Electrolytes Flashcards
Hyponatremia
Na < 135
Signs & symptoms of hypotnatremia
Lethargy
Nausea
Malaise
Less common
- stupor
- seizures
- coma
Plasma osmolarity of hyponatremia
Usually low
<275
Urine osmolarity of hyponatremia
< 100
Treatment of symptomatic hyponatremia
3% Normal saline
100 ml bolus up to 3 does
Treatment for asymptomatic hyponatremia
Isotonic saline (0.9% saline )
Correction of hyponatremia should not exceed
8 mEqs/ day
Hypernatremia Na+ level
Na+ >145
Hypernatremia is usually due to
Na+ gain
water deficit
Osmotic diuresis
Diabetes insipidus
Signs and symptoms of Hypernatremia
Severe symptoms
- Altered mental status
- weakness
- coma
- seizures
- polyuria/ thirst
Diagnostic tests for Hypernatremia:
Urine osmolarity =
> 800
Rate of correction for Hypernatremia should not exceed
10-12 mEq/L/day
Treatment fluids for Hypernatremia
D5W or quarter NS (0.22%)
Hypokalemia range
K+ < 3.5
Causes of hypokalemia
- decreased net intake
- transcellular shift
- increased renal k+ loss
S/S of hypokalemia
- fatigue
- muscle weakness
-myalgias - Lowe extremity cramps
Severe symptoms of hypokalemia
Complete paralysis
Hypoventilation
Rhabdomyolysis
Testing for Hypokalemia
Urine k+
Acid base- usually metabolic alkalosis
Hypokalemia EKG changes
- flattened t waves or inversion
- prominent U waves
- Prolonged PR interval
- widened QRS complex
Treatment of hyperkalemia
- Calcium gluconate
- Insulin
- NaHCO3
- B2 Adrenergic agonist (albuterol)
Dialysis
Treatment of hypokalemia
40 Meq oral
or IV KCL- 10 Meq
Calcium balance is regulated by
parathyroid hormone (PTH) and calcitriol.
PTH increases serum calcium by
stimulating bone resorption, increasing calcium reclamation in the kidney, and promoting renal conversion of vitamin D to calcitriol
Calcitriol
is the active form of vitamin D
hypocalcemia diagnostics
- albumin- pseudo eval
PTH
serum phosphorus
vitamin D
Magnesium
Ecg- prolonged QT and bradycardia
Hypocalcemia
serum calcemia- < 8.4
ionized calcium <4.2
hypocalcemia causes
- effective hypoparathyroidism
- vitamin D deficiency
- profound elevations in phosphorus
clinical manifestation of hypocalcemia
SEVERE
laryngospasm,
confusion,
seizures, or vascular collapse with bradycardia
decompensated heart failure.
moderate
- excitability of nerves and muscles, paresthesia, tetany
Trousseau’s sign
Trousseau sign is the development of carpal spasm when a blood pressure cuff is inflated above systolic pressure for 3 minutes.
Chvostek sign
refers to twitching of the facial muscles when the facial nerve is tapped anterior to the ear.
treatment of hypocalcemia
- if hypomagnesemia is present that much be treated first
- calcium supplement
- IV for severe or symptomatic
CACL or Calcium gluconate
initial dose of 90–180 mg of elemental calcium car
1–2 g of calcium gluconate
hypercalcemia
A serum calcium >10.3 mg/dL with a normal serum albumin or an ionized calcium >5.2 mg/dL defines hypercalcemia.
More than 90% of cases are due to
primary hyperparathyroidism or malignancy.
Clinical manifestations generally are present only if serum calcium exceeds
12 mg/dL
hypercalcemia manifestations
Renal manifestations include polyuria and nephrolithiasis. If serum calcium rises above 13 mg/dL, renal failure with nephrocalcinosis and ectopic soft tissue calcifications are possible.
GI symptoms include anorexia, vomiting, constipation, and rarely, signs of pancreatitis.
Neurologic findings include weakness, fatigue, confusion, stupor, and coma.
