Electrolytes Flashcards
HypoNAtremia
Na+ (sodium) level in the blood is <13
The concentration of sodium in the blood drops below normal
Causes of HypoNAtremia
- Salt loss from the body is > water loss
ex: diarrhea, NG suctioning, vomiting, sweating, salt-wasting diuretics - Body retains an excess amount of water compared to overall sodium level (dilution)
ex: water intoxication, CHF, overuse of hypertonic solution
What do you observe with HypoNAtremia?
Increased Na+ Excretion vs Diluted Na+ level
Increased Na+: decreased skin turgor, dry mucous membranes, orthostatic HYPOtension, abdominal cramps
Diluted Na+: edema, crackles, distended JVD (chf)
If Na+ level continues to DECREASE?
Headaches Changes in LOC: -altered mental status -extreme fatigue -seizures -coma -death ***secondary to increased ICP and cerebral edema
How to treat HypoNAtremia
Increased Na+ excretion vs Diluted Na+ vs Extreme Neuro Symptoms
Increased Excretion:
- fluid restriction
- Sodium replacement
- increased salt in diet, salt tabs,LR/ 0.9% NS
Diluted Na+:
- Fluid restriction
- Na+ restriction
Extreme Neuro Symptoms:
-Hypertonic IV Solution (3% NS)
HypERNAtremia
Na+ level in the blood is > 145
-The concentration of sodium in the blood is above normal
HypERNAtremia causes
- More salt than water is gained
- excessive intake of Na+
- fluid deprivation
- Diabetes Insipidus (excessive ADH) - More water than salt is lost
- watery stools
- Hyperventilation
- Excessive diaphoresis
What to observe with HypERNAtremia
*S.A.L.T.* S-skin flushed A- agitation L- low grade fever T- thirst -orthostatic hypotension -Weakness -delusions/hallucinations
How to treat HypERNAtremia
- Hypotonic Fluids ( D5W, 0.45% NS)
- Salt wasting diuretics
- Meds to suppress ADH
- Increase fluid intake
- Na+ restriction
NORMAL SODIUM LEVELS
135-145
-Helps to regulate fluid balance in the body
HypoKalemia
K+ level in the blood is < 3.5
NORMAL POTASSIUM LEVEL
3.5-5
Regulates a little of the fluid balance, but a lot of muscle contractions, and nerve signals
Causes of HypoKalemia
- K* wasting diuretic (lasix)
- Diarrhea/ Vomiting
- NG suction
- Inadequate intake (alcoholism, fasting/anorexia)
- Chronic Kidney Disease
- Excessive laxative use
- Increased aldosterone
- Diabetes
What to observe in HypoKalemia
- *Levels below 3
- Anorexia/ Fatigue
- Muscle weakness/ cramping
- N/V
- Decreased bowl motility
- Numbness/ tingling
- Decreased deep tendon reflexes
- Cardiac Arythmias (U wave)
How to treat HypoKalemia
Conservative vs Aggressive
Conservative:
- Increased oral intake
- K+ supplement
Aggressive:
- IV replacement (K+ jumps)
- **K+ can ONLY be given as IVPB
- Peripheral Line= 20 mEq over 2 hrs
- Central Line= 40 mEq over 2 hrs
HypERKalemia
Serum K+ level is > 5
Causes of HypERKalemia
- increased K+ intake
- K+ sparing diuretics
- Crush injuries
- trauma
- burns
- Kidney failure
- Decrease in aldosterone
What to observe with HypERKalemia
- Cardiac arythmias with EKG changes ( level > 6) ( T wave)
- muscle weakness/ paralysis
- nausea/ diarrhea
***Can lead to cardiac arrest (levels >8)
How to treat HypERKalemia
Conservative vs Aggressive
Conservative:
- restrict K+ intake
- Kayexalate (excretes K+ in stool)
Aggressive:
- IV calcium gluconate (protects cardiac function)
- IV insulin and dextrose solution
- Dialysis w/ kidney failure
HypoCALCemia
Serum CA++ levels < 8.5
**Calcium level is opposite of phosphate levels
Causes of HypoCALCemia
- limited CA++ in diet
- Poor oral intake (malnutrition, alcoholism)
- Hypoparathyroidism
- Vitamin D deficiency
- Medications (albumin based antacids)
What to observe with HypoCALCemia
- **Levels < 4.4 (severe symptoms)
- Tetany
- Seizures
- Trousseau Sign
- Chvostek Sign
How to treat HypoCALCemia
- increase oral intake of calcium
- Vitamin D therapy
- IV Calcium gluconate
- IV calcium chloride
Nursing Management of HypoCALCemia
- watch for patients w/ removed thyroid
- osteoporosis
- Seizure Precaution
- Fall precaution
- **Keep trach tray at bedside