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High Acuity > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

Define electrolyte

A

Electrically charged micro-solutes required for enzyme activities, muscle contraction, and metabolism

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2
Q

Extracellular electrolytes

A
  • Sodium (Na+)
  • Chloride (Cl-)
  • Calcium (Ca++)
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3
Q

Intracellular electrolytes

A
  • Potassium (K)
  • Magnesium (Mg)
  • Phosphorus/Phosphate (PO4)
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4
Q

Sodium Range

A

135-145 mEq/L

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5
Q

Normal functions of sodium

A
  1. Water retention/excretion (blood pressure and volume)
  2. Nerve/skeletal muscle impulse transmission (Active Transport - Na/K pump)
  3. pH balance: combines with chloride or bicarb to increase/decrease pH
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6
Q

What causes hypernatremia?

A

Net loss of body water relative to sodium

  1. excessive intake
  2. dehydration/fluid loss
  3. diuretic management of HF
  4. SIADH
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7
Q

Signs and Symptoms of Hypernatremia

A

Big + Bloated (FRIED SSHALTTT)

Flushed skin
Restless
Increased BP/Fluid Retention/tachy
Edema
Decreased urine output

Seizure
Sick (N/V)
Hypertension
Agitation and Confusion
Low grade fever
Thirst
Twitching
Too much reflexes

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8
Q

What causes hyponatremia?

A

Hypovolemic: decreased sodium and water
- increased GI loss (n/v, diarrhea)
- increased skin loss
- increased renal loss
> signs and symptoms of dehydration

Hypervolemic: increased water compared to sodium
- dilution of sodium
- edema
- ascites
- renal diseases

Overall
- sweating
- diuretics
- lack of dietary intake
- heart failure`

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9
Q

Signs and symptoms of hyponatremia

A

Depressed and Deflated (SALTTT LOSS)

Stupor/Coma
Anorexia (N/V)
Lethargy (weakness/fatigue)
Tachy
Twitch
Tremor

Limp Muscles
Orthostatic hypotension
Seizures
Stomach cramping (hyperactive bowel)

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10
Q

Action against sodium imbalances

A
  1. Monitor for cerebral changes (cerebral edema with hyponatremia)
  2. Monitor for muscle weakness: decrease strength of resp muscles (hyponatremia)
  3. Avoid increasing levels too quickly as they can cause CNS irritation, pulmonary edema
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11
Q

Treatment of hyponatremia

A
  • Sodium in tube feeds
  • Hypertonic (2-3% NS) Solution
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12
Q

Treatment of hypernatremia

A

o Fluids to dilute
o Furosemide

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13
Q

Chloride normal value

A

95-105

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14
Q

Normal functions of chloride

A
  1. Works with sodium to regulate fluids and osmolarity of ECF
  2. Works with magnesium to maintain nerve transmission and muscle contraction
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15
Q

What causes hyperchloridemia?

A

Follows sodium, so relatively the same

  • gain of chloride
  • decreased excretion
  • fluid shifts (water loss exceeds na/cl loss)
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16
Q

Signs and symptoms of hyperchloridemia?

A

Similar to that of hypernatremia

  • hypertension
  • tachycardia
  • agitation/headache/LOC changes
  • nausea
  • weakness
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17
Q

What causes hypochloridemia?

A

Follows sodium so relatively the same

  • loss of chloride
  • inadequate intake/absorption
  • fluid shifts (loss)
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18
Q

Signs and symptoms of hypochloridemia

A

Similar to hyponatremia

  • hypotension
  • tachycardia
  • confusion/disorientation
  • muscle cramps
  • shallow resps/bradypnea
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19
Q

Chloride imbalance management

A
  1. imbalances never alone - look at other electrolyes
  2. treat underlying cause - usually fluid status
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20
Q

What drugs increase and decrease chloride?

A
  • Drugs that increase Cl: ammonium chloride/KCl, NaCl
  • Drugs that decrease Cl: RL, sodium bicarb
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21
Q

Normal calcium value

A

2.3-2.8

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22
Q

Normal Function of Calcium

A

the 3 B’s!!

Bone integrity
Blood clotting
Beats (heart/neuromuscular contraction)

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23
Q

What regulates calcium levels?

A

PTH, calcitonin, calcitril

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24
Q

What 3 systems maintain serum calcium levels?

A
  • kidneys (excretion)
  • GI tract (absorption)
  • Bones (mobilization from bone to blood)
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25
Q

Calcium/Phosphorous relationships

A

Inverse

26
Q

Calcium/Magnesium relationships

A

direct

work together to build bone

27
Q

Result of acute hypocalcemia

A

the rapid onset of acute life-threatening conditions such as seizures or respiratory distress because of neuromuscular irritability

28
Q

Causes of hypercalcemia

A
  • overactive PTH (stimulate osteoclast activity therefore increasing calcium release from bone)
  • increased absorption
  • increased available calcium
29
Q

Signs and symptoms of hypercalcemia

A

Slow and Swollen - Moans, Groans, and Stones
(BACK ME)

Bone Pain + fractures (calcium leaving)
Arrhythmias
Constipation + Cog changes
Kidney Stones
Muscle Weakness/Decreased DTR
Excess urination

30
Q

Signs
of hypocalcemia

A

Irritable and At Risk

Trousseaus and Chvosteks
Numbness/Tingling/cramps
Fracture risk
Bleed risk
Dysrhythmias risk

31
Q

Management of calcium imbalances

A
  1. Assess chvostek and trousseaus signs
  2. Mobilzation for hypo to enhance transfer from bone to blood
  3. Treat cause (bone mets v nutrition)
  4. Replace if low (IV calcium chloride)
  5. Monitor ECG (pacemaker cells and contraction)
  6. Dietary management
32
Q

Normal potassium value

A

3.5-5

33
Q

Normal function of potassium

A

Major intracellular cation

Keeps HEART and MUSCLE CONTRACTED

Additionally
- nerve impulse
- carb metabolism

34
Q

Excess potassium is excreted by the

A

Kidneys

Therefore if damaged can cause hyper

35
Q

Effect of diuretics on potassium

A

Enhance excretion and stop reabsorption

36
Q

Potassium levels of patient with renal damage

A

can not excrete and often have high levels

37
Q

What occurs in metabolic acidosis to potassium levels

A

potassium shifts from intracellular compartments to the extracellular space in exchange for hydrogen in an effort to maintain acid-base balance.

38
Q

Causes of hyperkalemia

A
  1. increased intake/supplements
  2. renal damage decreasing excretion
  3. fluid shifts/losses
39
Q

Signs and symptoms of hyperkalemia

A

TIGHT + CONTRACTED

<3
- ST elevation
- peak T wave
- wide QRS
- vfib/asystole
- bradycardia/hypotension

GI
- diarrhea
- hyperactive bowel
- cramps

Neuromuscular
- paralysis
- increased DTR
- weakness

40
Q

Signs and symptoms of hypokalemia

A

LOW + SLOW

<3
- flat t wave
- ST depression
- U wave
- irregular pulse
- cardiac arrest

GI
- decreased motility (constipation/distention)
- decreased bowel sounds
- paralytic ileus

Neuromuscular
- decreased DTR
- cramps
- flaccidity
- resp arrest

41
Q

Causes of hypokalemia

A
  1. decreased intake
  2. GI loss
  3. urinary excretion
  4. fluid shifts
42
Q

What can occur in the danger zone of potassium

A

Lethal arrhythmias and resp arrest

43
Q

What medication must you monitor potassium with and why?

A

Digoxin

Hypokalemia increases the cardiac muscles sensitivity to the drug- can result in dig toxicity.

44
Q

Management of potassium imbalances

A
  • Assessments- cardiac specifically
  • Treat causes
  • If LOW give IV KCL- high risk drug; avoid potassium in renal patients or Oral- Slow K Solution, or KCL elixer
  • If HIGH K
  • Kayexalate: promotes uptake of potassium into bowels and excretes through stool
  • Insulin: forces potassium back into cells
  • Furosemide: forces renal loss/enhances excretion
  • IV sodium bicarb: gives potassium something to bind to
  • ventolin neb: forces back into cells
  • Monitor diet – avoid foods with potassium in them
45
Q

Normal magnesium levels

A

1.5-2.5

46
Q

Normal function of magnesium

A

Maintains law and order in muscles, mainly heart, uterus, and neuromuscular

Required for calcium and vitD absorption

47
Q

Causes of hypermagnesia

A
  1. excessive intake
  2. increased absorption
  3. renal retention
48
Q

Signs and symptoms of hypermagnesia

A

Calm and Quiet!

<3
- heart block
- wide QRD/prolonged PR
- decreased HR/BP

  • decreased DTR/weakness
  • depressed shallow resps
  • hypoactive bowels
  • decreased LOC
49
Q

Cause of hypomagnesia

A
  • losses
  • inadequate intake
  • impaired absorption
  • fluid shifts
50
Q

Signs and symptoms of hypomagnesia

A

Buck wild!!!

<3
- torsades de point
- vfib
- increased HR

Hyperreflexes/irritability
- trousseaus and chvosteks
- nystagmus
- anorexia/N/V

51
Q

Hypomagnesia ECG

A

Torsades, PVC, Vtach, V fib, cardiac arrest

52
Q

Hypermagnesia ECG

A

complete heart block, brady, arrest

53
Q

Normal phosphorous value

A

1.7-2.6

54
Q

Normal function of phosphate

A

bone and teeth
calcium regulation
energy and nutrition

55
Q

What causes hyperphosphatemia

A

§ PO4 gain
§ Increased absorption or retention
§ Fluid shifts

56
Q

What causes hypophosphatemia

A

§ PO4 loss
§ Inadequate intake
§ Impaired absorption
§ Increased excretion
§ Fluid shifts
§ Refeeding syndrome

Closely tied to malnutrition

57
Q

Signs of hyperphosphatemia

A

Signs and Symptoms of HYPOcalcemia

Irritable and at risk

Trousseaus and Chvosteks
Numbness/Tingling/cramps
Fracture risk
Bleed risk
Dysrhythmias risk

muscle cramping, weakness, tachycardia, diarrhea, nausea, abdominal cramping.

58
Q

Signs of hypophosphatemia

A

Signs of HYPERcalcemia

Tied with malnourished

Slow and Swollen - Moans, Groans, and Stones
(BACK ME)

Bone Pain + fractures (calcium leaving)
Arrhythmias
Constipation + Cog changes
Kidney Stones
Muscle Weakness/Decreased DTR
Excess urination

weakness, numbness, tingling, pathologic fractures, diminished myocardial function, N&V, anorexia, disorientation, irritability, seizure, coma. Severe myocardial, respiratory, and nervous system dysfunction if severe imbalance.

59
Q

Treatment of hypophosphatemia

A

IV NaPO4 or K2PO4; po phosphate effervescent

60
Q

Treatment of hyperphosphatemia

A

diuretics, oral antacids

61
Q

What can be given to increase PO4 absorption

A

Vit D

High Acuity (20 decks)

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