. Dialysis.
7. Strict restriction K+ diet.
8. Blood products and transfusions could raise K+ levels because of lysis of cells.

Question 6

What is Hypokalemia

Answer 6

Hypokalemia is when there is not enough K+ in the blood and low levels can cause severe heart and muscles problems.

Question 7

Causes of Hypokalemia?

Answer 7

1. K+ wasting diuretics/loop.
2. Corticosteroids causes H20 retention which causes hemodilution.
3. Fluid overload.
4. Alkolosis- hydrogen moving out of the cell and K+ moving into the cell.
5. N/V/S/D/NG suction.
6. Hyperadolsteronism aka Cushing syndrome.
7. NPO diets and depletion of K+ intake.

Question 8

What are S&Sx of Hypokalemia?

Answer 8

1. Cardiac: low and slow
   - Low BP/Pulse/thready/irregular.
   - Dysrhythmias
2. Respiratory: inadequate muscle strength to recoil lungs, diminished breath sounds.
3. GI: slow and contracted. GI obstruction can occur=fatal.
   - No bowel sounds
   - N/V/D
   - Abdominal distension
4. Neuromuscular:
   - AMS: anxiety, lethargy, confusion, coma
   - Parathesia-numbness and then pain in hands/feet/mouth
   - Deep Tendon Hyper-reflexia
   - Skeletal muscles weakness
   - Loss of tactile disfunction
5. Labs/EKG:
   - Depressed ST waves
   - Inverted, flattened or shallow T waves
   - U wave

Question 9

How do you treat Hypokalemia?

Answer 9

1. Introduce K+ diet.
2. Use K+ sparing diuretics such as spirinolactone.
3. Potassium IV ONLY, never push, gove over an hour at 10 cc in 100cc NS OVER AN HOUR. CAN KILL PATIENT.
4. Monitor cardiac.
5. Give oral K+.

Question 10

What is Sodium?

Answer 10

Sodium aka Na+ is in the blood serum with 135-145. It helps control muscles conduction, fluid shifts in the body, BP & BV, electrical nerve impulses.

Question 11

What is Hyponatremia?

Answer 11

Hyponatermia is when there is less than 135 mEq/L in the blood and needs to be recorrected.

Question 12

What causes Hyponatermia

Answer 12

1. Fluid Overload/hemodilution.
2. S/N/V/D.
3. Hyperuricemia.
4. Drainage.
5. Hypoaldosteronism- dimished secretion of aldosterone and cortisol leads to less sodium absorption and more excretion.
6. Lithim Rx, causes decrease reabsorption of sodium. Causes toxicity and build up of lithium by depleting lithium excretion by kidneys.
7. Hypotonic Solutions.
8. Congested Heart Failure.
9. Diuretics.

Question 13

How do you treat Hyponatremia?

Answer 13

Give resusitation of sodium slowly. Can cause CE or ICP if given too fast. Check sodium levels q 2-4 hours.

1. Hypovolemic Hyponatermia with 0.9% NS, IV.
2. Sodium rich foods.
3. Balance water ratio and restrict fluids for hypervolemia hyponatermia. Give osmotic diuretics.
4. Only 0.5 mEq/L per hour max.
5. 3% NS THROUGH CENTRAL LINE ONLY!!!!! And very slowly.

Question 14

S&Sx of Hyponatermia?

Answer 14

1. Cardiac 2nd to Serum Volume:
   - Normovolemic: rapid pulse/ norm BP.
   - Hypovolemic: weak, thready pulse, low BP, flat neck veins, norm or low CVP.
   - Hypervolemic: rapid bounding pulse, normal or high BP, norm or high CVP.
2. Respiratory: ineffective muscle contractions in lungs leading dinished breath sounds due to muscle weakness because no sodium in muscle conduction.
3. NMS:
   - Muscle weakness due to no aodium enabled to muscle contractions, especially in exremities.
   - Diminished deep tendon reflexes.
   - Increased ICP and CE due to fluid shifts inside of brain cellular tissue.
4. CNS:
   - Personality Changes
   - Coma
   - Headaches
   - Seizures
   - Confusion.
5. GI:
   - Increased bowel sounds
   - V/D/ abdominal cramps.
6. Renal: increased urine output.
7. Skin: dry membranes.
8. Labs: sodium less than 135 and and decreased USG.

Early Sign:

• Headache
• N/V
• Fatigue

Moderate Signs:

• Lethargy
• Weakness
• Altered LOC

Severe Signs:

• Coma
• Seizures
• Paralysis
• Respiratory Arrest
• Death

Question 15

What is Hypernatermia?

Answer 15

Hypernatermia is when there is an excess of sodium in the blood serum, over 145 mEq/L of blood.

Question 16

What are the causes of Hypernatermia?

Answer 16

1. Renal failure.
2. Corticosteriods which cause depletion of excretion of sodium in urine.
3. Cushing Syndrome: expisure to glucocorticoids such as predisone or tumors can result in excessive cortisol productions by the adrenal gland.
4. Hyperaldosteronism: high sodium and high water retention.
5. Hypertonic solutions.
6. Anything containing sodium. Such as aspirin, alkaseltzer or cough syrups that have sodium.
7. Decrease water intake.
8. Increass water loss: S/N/V/D/Suctioning/ Infections/ Fever.

Question 17

S&Sx of Hypernatermia?

Answer 17

1. Cardiovascular:
   - Decrease in contractility
   - Blood pressure and heart rate respond to volume status.
2. Hypovolemic: Weak, thready, low pulse; hypotension, flat neck veins; moderate or low CVP.
3. Hypervolemia: Bounding, strong, pulses; normal BP or hypertension; normal or elevated CVP.
4. Respiratory: PE if hypovolemia involved; crackles and diminished breath sounds in hypervolemia.
5. NMS:
   - Early: Muscle twitches and irregular muscle contractions.
   - Late: Absent deep tendon reflexes and skeletal muscle weaknesses.
6. CNS: Altered level of cognition is expected.
   - Normo or hypovolemia equates to agitation, confusion and seizures (cranky)
   - Hypervolemia equates to lethargy and stupor (COMA)
7. GI: Extreme thirst.
8. Renal: Decreased urinary output.
9. Skin: Dry skin or flushed and dry mucous membranes. Absent or pitting edema depending on fluid levels.
10. Lab: Increased sodium levels above 145 and increased USG.