Electrolytes Flashcards
Define electrolyte
Electrically charged micro-solutes required for enzyme activities, muscle contraction, and metabolism
Extracellular electrolytes
- Sodium (Na+)
- Chloride (Cl-)
- Calcium (Ca++)
Intracellular electrolytes
- Potassium (K)
- Magnesium (Mg)
- Phosphorus/Phosphate (PO4)
Sodium Range
135-145 mEq/L
Normal functions of sodium
- Water retention/excretion (blood pressure and volume)
- Nerve/skeletal muscle impulse transmission (Active Transport - Na/K pump)
- pH balance: combines with chloride or bicarb to increase/decrease pH
What causes hypernatremia?
Net loss of body water relative to sodium
- excessive intake
- dehydration/fluid loss
- diuretic management of HF
- SIADH
Signs and Symptoms of Hypernatremia
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
What causes hyponatremia?
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`
Signs and symptoms of hyponatremia
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)
Action against sodium imbalances
- Monitor for cerebral changes (cerebral edema with hyponatremia)
- Monitor for muscle weakness: decrease strength of resp muscles (hyponatremia)
- Avoid increasing levels too quickly as they can cause CNS irritation, pulmonary edema
Treatment of hyponatremia
- Sodium in tube feeds
- Hypertonic (2-3% NS) Solution
Treatment of hypernatremia
o Fluids to dilute
o Furosemide
Chloride normal value
95-105
Normal functions of chloride
- Works with sodium to regulate fluids and osmolarity of ECF
- Works with magnesium to maintain nerve transmission and muscle contraction
What causes hyperchloridemia?
Follows sodium, so relatively the same
- gain of chloride
- decreased excretion
- fluid shifts (water loss exceeds na/cl loss)
Signs and symptoms of hyperchloridemia?
Similar to that of hypernatremia
- hypertension
- tachycardia
- agitation/headache/LOC changes
- nausea
- weakness
What causes hypochloridemia?
Follows sodium so relatively the same
- loss of chloride
- inadequate intake/absorption
- fluid shifts (loss)
Signs and symptoms of hypochloridemia
Similar to hyponatremia
- hypotension
- tachycardia
- confusion/disorientation
- muscle cramps
- shallow resps/bradypnea
Chloride imbalance management
- imbalances never alone - look at other electrolyes
- treat underlying cause - usually fluid status
What drugs increase and decrease chloride?
- Drugs that increase Cl: ammonium chloride/KCl, NaCl
- Drugs that decrease Cl: RL, sodium bicarb
Normal calcium value
2.3-2.8
Normal Function of Calcium
the 3 B’s!!
Bone integrity
Blood clotting
Beats (heart/neuromuscular contraction)
What regulates calcium levels?
PTH, calcitonin, calcitril
What 3 systems maintain serum calcium levels?
- kidneys (excretion)
- GI tract (absorption)
- Bones (mobilization from bone to blood)
Calcium/Phosphorous relationships
Inverse
Calcium/Magnesium relationships
direct
work together to build bone
Result of acute hypocalcemia
the rapid onset of acute life-threatening conditions such as seizures or respiratory distress because of neuromuscular irritability
Causes of hypercalcemia
- overactive PTH (stimulate osteoclast activity therefore increasing calcium release from bone)
- increased absorption
- increased available calcium
Signs and symptoms of hypercalcemia
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
Signs
of hypocalcemia
Irritable and At Risk
Trousseaus and Chvosteks
Numbness/Tingling/cramps
Fracture risk
Bleed risk
Dysrhythmias risk
Management of calcium imbalances
- Assess chvostek and trousseaus signs
- Mobilzation for hypo to enhance transfer from bone to blood
- Treat cause (bone mets v nutrition)
- Replace if low (IV calcium chloride)
- Monitor ECG (pacemaker cells and contraction)
- Dietary management
Normal potassium value
3.5-5
Normal function of potassium
Major intracellular cation
Keeps HEART and MUSCLE CONTRACTED
Additionally
- nerve impulse
- carb metabolism
Excess potassium is excreted by the
Kidneys
Therefore if damaged can cause hyper
Effect of diuretics on potassium
Enhance excretion and stop reabsorption
Potassium levels of patient with renal damage
can not excrete and often have high levels
What occurs in metabolic acidosis to potassium levels
potassium shifts from intracellular compartments to the extracellular space in exchange for hydrogen in an effort to maintain acid-base balance.
Causes of hyperkalemia
- increased intake/supplements
- renal damage decreasing excretion
- fluid shifts/losses
Signs and symptoms of hyperkalemia
TIGHT + CONTRACTED
<3
- ST elevation
- peak T wave
- wide QRS
- vfib/asystole
- bradycardia/hypotension
GI
- diarrhea
- hyperactive bowel
- cramps
Neuromuscular
- paralysis
- increased DTR
- weakness
Signs and symptoms of hypokalemia
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
Causes of hypokalemia
- decreased intake
- GI loss
- urinary excretion
- fluid shifts
What can occur in the danger zone of potassium
Lethal arrhythmias and resp arrest
What medication must you monitor potassium with and why?
Digoxin
Hypokalemia increases the cardiac muscles sensitivity to the drug- can result in dig toxicity.
Management of potassium imbalances
- 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
Normal magnesium levels
1.5-2.5
Normal function of magnesium
Maintains law and order in muscles, mainly heart, uterus, and neuromuscular
Required for calcium and vitD absorption
Causes of hypermagnesia
- excessive intake
- increased absorption
- renal retention
Signs and symptoms of hypermagnesia
Calm and Quiet!
<3
- heart block
- wide QRD/prolonged PR
- decreased HR/BP
- decreased DTR/weakness
- depressed shallow resps
- hypoactive bowels
- decreased LOC
Cause of hypomagnesia
- losses
- inadequate intake
- impaired absorption
- fluid shifts
Signs and symptoms of hypomagnesia
Buck wild!!!
<3
- torsades de point
- vfib
- increased HR
Hyperreflexes/irritability
- trousseaus and chvosteks
- nystagmus
- anorexia/N/V
Hypomagnesia ECG
Torsades, PVC, Vtach, V fib, cardiac arrest
Hypermagnesia ECG
complete heart block, brady, arrest
Normal phosphorous value
1.7-2.6
Normal function of phosphate
bone and teeth
calcium regulation
energy and nutrition
What causes hyperphosphatemia
§ PO4 gain
§ Increased absorption or retention
§ Fluid shifts
What causes hypophosphatemia
§ PO4 loss
§ Inadequate intake
§ Impaired absorption
§ Increased excretion
§ Fluid shifts
§ Refeeding syndrome
Closely tied to malnutrition
Signs of hyperphosphatemia
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.
Signs of hypophosphatemia
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.
Treatment of hypophosphatemia
IV NaPO4 or K2PO4; po phosphate effervescent
Treatment of hyperphosphatemia
diuretics, oral antacids
What can be given to increase PO4 absorption
Vit D