Electrolytes Flashcards
Sodium levels
136-145
Potassium levels
3.5-5.0
Calcium levels
9.0-10.5
Phosphate levels
3.0-4.5
Magnesium levels
1.3-2.1
Maintaining normal nerve and muscle function, regulation of acid-base balance
Sodium Role
Imbalances for sodium
Hypernatremia
Hyopnatremia
a. Increased free water loss or increased sodium gain
b. Causes hyperosmolality (shifts out of cell) leading to cellular dehydration
c. Body’s protection – thirst!
Hypernatremia
a. Clinical Manifestations; hypernatremia
i. Excessive thirst
ii. Cognitive dysfunction
iii. Signs of volume depletion if there is volume deficit
Nursing interventions/treatment: hypernatremia
i. Monitor VS, assessments, fluid status
ii. Treat the underlying cause!
1. Free water loss - IV Fluids (hypotonic or isotonic)
2. Abnormal sodium gain – Sodium-free IVF + diuretic
iii. Monitor sodium levels and response to treatment
a. Results from excess water intake or abnormal sodium/water loss
b. Can be an isolated event or occur secondary to other illnesses
Hyponatremia Na <136
Clinical manifestations: Hyponatremia
i. Mild to severe neurological symptoms
ii. Headache, irritability, confusion, lethargy, seizures, coma
Treatment: hyponatremia
if excess water:
if abnormal fluid loss is cause;
i. Euvolemic - fluid restriction
ii. If excess water is cause – diuretics
iii. If abnormal fluid loss is cause – administer isotonic fluids, encourage fluid intake
Excess water:
i. Fluid restriction may be only treatment
ii. Loop diuretics and demeclocycline
iii. Severe symptoms (seizures)
iv. Give small amount of IV hypertonic saline solution (3% NaCl)
Abnormal fluid loss
i. Fluid replacement with isotonic sodium-containing solution
ii. Encouraging oral intake
iii. Withholding diuretics
i. Promotes normal function of nerve and muscle cells, maintains normal electricity of the heart, aids in movement of nutrients and waste products, cellular growth, acid-base balance
Potassium
Clinical manifestations: Hyperkalemia
i. Cardiac arrhythmias
ii. Fatigue, confusion
iii. Muscle cramps (tetany)
iv. Weak or paralyzed skeletal muscles
v. Abdominal cramping, diarrhea
Meds for K excretion
diuretics, dialysis, Veltessa and/or Kayexalate (in stool)
calcium gluconate
a. Results from increased loss of K+ via the kidneys or GI tract
i. Secondary to being overdiuresed or diarrhea/vomiting
Hypokalemia
Manifestations: hypokalemia
i. Cardiac most serious
1. Cardiac arrythmias
ii. Skeletal and smoothe muscle weakness
iii. Decreased GI motility
iv. Hyperglycemia
Administer KCl through
PO or IV NEVER PUSHING OR BOLUS
i. Formation of teeth and bone
ii. Blood clotting
iii. Transmission of nerve impulses
iv. Myocardial contractions
v. Muscle contractions
Calcium
Increases calcium deposition into bone, increases renal calcium excretion, and decreases GI absorption
Calcitonin
Calcium balance controlled by:
Parathyroid hormone
a. High levels of serum calcium caused by
i. Hyperparathyroidism (two-thirds of cases)
Hypercalcemia
Manifestations; Hypercalcemia
i. Fatigue, lethargy, weakness, confusion
ii. Hallucinations, seizures, coma
iii. Dysrhythmias
iv. Bone pain, fractures, nephrolithiasis (kidney stones)
v. Polyuria, dehydration
Implementation; hypercalcemia
- Low calcium diet
- Increased weight-bearing activity
- Increased fluid intake (3k-4k L)
- Hydration with isotonic saline infusion
- Bisphosphonates—gold standard
- Calcitonin
a. Immediate effect
a. Low serum Ca levels caused by
i. Decreased production of PTH (parathyroid hormone)
ii. Multiple blood transfusions
iii. Alkalosis
iv. Increased calcium loss
Hyopcalcemia
Manifestations hypocalcemia
i. Positive Trousseau’s or Chvostek’s sign
1. Trousseau’s: BP on cuff, inflate for a few minutes-will have carpal spasms
2. Chvostek’s: Tap on facial nerve, facial twitching
ii. Laryngeal stridor
1. Noisy respirations
iii. Dysphagia
iv. Numbness and tingling around the mouth or in the extremities
v. Dysrhythmias
treatment of hypocalcemia
i. Treat cause
ii. Calcium and Vitamin D supplements
iii. IV calcium gluconate
iv. Rebreathe into paper bag
v. Treat pain and anxiety to prevent hyperventilation-induced respiratory alkalosis
b. Essential to function of muscle, red blood cells, and nervous system
d. Serum levels controlled by parathyroid hormone
e. Maintenance requires adequate renal functioning
Phosphate (anion) in ICF
Hyperphosphatemia Phos caused by:
i. Acute kidney injury or chronic kidney disease
ii. Excess intake of phosphate or vitamin D
iii. Hypoparathyroidism
Hyperphosphatemia manifestations
i. Tetany, muscle cramps, paresthesias, hypotension, dysrhythmias, seizures (hypocalcemia)
ii. Calcified deposition in soft tissue such as joints, arteries, skin, kidneys, and corneas (cause organ dysfunction)
V. Hyperphosphatemia management
i. Identify and treat underlying cause
ii. Restrict intake of foods and fluids containing phosphorus
1. Milk, beans
iii. Oral phosphate-binding agents
1. Calcium carbonate
iv. Hemodialysis
v. Volume expansion and forced diuresis
vi. Correct any hypocalcemia
a. Cofactor in enzyme for metabolism of carbohydrates
b. Required for DNA and protein synthesis
c. Blood glucose control
d. BP regulation
Magnesium
i. Increased intake of products containing magnesium when renal insufficiency or failure is present
ii. Excess IV magnesium administration
hypermagnesmia
hypermagnesmia manifestations
i. Hypotension, facial flushing
ii. Lethargy
iii. Nausea and vomiting
iv. Impaired deep tendon reflexes
v. Muscle paralysis
vi. Respiratory and cardiac arrest—can lead to coma
i. Prolonged fasting or starvation
ii. Chronic alcoholism
iii. Fluid loss from GI tract
iv. Prolonged parenteral nutrition without supplementation
v. Diuretics, proton-pump inhibitors
vi. Hyperglycemic osmotic diuresis
Hypomagnesemia
Manifestations; hyopmagnesemia
i. Resembles hypocalcemia
1. Muscle cramps, tremors
2. Hyperactive deep tendon reflexes
3. Chvostek’s and Trousseau’s signs
4. Confusion, vertigo, seizures
Hypophosphatemia causes
Malnurishment/malabsorption
diarrhea
use of phosphate-binding antacids
inadequate replacement during parenteral nutrition
Hypophosphatemia Manifestations
CNS depression
Muscle weakness/p!
Rickets (bow legged) & osteomalacia (softening of bones)
