Electrolytes Flashcards
Calcium
- 9 - 10.5 mg / dL
- Absorbed in GI system, excreted by kidneys
- Important in bones, nerves, muscles, & coagulation/clotting factors
- Regulated by PTH and vitamin D
Has an inverse relationship with phosphorus
Hypocalcemia
Causes
* Renal failure
* Acute pancreatitis
* Malnutrition
* Celiac disease
* Crohn’s disease
* Alcoholism
* Bulimia
* Vitamin D deficiency
* Hypoparathyroidism
* Hyperphosphatemia
* Glucocorticoids
S/S
* Irritability
* Hallucinations
* Seizures
* Chvostek’s sign
* Trousseau’s sign
* Muscle spasms
Treatment
* PO calcium supplements
* Administer with Vitamin D
(increases absorption)
* IV calcium supplements
Calcium rich diet
Hypercalcemia
Causes
* Excessive intake of calcium
* Hyperparathyroidism
* Excessive Vitamin D intake
* Vitamin D toxicity
* Cancer of the bones
* Immobility
S/S
* Weakness
* Bradycardia
* Cyanosis
* Dec LOC
* Abd pain
* Kidney stones
Treatment
* Reduce dietary calcium intake
* Encourage PO hydration
* IV fluids - NS preferred
* Loop diuretics
* Calcium binders
* Dialysis
Cardiac monitoring
Magnesium
- 1.5 - 2.5 mEq / L
- Stored in the bones & cartilage
- Plays a major role in skeletal muscle contraction & ATP formation
- Activates vitamins
- Necessary for cellular growth
Mg is directly related to calcium because it is necessary for PTH production.
Hypomagnesemia
Causes
* Alcoholism
* Malnutrition
* Malabsorption
* Hypoparathyroidism
* Hypocalcemia
* Diarrhea
S/S
* Numbness
* Cramping
* Seizures
* Torsade De Points
* Psychosis
* Confusion
Treatment
* Treat the cause
* Monitor cardiac rhythm
* Administer magnesium
○ PO - Magnesium hydroxide
IV - given very slowly
Hypermagnesemia
Causes
* Excessive dietary intake
* Too many magnesium containing medications
* Over-correction of
Hypomagnesemia
* Renal failure
S/S
* Weakness
* Shallow breathing
* Bradycardia
* Hypotension
* Drowsiness
* Lethargy
* Coma
Treatment
* Treat the cause
* Hold any fluids or meds
containing Mg
* Loop diuretics
* Calcium gluconate
* Dialysis
Potassium
- 3.5 - 5 mEq / L
- Most abundant intracellular cation
- Important in muscle contraction, nerve impulses, & acid-base imbalances
Hypokalemia
Causes
* Drugs: laxatives, diuretics, corticosteroids
* Inadequate K+ intake: NPO, eating disorders, alcoholism
* Too much water: polydipsia, excessive IVF
* Cushing’s Syndrome: too much cortisol, Na/H2O retention, K+ secretion
* Heavy Fluid loss: NGT suction, vomiting, diarrhea, wound drainage, sweating
* Alkalosis
* Hyperinsulinism
S/S
* Weakness
* Shallow resp
* Constipation
* Abd distention
* Orthostatic hypotension
* Cardiac dysrhythmia
* EKG changes
Treatment
* Place on cardiac telemetry
* Hold lasix or other potassium wasting drugs
* Hold digoxin
* Encourage diet rich in potassium
* Oral potassium supplements
* Give with food to prevent GI upset
* IV potassium supplements
* Give slowly!! And always on a pump, never IV push!
Monitor IV site for extravasation, K+ causes tissue damage.
Hyperkalemia
Causes
* Burns or tissue damage (potassium forced out of the damaged cells)
* DKA
* Renal failure
* Excessive potassium intake
* ACE inhibitors and ARBs
* Potassium-sparing diuretics
S/S
* Muscle weakness
* shallow resp
* Weak pulse
* Bradycardia
* Hypotension
* Metabolic Acidosis
* EKG changes
Treatment
* Discontinue any IV or PO potassium supplements
* Potassium-restricted diet (NO SALT substitutes as they are KCL)
* IV Calcium gluconate or chloride if EKG changes present (protects heart)
* Reduce total body potassium
○ Kayexalate: PO or enema, causes sodium to be absorbed & potassium excreted
○ Potassium wasting diuretics
* Drive potassium into cells by giving:
○ Bicarbonate: important in acidosis with hyperkalemia
○ D5W + regular insulin
○ Albuterol
* Dialysis (for severe cases)
Chloride
- 98 - 106 mEq / L
- Most abundant extracellular anion
- Works with sodium to maintain fluid balance
- Binds with hydrogen ions to form stomach acid - HCl
- Inversely related to bicarbonate
Directly related to sodium and potassium
Hypochloremia
Causes
* Volume overload
* CHF
* Water intoxication
* Salt losses
* Burns
* Sweating
* Vomiting
* Diarrhea
* Cystic Fibrosis
* Addison’s Disease
S/S
* Cerebral edema
* Seizures
* Lethargy
* Muscle spasms
* Orthostatic hypotension
* Abd cramping
Treatment
* Treat the underlying cause (correct the imbalance)
○ Normal Saline - 0.9% NaCL
* Monitor all electrolytes - it’s
usually not the only imbalance
Foods with chloride are same as sodium
Hyperchloremia
Causes
· Fluid loss
○ Dehydration
○ Vomiting
○ Sweating
· Steroids
○ Cushing’s disease
○ Excess corticosteroid administration
· Excess chloride administration
○ NORMAL SALINE!
S/S
· Restlessness
· Agitation
· Drowsiness
· Fever
· Cramping
· Twitching
· Dec urine output
· Dry mouth
Treatment
· Treat the underlying cause (correct the imbalance)
○ Bicarbonate administration
○ Discontinue any sodium- containing meds
○ No NS for IVFs - consider LR instead
Monitor all electrolytes - it’s usually not the only imbalance!
Phosphorus
- 2 - 4.5 mEq / L
- Major role is in cellular metabolism and energy production (ATP)
- Makes up the phospholipid bilayer of cell membranes
- Large component of bones and teeth
Has an inverse relationship with calcium
Hypophosphatemia
Causes
* Malnutrition
* Alcoholism
* TPN
* Hyperparathyroidism
* Hypercalcemia
* Hypophosphatemia
S/S
* Weakness
* Bradycardia
* Cyanosis
* DVT
* Dec LOC
* Hypoactive bowel sounds
* Constipation
* Kidney stones
Treatment
* Treat the cause
* Phosphorus replacement
○ PO
○ IV - give slowly
* Phosphorus-rich diet
Diet low in calcium
Hyperphosphatemia
Causes
* Excessive dietary intake of phosphorus
* Tumor lysis syndrome
* Renal failure
* Hypoparathyroidism
* Hypocalcemia
* Hyperphosphatemia
S/S
* Irritability
* Hallucination
* Seizures
* Chvostek’s sign
* Trousseau’s sign
* Diarrhea
* Weak bones / nails
Treatment
* Phosphate binders Given with food
* Manage hypocalcemia
* PO calcium supplements
* Administer with Vitamin D
(increases absorption)
* IV calcium supplements
* Calcium-rich diet
Sodium
- 135 - 145 mEq / L
- Most abundant extracellular cation
- Water likes to crash sodium parties! It always moves to the area with high concentrations of electrolytes
Correct sodium imbalance slowly (0.5 mEq/hr) - changing too quickly can cause cerebral edema and ICP
Hyponatremia
Causes
* Euvolemic Hyponatremia
○ Water in the body increases, but sodium stays the same. Dilutional hyponatremia. Fluid balance is normal.
○ Cause: Addison’s, Low Na intake, Polydipsia
○ Tx: Sodium tab, osmotic diuretic, high salt diet
* Hypervolemic Hyponatremia
○ Water in body increases significantly and dilutes amount of sodium. Dilutional/relative hyponatremia.
○ Cause: CHF, Kidney failure, Liver Failure
○ Tx: Sodium tab, osmotic diuretic, high salt diet
* Hypovolemic Hyponatremia
○ Water and sodium are both lost.
○ Cause: V/D, Diuretics, Burns, excessive sweating
○ Tx: mild = 0.9 NaCl., severe = 3% NaCl
S/S
* Weakness
* Shallow resp
* Muscle spasms
* Orthostatic hypotension
* Seizure
* Confusion
* Lethargy
* Cerebral edema
* Loss of appetite
Hypernatremia
Causes
* Euvolemic Hypernatremia
○ Water in the body decreases, but sodium stays near normal.
○ Cause: Hyperventilation, sweating, fever
○ Tx: give free water
* Hypervolemic Hypernatremia
○ Water AND sodium increase, but sodium increases more.
○ Cause: Corticosteroids, Cushing’s, hyper aldosterone
○ Tx: Loop diuretic, give free water
* Hypovolemic Hypernatremia
○ Water and sodium are both lost, but more water is lost. Relative hypernatremia.
○ Cause: Dehydration, NPO, D/V, burns, diuretics
○ Tx: Isotonic IV fluids
S/S
* Restlessness
* Agitation
* Lethargy
* Fever
* Twitching
* Dec urine output
* Dry mouth
Flushed skin
