Electrolytes Flashcards
What is the sodium range (Na+) in mEq/L?
Also, Range for hypo and hypernatremia:
135-145 mEq/L
Hypo: <135
Hyper >145
Sodium is a:
Major cation, essential for nerve signals, muscle contractions and fluid balance.
Sodium is mainly regulated by:
-Kidneys: Adjust levels to filter and excrete excess Na+ in urine. (or keep more)
-Small Na loss through GI (feces) & skin (sweat) 10%
Na:Renin-Angiotensin-Aldosterone System helps ____ and activates when ___
Helps increase BP and Na+ retention. It activates when BP or Na levels drop, releasing aldosterone.
Na: Adrenal glands release Aldosterone to:
Trigger sodium reabsorption in the kidneys, retaining more Na (and H2O follows, increasing blood vol and BP.
Na: Posterior Pituitary releases ADH to:
Regulate water balance, affecting Na concentration.
↑AHD= ↑ H20 reabsorption= Diluted Na
↓ ADH= ↑ H20 excretion =Na concentration
What works together to keep Na+ at the right level:
- Thirst mechanism
- Hormones
- Kidneys.
Quick function: Aldosterone. RAAS. ADH.
- Aldo: retains Na
- RAAS: helps when Na or Bp is low
- Regulates H2O
What electrolytes does Sodium influence:
- K: to maintain cell function, (nerves/muscles)
- Cl: to maintain fluid balance and acid base regulation
What are the signs and symptoms of hypernatremia?
F: flushed skin
R: Restless, anxious, irritable
I: Increased BP and fluid retention (h20 follows Na)
E: Edema (cerebral)
D: Decreased urine output (Oliguria)
S: skin-mucous membrane are dry
A: agitation
L: low grade fever
T: thirst
* Decreased BP (hypotension) bc dehydration
* Disorientation/Hallucinations
What are some nursing interventions for hypernatremia?
- Monitor I&Os
- Daily weights
- Sodium levels
- Watch for neuro changes: restlessness, disorientation
*Assess for thirst, fever
Hypernatremia treatment:
- restrict Na intake
- IV fluids if due to fluid loss (0.45% NS)
(Hypotonic: hydrates cells by moving H20 from blood into cell)
Which conditions can cause sodium loss?
- Diuretics
- Kidney disease
- Vomiting, Diarrhea, NG suction
- Excess sweating
- SIADH: Syndrome Of Inappropriate ADH:
↑ ADH; kidneys hold ↑ h2O = ↓ Na - Adrenocorticoid insufficiency (not enough aldosterone produced)
What are some dietary sources high in sodium?
- Cheese (cottage/cream)
- Cured meats (ham, bacon)
- Pickles and olives
- Salted nuts
- Pretzels, chips, crackers
- Seafood, soy sauce
What are the signs and symptoms of hyponatremia?
Mostly neurologic due to brain swelling = altered mental
* Lethargy/fatigue
* headache/ seizures
*Nausea/vomiting
* Disorientation/Hallucinations
* Decreased BP, orthostatic hypotension
* Confusion
* Decreased reflexes
*Muscle cramps
What are the nursing interventions for hyponatremia?
- Monitor I&O, weights, Na level
*Assess renal function
*Encourage Na rich foods - Watch for neuro changes
*Hypertonic solutions
What type of solution for Hypo and Hyper natremia
Hypo: Hypertonic solution 0.9% NS
Hyper: Hypotonic solution 0.45% NS
Two types of Hyponatremia:
1.Hypovolemic: ↓ levels of fluid and Na. Treated with IV sol. Iso or hypertonic.
- Hypervolemic: ↑ levels of H2O = diluted Na-Treated with furosemide, urine to remove excess fluid.
Potassium level and what is it for:
Also, hypo and hyperkalemia value:
-3.5 - 5.0
Important electrolyte to maintain ICF, neuromuscular function.
Hypo: <3.5
Hyper: >5.0 (>5.2 affects heart, >7 life threatening)
Potassium excretion:
-98% is inside the cells (neuromuscular func) 2% found in blood.
-90% is excreted thru kidneys, the rest is lost thru bowels.
-Aldosterone increases K excretion, especially when there’s too much
Potassium regulation:
-Kidneys are main regulator of how much excretes in urine.
-Aldosterone regulates K by promoting Na retention and k excretion.
What are the dietary sources low in potassium?
- Fruits: apples, berries, grapes, peach, pineapple
- Veggies: lettuce, cucumber,
- Protein: eggs, tofu
*boiled veggies to reduce K
What are the signs and symptoms of hyperkalemia?
“tight and contracted”
* Diarrhea/ Nausea / Vomiting
*Tingling (paresthesia)/ dizziness
* Muscle cramps/ weakness
* ECG changes: Tall peaked T-waves, wide QRS
(DYSRHYTHMIAS) decreased BP/HR
What causes hyperkalemia?
- Increased intake
- Release from intracellular compartment (burns, injury)
- Kidney failure: cant excrete K properly.
- Adrenal insufficiency
*DKA diabetic ketoacidosis
*K sparring diuretic (spironolactone)
What is the lab value that defines hypokalemia?
<3.5 mEq/L
Causes of Hypokalemia:
-Vomiting/diarrhea/GI suction
-Diuretics (loop/thiazide)
-Metabolic alkalosis
-Alcohol misuse/malnutrition
What are the signs and symptoms of hypokalemia?
- Polyuria
- Polydipsia
- Paralytic ileus/constipation
- Weakness/ Fatigue
- Confusion
- DYSRHYTHMIAS (ECG change: flat t wave)
What are some dietary sources high in potassium?
- Bananas
- Oranges
- Cantaloupe
- Potatoes (skin)
- Spinach
- Broccoli
*Lentils
Treatment for HYPO and HYPERkalemia:
- Hypo: vitamin replacement/ oral or IV DILUTED-slowly given
- HYPER: Insulin + glucose: glucose transports K into the cells. risk for hypoglycemia, that’s why its given with dextrose
*KAYEXALATE: sodium polystyrene sulfonate: exchanges NA for K, increasing K excretion thru stool.
Calcium range level:
Also Hypo and hypercalcemia:
-8.5 to 10.5 mEq/L
-Hyper: >10.5 mEq/L
-Hypo: < 8.5 mEq/L
Calcium function:
Cation found 99% bones/teeth, muscles.
Essential for:
-neuromuscular function, nerve transmission”
-Bone teeth formation
-Clotting of blood
Calcium regulation:
-Requires Vit D and stomach acid. Helps ↑ absorption in GI tract ,& ↑ phosphate excretion.
-Phosphate level=inverse relationship, if Ca ↓ Phos ↑
–PTH: released when Ca ↓, increases absorption activating Vit D. releases Ca from bones= ↑ Ca
–Calcitonin: PTH antagonist = ↓ Ca. Released when Ca rises, inhibits Ca breakdown (from bones), promotes Ca excretion (kidneys)
What are the causes of hypercalcemia?
- Malignancy/bone cancer (increases breakdown)
- Hyperparathyroidism (thyroid gland doesn’t work)
- Thiazide diuretics (increase Ca excretion)
- Milk-Alkali syndrome (high ca and sodium bicarb intake)
What are the signs and symptoms of hypercalcemia?
*bone pain
*Decreased DTR
* Muscle weakness
* Poor coordination
* Lethargy
* Confusion
* Constipation (due to high Ca in urine)
* Nausea/vomit
Nursing intervention for Hypercalcemia
- Calcitonin helps tone down Ca in blood.
- Increase fiber (beans, lentil, whole grains)
3.Monitor ECG for arrhythmias
4.Encourage fluids and mobility
What are the signs and symptoms of hypocalcemia?
- Numbness & tingling
- Tetany (muscle contraction/cramps)
- Hypotension (weak heart contraction)
- ECG changes
*Risk for seizures
*Chvosteks sign: twitching when tapping cheek
*Trosseau’s sign: carpal spasm flexed wrist
What are the nursing interventions for hypocalcemia?
- Seizure precautions
- Airway/ Cardiac monitoring
*No alcohol, caffeine, smoking (inhibit Ca absorption) - Encourage weight-bearing exercise
Diet for hypocalcemia:
-Milk
Leafy greens
Canned salmon, sardine, oysters
Causes of hypocalcemia:
Hypoparathyroidism
-Vit D deficiency (needed for Ca absorption)
-diarrhea, diuretics
-kidney failure
Hypocalcemia treatment:
- ↑ intake in diet: foods, supplements
Severe: IV calcium gluconate (slowly)
Hypercalcemia treatment:
*Calcitonin-increases Ca excretion (renal)
*Isotonic -hypotonic Saline (0.9 NS)
*Bisphosphonates: inhibits bone breakdown (4 days for effect)
*Furosemide if RF present (enhances Ca excretion)
Magnesium lab values. hypo and hyper:
1.3-2.3
Hyper: >2.3 mEq/L
Hypo: <1.3
Magnesium function:
Intracellular cation.
-Activates enzymes for protein and carb metabolism.
-Neuromuscular function: Regulates neuromuscular transmission-contraction
- Causes vasodilation, improves airflow (bronchodilator)
What are the signs and symptoms of hypermagnesemia?
LOW EVERYTHING
↓ DTR
↓ BP, HR, RR
Neuro-muscular weakness
↓ bowel sounds
↓ energy (drowsiness/coma)
cardiac arrest / lethargy
What are the nursing interventions for hypermagnesemia?
*Avoid laxatives/antacids
*seizure precaution
*Give loop diuretics (furosemide helps bring down Mg)
*Hemodialysis, when kidney function is impaired
*Calcium helps reverse cardiac effect
Hypermagnesemia causes
- DKA
*CKD
*adrenal insufficiency
*Excess laxative, antacids, Mg
Hypomagnesemia causes:
- diarrhea, GI suction (high lvl Mg in low intestine)
- Loop/thiazine diuretics
- Malnutrition, alcoholism
-Burns
What are the signs and symptoms of hypomagnesemia?
EVERYTHING GOES UP
↑ BP, RR, HR
* Tremors/ Tetany: muscle contraction/cramps
* Muscle weakness
* Seizures
* Depression
* Confusion
Hypomagnesemia nurse interventions:
- intake
- Observe for signs
-Monitor Vs
-Adm. magnesium sulfate IV or PO
High magnesium foods:
-Green leafy veggies
-nuts/seeds
-Legumes
-Cocoa/chocolate
-whole grains
What is the phosphate range (PO4) ?
Hypo and hyper
2.5-4.5 mg/dL
Hypo: <2.5
Hyper: > 4.6
Phosphate function:
*Important for muscle function, RBC, ATP formation, bone health, nervous system.
*Provides structural support to bones and teeth in form of Phosphate
What are the causes of hyperphosphatemia?
*Excessive intake
* Kidney failure (decreased output)
*Consistent laxative/enema use
What are the signs and symptoms of hyperphosphatemia?
LEADS to LOW Ca levels (hypocalcemia)
* Bone/joint weakness and pain
*Tetany/ muscle spasms
*Seizures
*Dry skin/ brittle nails
Nursing interventions for Hyperphosphatemia:
*Diet- avoid food intake
*Use phosphate binders.
*Avoid laxatives/enemas
*Monitor calcifications and changes in urine out
Treatment for Hyperphosphatemia:
-Dialysis for pt with ESRD
-Control hypertension to maintain kidney function
Causes of Hypophosphatemia:
Anything that causes fluid loss:
-Vomiting, diarrhea, burns, defecation
- ↑Diuretics
-Malnutrition
-Alcohol dependency
Symptoms of Hypophosphatemia:
-Fatigue/Weakness
-Confusion/seizures
-Delayed growth/develop
- ↓ bone density/fractures
- ↓ appetite
- Cardiac arrhythmias
-Diplopia (double vision)
-Dysphagia (trouble swallowing)
Nursing interventions for Hypophosphatemia:
-Encourage high phos foods
-Monitor for signs of confusion and weakness
-give supplements (Neutra-phos)
Treatment/Diet for Hypophosphatemia:
-Glucose/insulin cause ↓ in phos
-Administer supplements (neutra-phos)
-Reduce diuretic
-Proper care for burns
High phosphorus foods:
Red meat, beans, dairy products, nuts, lentils
What percentage of total body weight is water for males and females?
- Males: 60-65%
- Females: 55-60%
What are the two types of body fluid?
- Intracellular fluid (ICF)
- Extracellular fluid (ECF) (easily lost)
Where can extracellular fluid be found?
- Intravascular space (plasma)
- Interstitial space
- Transcellular space
What is fluid balance?
Balance maintained through intake and output regulation.
What are the sources of water intake?
- Fluids
- Food
- Byproducts of metabolism
What are the two types of water loss?
- Sensible loss
- Insensible loss
Who is at the greatest risk for dehydration?
- Infants
- Elderly
- Individuals with excessive fluid loss (e.g., vomiting, diarrhea, sweating, burns)
What does third spacing refer to?
A shift in fluid to an unusable space, often in the peritoneal cavity.
What is sodium’s role in the body?
- Major cation for nerve signals
- Muscle contractions
- Fluid balance
How does sodium affect osmotic pressure?
Influences water distribution throughout the body.
What is the treatment for HYPOnatremia?
- Identify cause and treat
- Restrict fluid intake
- Administer hypertonic 3% NaCl slowly
- Administer 0.9% NaCl
What is the treatment for HYPERnatremia?
- Gradual lowering of sodium levels
- Administer hypotonic solutions like 0.45% NaCl
- Monitor sodium levels frequently
What is potassium’s primary function?
Crucial for neuromuscular function.
How is potassium primarily excreted?
90% through the kidneys.
What is HYPOkalemia?
Low potassium levels in the blood.
What is the treatment for HYPOkalemia?
- Identify cause
- Replacement therapy (oral or IV)
- Monitor kidney function
What is chloride’s role in the body?
- Major anion in ECF
- Maintains acid-base balance and osmotic pressure
What regulates chloride levels?
Primarily regulated by kidneys.
What are the signs and symptoms of hypochloremia?
- Metabolic alkalosis
- Muscle hypertonicity
- Depressed respirations
What regulates calcium levels in the body?
- Parathyroid hormone
- Calcitonin
- Vitamin D
What is the effect of low calcium on PTH release?
Increases PTH release which dissolves/weakens more bones to maintain calcium levels.
This condition can lead to hyperparathyroidism.
What laboratory tests are used to diagnose hypercalcemia?
Tests include:
* PTH
* Calcium
* Phosphorus
* Magnesium
* X-ray for osteoporosis
* Hypercalciuria (calcium excretion >350 mg/day)
These tests help assess calcium levels and potential bone health.
What are the key treatments for hypercalcemia?
Treatments include:
* Stopping thiazide diuretics and vitamin D compounds
* Restricting dietary calcium
* Hydration (6-8 glasses of water/day)
* Increasing mobility
These measures help reduce calcium release from bones and prevent kidney stones.
What IV treatments are used for severe hypercalcemia?
IV treatments include:
* IV Bisphosphonates
* Calcitonin
* Isotonic Saline (0.9% NaCl)
* Furosemide (only if renal failure or heart failure present)
These interventions help manage severe cases of hypercalcemia.
What is the treatment for hyperphosphatemia in kidney failure?
Treatment includes:
* Phosphate restriction
* Phosphate binders
* Vitamin D preparations (e.g., calcitriol)
IV calcitriol should only be given if phosphate levels are above 5.5 mg/dL and calcium is less than 9.5.
What can falsely elevate magnesium levels?
- Hemolysis of blood specimens
- Tight or prolonged application of tourniquets
These conditions can lead to inaccurate lab results.
What is the management for severe hypermagnesemia?
Management includes:
* Avoiding magnesium administration in kidney failure
* Monitoring patients receiving magnesium salts
* Discontinuing parenteral and oral magnesium salts
* Using ventilatory support and IV calcium in emergencies
* Administering loop diuretics
* Providing IV isotonic fluids
These interventions help manage symptoms and complications associated with hypermagnesemia.
Hyponatremia unique symptoms
Seizures
cerebral edema (severe cases)
headache
Hypernatremia unique symptoms
Dry mucous membranes, thirst, flushed skin, restlessness, irritability, hyperreflexia
Hypokalemia unique symptoms
Polyuria (KF), U waves on ECG, decreased bowel motility → constipation, ileus, decreased reflexes
Hyperkalemia unique symptoms
Peaked T waves, , paresthesia (tingling)
Hypocalcemia unique symptoms
Chvostek’s & Trousseau’s signs,
Hypercalcemia unique symptoms
Bone pain, kidney stones, polyuria, decreased DTRs
Hypophosphatemia unique symptoms
Tissue hypoxia, hemolysis, Irritability
Hyperphosphatemia unique symptoms
Soft tissue calcifications, Decreased urine output, Tachycardia,
Hypomagnesemia unique symptoms
Hyperreflexia, torsades de pointes (ECG),
Hypermagnesemia unique symptoms
Decreased DTRs, respiratory depression
