Electrolytes II Flashcards
Na+ range
135 - 145
K+ range
3.5 - 5
Ca+
Total
Ionized
Total 8.5 - 10.5 mg/ dL
Ionized 4 - 6mg / dL
Mg+ range
1.3 - 2.1mEq/L
Cl- range
95 - 105 mEq/L
PO4- phosphate
Range
2.5 - 4.5 mg/ dl
Electrolyte Relationships
Sodium / Potassium
(Similar / Inverse)
High Na = ___K
Inverse
High Na =Low K
Electrolyte Relationships
Calcium /Phosphorus
High Calcium = ___ Phosphorus
Inverse
High Ca = Low Phos
Electrolyte Relationships
Calcium / Vitamin D
Similar or Inverse
Similar
High Ca = high Vit D
Electrolyte Relationships
Magnesium/ Calcium
Similar or Inverse
Low Mg = ____ Ca
Similar
Low Mg = Low Ca
Electrolyte Relationships
Magnesium/ Potassium
Similar or Inverse
If there is high Mg there will be ___ K
Similar
High Mg = high K
Electrolyte Relationships
Magnesium/ Phosphorus
Similar or Inverse
Low Mg = ___ Phos
Inverse
Low Mg = High Phos
Besties with H²O
Sodium NA+ 135 - 145mEq/L
Fluid distribution and elimination (BP)
Sodium NA+ 135 - 145mEq/L
Transmits impulses in nerve and muscle fibers
Sodium NA+ 135 - 145mEq/L
How many weeks vacation do RNs get per year
2 atleast to start
Plus 2.5x pay for holidays
Maintained by ADH & Assisted by Aldostrone
Sodium NA+ 135 - 145mEq/L
Neurological symptoms are most likly due to this electrolyte
Sodium NA+ 135 - 145mEq/L
Labs for Diagnostic for Hyponatremia
Serium osmolality Less than….
Serum Sodium level Less than….
Urine specific gravity less than…. (unless SIADH)
What happens to the Hemocrit and plasma protein
Labs for Diagnostic for Hyponatremia
Serium osmolality (280 mOsm/kg) Less than 280
Serum Sodium level Less than 135
Urine specific gravity less than 1.010 (unless SIADH)
Hemocrit & plasma proteins elevated
Sodium levels may appear low bc too much fluid is in the body?
Isovolemic hyponatremia
This type of hyponatremia
S/S
Maybe no signs
Thrist in SIADH (High Concentration Urine, increased ADH)
Primary polydipsia
NEURO/PSYCH
Isovolemic Hyponatremia
This type of Hyponatremia
Causes
Glucocortidicoid deficiency (causing inadequate fluid filtration by kidneys)
Hypothyroidism (limited water excretion)
Renal failure (increased H2O levels)
Medication: Psych / Lithium
Tramatic Brain Injury
Adrenal Insufficiency
SIADH (too much ADH causes, increased thrist, H2O retention, increased NA+ excretion)
Isovolemic Hyponatremia
Interventions for this type Hyponatremia
Oral urea (extreme cases)
Fluid restrictions
1L q day
Increases Serum osmolality/ stabilizes ADH
High Na+ Diet
Daily weight
I & Os
NEURO CHECKS
SODIUM CHLORIDE TABS
Isovolemic hyponatremia
Diagnostics
Low urine sodium <25
Low urine osmolality <100
Hypovolemic hyponatremia
low urine sodium and low urine osmolality in the context of hyponatremia suggests a situation where the body is conserving sodium and attempting to retain water, likely due to a loss of both sodium and water (hypovolemia).
Result from conditions such as vomiting, diarrhea, excessive sweating, or the use of diuretics.
Both sodium and water are decreased in extracellular area, sodium loss is greater than water loss
Hypovolemic hyponatremia
Renal causes
Salt-losing nephritis adrenal insufficiency
Diuretic use, loop, thiazide (volume depletion, thirst and H²O retention)
Osmotic diuresis (Inhibiting Na+ reabsorbs)
Hypovolemic Hyponatremia
S/ S
Mental confusion, headache
Altered LOC
hyperirritability, anxiety
Tremors, seizures
Hyperreflexia, muscle weakness, twitching
Nausea, Vomiting, abdominal cramps
Edema and weight gain
Hypovolemic Hyponatremia
Non-renal Causes
Vomiting
Diarrhea
Fistulas
Sweating excess
Burns
Continuous NG suction
Hypovolemic Hyponatremia
Interventions
High Na+ Diet
Daily weight / I & O
Neuro checks
Sodium Chloride tabs
ISOTONIC IV FLUIDS (NO D5W)
Hypovolemia hyponatremia
Diagnostics
Low urine sodium
GI loss (diarrhea)
Renal loss due to diuretics (after diauretics stopped)
Third spacing
Hypovolemia hyponatremia
High urine sodium
> 40 mEq/L
Metabolic alkalosis (Vomiting)
Renal Salt losses due to diuretics
Adrenal insufficiency, or cerebral salt wasting
Hypovolemia hyponatremia
Both sodium and water are INCREASED in the EXTRACELLULAR area, but water gain is more than sodium gain (Aldosterone)
Hypervolemic Hyponatremia
S /S
Edema / Third Spacing
Hypertension
Weight gain
Rapid / Bounding pulse
Causes
Heart Failure
Renal failure
Liver failure
Nephrotic syndrome
EXCESSIVE ADMINISTRATION OF HYPOTONIC IV
HYPERALDOSTRONE
Hypervolemic hyponatremia
Interventions
High Na+ diet
Daily weight/ I & O
Neuro checks
Sodium chloride tabs
ISOTONIC IV FLUIDS (NO D5W)
Maybe given dose of Lasix while receiving hypertonic solutions
Hypervolemic hyponatremia
The normal serum osmolality is _____ mOsm/kg.
Lower significa….
Higher…
285–295
Lower: less solutes in water Over hydration
Higher: more solutes in water Dehydration
Addisons adreal insufficiency
SIADH
Fluid Overload: CHF, Liver failure
Renal problems, NG
This electrolyte problem
Hyponatremia
<135
Assessment for Hyponatremia
SALT LOSS
S = Seizures
A = ____ cramps
L =
T= tendon reflex
L = loss ____
O =
S = ____ Respiration
S = ____ of muscles
Seizures & Stupor
Abdominal cramping & Attitude
Lethargic
Tendon Reflexes Diminished
Loss Urine/ Appetite
Orthostatic Hypotension/ Overactive bowle sounds
Shallow respiration (late Dev- muscle weakness)
Spasms of muscles
S/S
Restlessness
Fever / Flushed Skin
Nause / Vomiting
Lethargy/ Confused
Seizures/ Coma
TWITCHING/ HYPERREFLEXIA
ATAXIA
Causes:
Hypothalamus lesion
Elderly / Confused
Infants
May appear hypervolemic
Elevated BP
Bounding pulse
Dyspnea
Hypernatremia > 145
Causes (electrolyte imbalance)
Cushing’s syndrome & hyperventilating
GI feeding out H2O
Corticosteroids, failed compensatory
Aldosterone (too much)
Thirst impairment
Hypernatremia >145
Hypernatremia
No FRIED foods for you
F = (2)
R = Relaxed or Restlessness
I = increased (2)
E = (2)
D = Describe Skin
Fever & Flushed Skin
Restlessness
Increased fluid retention/ increased deep tendon reflexes
Edema, extremely confused
Dry skin, decreased tugor, dry mucous
Decreased urine output
For Hypernatremia >145 use this IV bag
D5 / .45% or
D5W
Why do you use
D5 / .45% or
D5W
To treat Hypernatremia >145
Gradual reduction to prevent cerebal edema
Hypernatremia Vs Hyponatremia
Agitation
Confusion
Flushed Skin / low fever
Thrist
Restlessness
Weakness
Hypernatremia Vs Hyponatremia
Decreased Reflexes
Ab cramps
Leathargy /Confused
Headache
Muscle twitching
Nausea / Vomiting
Anorexia
Hypernatremia
Agitation
Confusion
Flushed Skin / low fever
Thrist
Restlessness
Weakness
Hyponatremia
Decreased Reflexes
Ab cramps
Leathargy /Confused
Headache
Muscle twitching
Nausea / Vomiting
Anorexia
Assist in skeletal and heart muscle contraction
Aids in transmission of nerve impulse
Acid base balance
Potassium
Hydrogen- potassium exchange
When there is an increase in extracellular acidity (low pH), cells may take up more hydrogen ions in exchange for releasing potassium ions.
How is the most K+ lost
Urine 80%
______ stimulates Na+ reabsorption and K+ excretion
Aldosterone
(Low / High) pH in ECF can cause H+ to be substituted for K+ to maintain ICF neutrality
Low (Acidic)
<7.35
Norm
7.35 to 7.45.
Cellular Excitability:
The sodium-potassium pump helps establish and maintain the resting membrane potential of cells, which is critical for electrical excitability and nerve impulse transmission.
Osmotic Balance:
By regulating the concentration of sodium and potassium ions, the pump helps control osmotic balance, preventing cells from swelling or shrinking excessively.
Energy Conservation:
The pump consumes energy (in the form of ATP) to move ions against their gradients. This constant energy expenditure contributes to overall cellular metabolism.
Secondary Active Transport:
The sodium-potassium pump creates a sodium concentration gradient that indirectly drives the cotransport of other substances, such as glucose and amino acids, into cells.
All describe the action of which ACTIVE TRANSPORT mechanism
Sodium Potassium Pump
Cushings syndrome
Decreased Magnesium
Hyperaldostronism
Hepatic disease
Hyperglycemia
Lasix, steroids, laxatives
Respiratory alkalosis
Hypokalemia <3.5
Severe <2.5
Your body threw K+ in the DITCH
D = drugs (name them)
I = inadequate intake K+
T = too much _____
C = ______ syndrome
H = heavy fluid loss
(Hypokalemia)
Hypokalemia
Drugs (laxatives, diuretics, corticosteroids)
Inadequate intake of K+
Too much water
Cushings syndrome
Heavy fluid loss (NG suction, N&V, wound drainage, Profuse sweat)
Assessment finding
Hypokalemia
Cardiac
Neurovascular
GI motility
Deep tendon reflexes
Cardiac
Weak irregular Pulse, Palpation, Orthostatic hypotension
Neurovascular
Weakness, cramps, paresthesia, fatigue
GI motility
Decreased/ Constipation
Deep tendon reflexes
Decreased
Hypokalemia
If its low its slow
7 L’s
Lethargic
Low shallow respiration
Lethal cardiac Dysthymia
Loss urine
Leg cramps
Limp muscles
Low BP & HR
SUCTION
describes symptoms for which electrolyte imbalance
Hypokalemia
Skeletal muscle weakness / decreased reflexes
U-wave (ECG changes)
Constipation
Toxic effects of Digoxin
Irregular, weak pulse (low bp)
Orthostatic hypotension
Numbness (Paresthesia)
You will be able to work as much as you want when your an RN
And get raises and promotions
Hypokalemia
ECG changes
______ ST segment
______ T-wave
______ U- wave
Depressed ST segment
Flat T-wave
Prominet U- wave
IV replacement for Hypokalemia
Never give….
Max….
Replace ____ first
Never give IV push or Bolus, FATAL
Max 10mEg/hr
Replace Mg first, inverse
Assess
VS
HR & Rhythm
Labs
Digoxin level
I & O
Hypokalemia
Both hypokalemia and digoxin can affect the electrical activity of the heart, and when combined, there is an increased risk of adverse effects.
Causes of this electrolyte problem
Tissue injury
Drugs (ACE, NSAID, ARBs, certain diuretics)
Renal failure
Blood transfusion
Elevated pH (H+)
Salt substitutes
Hyperkalemia >5
The body “CARED” too much for K+
Hyperkalemia
C = Cells what happens to the cells
A = This disease
R = _____ FAILURE
E = Excessive _____
D = Drugs (3)
Hyperkalemia
Cellular movement from Intra - Extracellular space. (Burns, tissue damage, acidosis, cell destruction)
Addisons (Adrenal Insufficiency)
Renal failure
Excessive K+ / Salt Substitutes
Infection, extensive surgery, hemolysis
Drugs (Aldactone, ACE inhibitor, NSAIDS)
Hemorrhage
Hyperkalemia Assessment
Cardiac
Neuromuscular
GI / GU
Cardiac
Bradycardia
Irregular pulse
Hypotension
Rhythm changes
Neuromuscular
Paresthesia
Muscle weakness
Paralysis
Hyperreflexia
Respitory Distress
GI / GU
Ab cramps
Nausea
Decrease urine output
Hyperkalemia will MURDER you
M = muscle _____
U = Urine level
Respitory failure
D = Decreased
E = Early Sign
R = Rhythm Changes
Hyperkalemia
Muscle weakness
Urine low
Respitory failure
Decreased cardiac contraction
Early signs / Twitching/ Cramps
Rhythm changes in heart
VFIB / VTACH
Labs
K >5 , sever >7
Decreased pH Acidosis
H+ levels
Tall peaked T-wave
Flat or absent P-wave
Wide QRS complexes (Cardiac Arrest)
Prolonged PR interval
VFIB or VTACH
Hyperkalemia
Hyperkalemia
Labs
K level, K level sever
pH level
H+ level
K >5 , severe >7
pH <7.35 Decreased
H+ levels INCREASED
Interventions for ______
Eliminate from body
(This_Type) Diuretic
Dialysis
Sodium polystyrene sulfonate
NaHCO³ (Stablizes acidosis)
Dextrose & insulin
Albuterol
Admin CaCl or Ca gluconate …. Why
Hyperkalemia
Loop diuretic
Combat myocardial effects
Magnesium range
1.3 - 2.1
This electrolyte
Maintains electric activities in nerves and muscles
Vasodilation and irritability
Contraction of cardiac muscles
Skeletal muscle contraction
Carb metabolism, ATP formation, vitamin activation, cell growth
Magnesium+ 1.3 - 2.1
Causes of this electrolyte imbalance
Hypocalcemia
Cirrhosis
Sepsis
Loss from GI / urine
DM / DKA (w/ insulin)
Alcohol
Medications
Insulins
Diuretics
PPI / Prilosec
Laxatives
(TPN) is when the IV administered nutrition is the only source of nutrition the patient is receiving
Hypomagnesemia
LOW MAG anagram
L = limited intake
O = other electrolytes issues ___ & ___
W = ___ via kidneys
M = Malabsorption
A = _____
G = ____ Issue
Limited intake
Other electrolyte issue (Hypocalcemia & Hypokalemia)
Wasting via Kidneys
Malabsorption
Alcohol
Glucemic issue (DKA)
Assessment for Hypomagnesemia
TWITCHING
Trousseau’s sign (related to Hypocalcemia) uncontrolled muscle spasm / Chvostek (Hypocalcemia) facial twitching
Weak respiration
Irritability / confusion
Torsade de pointes (ECG Arythmia, Fatal, alcohol abuse)
Cardiac changes
Hypotension
Involuntray movement, muscle cramps, seizures
Nausea
GI issues (Decreased bowel sounds and motility)
In low magnesium <1.3 how is
Chvostek sign tested
Trousseau’s sign
Chvostek sign tested
Tap on face.
Positive = uncontrolled muscle spasms
Trousseau’s sign
Blood pressure cuff inflated to just above systolic
Positive: Carpuel tunnel flailing of hands or wrist
Diagnostic Lab
Mg < 1.3 (1.5)
May see LOWER this electrolyte
ECG changes
PR & QT _____
QRS ______
Hypomagnesemia
Lower K+
ECG
PR & QT PROLONGED
QRS WIDE
Chocolate, dry beans, peas, green leafy veg, meats, nuts, seafood, whole grains
High in ….
Mg
Causes
Addisons Disease
DKA
Cell Damage
Hypothyroidism
Hyperparathyroidism
Antacids
Hypermagnesemia >2.1
Assessment Findings Hypermagnesemia
LETHARGIC
L =
E =EKG
T = tendon reflexes
H = ____ tension / Diaphoresis
A=
R= Respitory _____
G =
I = _____breathing
C = Cardiac ___
Lethargy,weakness, confusion, dprsd
EKG changes, PR & QT Wide, QRS Prolonged
Tendon reflexes diminished
Hypotension/ Diaphoresis
Arrhythmia, Bradycardia / weak pulse
Respiratory arrest (Sudden)
GI issues (N&V)
Impaired breathing
Cardiac Arrest
Mg 2.9
ECG
Wide PR & QT
Prolonged QRS complex
Indicative of…
Hypermagnesemia >2.5
Interventions
Dialysis
Fluids
Loop diuretics
CALCIUM GLUCONATE
Hypermagnesemia
Role:
Maintains cell membrane structure and impulses
Required for blood clotting
Structure for bones and teeth
Calcium
Activación of this electrolyte requires vitamin D
Calcium
When more calcium is needed ______ is released
Excess calcium is present, the thyroid gland secrets ______
Parathyroid hormone
Thyrocalcitonin
Hypocalcemia
LOW CALCIUM
Low (this hormone)
Oral intake, Problems
Wound drainage an issue?
C = This disease
A = Acute ______
L = Low this vitamin
C = Chronic __ diseae
I = increased ____ level
U = Using these meds
M = These types of issues
Low parathyroid hormone
Oral intake lacks (alcoholism, bulimia)
Wound drainage
Celiacs disease
Acute pancreatitis
Low vitamin-D (needed 4 absorption)
Chronic Kidney disease
Increased Phosphorus levels
Using meds (lax, loop diuretics)
Mobility issues (bones)
Assessment Hypocalcemia
CRAMPS
Confusion
Reflexes
Arrythmia
Muscle Spams & Seizures
Positive Trousseau’s (BP cuff,hand contracts)
Sing of Chvostek (Facial nerve hyperexcitable)
(Ionized /Serum) calcium is the total amount of calcium in the blood, including both free calcium (in Blood stream) and calcium bound to proteins (mainly albumin).
What is free calcium floating in the blood stream called____
Serum
Ionized
Hypoglycemia
Serum Ca <_____
Ionized Ca<_____
ECG
______ QT & ST intervals
Serum <8.5
Ionized <4.5
Prolonged QT & ST intervals
Hypocalcemia Intervention
Calcium Chloride (Describe)
Calcium gluconate (Describe)
Give more (Mg or Phosphate)
Give less (Mg or Phosphate)
Vitamin D Supp
Calcium Chloride (faster 3x stronger)
Calcium gluconate (commonly used)
Give more Mg
Give less Phosphate
VS
Respuratory Stridor
ECG
PROLONGED QT & ST
Chvostek’s & Trousseau
Hypocalcemia <8.5
Hypercalcemia
Menomic HIGH CAL
Hyperparathyroidism Too much Ca released in the blood
Increased intake of Ca+
Glucocorticoids
Hyperthyroidism
Calcium excretion decreased (thiazide diuretics, renal failure, bone cancer)
Addisons Adrenal Insufficiency
Lithium Use (Affects parathyroid and decreases phosphorus)
Assessment fir Hypercalcemia
WEAK
W = Weak ….
E= EKG
A = Absent …
A= Abdominal…
Weakness of muscle
EKG changes Shortened QT & Prolonged ST
Absent reflexes & Abdominal distention
Total (Serum) Calcium 11.1
Ionized 5.9
ECG changes
_____ QT interval
_____ ST interval
Hypercalcemia
Total Ca >10.5
Ionized >5.1
Shortened QT
Prolonged ST
Interventions
Increase Excretion
Hydration, diuretics, hemodialysis
Strain urine
Hypercalcemia
PO⁴
Name & Normal level
Phosphate / Phosphorus
2.5 - 4.5
Role
Nerve & Muscle function
Works with Ca for Bone Structure
WBC phagocytosis & platelet function
Activates vitamins and enzymes; assists in cell growth
Phosphate/ Phosphorus / PO⁴
2.5 - 4.5
Causes:
Malnutrition/ absorption
Hyperglycemia
Alcoholism
S/S
Weakness, Confused
Hypercalcemia
Po⁴ less than 2.5 mg
Hypercalcemia
Bone fractures
Treatment:
Increase oral intake
Oral / IV supplements
Safety/Teaching/ monitoring
Hypophosphatemia
<2.5
Causes
Hypoparathyroidism
Cell destruction
Enemas
S/S
Calcification hypocalcemia (bones & teeth)
Hyperactive Deep tendon reflexes
Hyperphosohatemia
Chloride
CL-
NORMAL RANGE
96 - 106
Travels with Na+ to maintain serum osmolality
Acid/base balance
Secreted by gastric mucosa (HCI)
SAME S/S as ….
Chloride
Same S/S as Na
Electrolyte associated with
Mental Status
Na
Electrolyte associated with
Cardiac and muscles
K potassium
Electrolyte associated with
Reflexes and muscles
Mg
Addisons disease causes this electrolyte imbalance.
Why
Hyponatremia and hyperkalemia
Adrenal insufficiency.
Hyponatremia is mainly due to the increased release of antidiuretic hormone
With Cushings syndrome these electrolytes are impaired how?
Low potassium &
High sodium, and high bicarbonate levels
Oppsite of Addisons
Addison’s lack Cortisol (and Aldosterone),
Cushing’s too much cortisol (hypercortisolism)
To treat hypovolemic,hyponatremia give isotonic IV.
However, do not give this IV type
D5W.
It is hypo in the body system
Interventions
Hypervolemia/ hyponatremia
Isotonic IV given no D5W
Hypertonic IV can be given in ICU slowly (Risk Brain damage) if sodium is under
120
Insufficiently low levels of _______ result in low sodium levels (hyponatremia), elevated potassium levels (hyperkalemia
aldosterone
Which number value is more likely to complain of
Agitation, Increased Reflexes, Low-grade fever, Weakness
From Na issues
Hypernatremia
> 145
Which value range is more likely
Lethargy, Abdominal cramping, Nausea, Vomiting, Anorexia
Due to Na issues
Hyponatremia
<135
Which group is more likely to experience
Headache, Muscle Twitching, Lethargy, and GI issues
From Na issues
Hyponatremia
<135
Which group is more likely to experience
Falls, Flushed Skin / Fever, Thirst, increased reflexs and confusion
From Na issues
Hypernatremia
> 145
Interventions
Hyponatremia/ Hypernatremia
Isotonic IV fluids (No D5W)
Hypertonic (if under 120 given in ICU slow, “Brain Damage Risk”) -
Lasix maybe given when receiving Hypertonic Solutions
Hyponatremia/ Hypernatremia
Salt free fluids (No Gatorade)
Use Hypotonic IV (D5 / .45% or D5W)
Diuretics and water
Hyponatremia
Isotonic IV fluids (No D5W)
Hypertonic (if under 120 given in ICU slow, “Brain Damage Risk”) -
Lasix maybe given when receiving Hypertonic Solutions
Hypernatremia
Salt free fluids (No Gatorade)
Use Hypotonic IV (D5 / .45% or D5W)
Diuretics and water
Aldosterone will raise this number _____ and lower this numer
Lower K+ potassium
Raise Na sodium
Cushings syndrome has which effect on electrolytes
Lowers K potassium
Raises Na sodium
Causes
Hypokalemia/ Hyperkalemia
Drugs (ACE, NSAID, ARBS, Certain Diuretics)
Blood transfusions
Elevated pH
Salt substitutes
Hypokalemia/ Hyperkalemia
Decreased Mg
Hyperaldosteronism
Respitory Alkalosis
Insulin therapy
Cushings
Hyperkalemia >5 mEq/L
Drugs (ACE, NSAID, ARBS, Certain Diuretics)
Blood transfusions
Elevated pH
Salt substitutes
Hypokalemia <3.5 - Sever <2.5
Decreased Mg
Hyperaldosteronism
Respitory Alkalosis
Insulin therapy
Cushings
Assessment Findings
Hypokalemia/ Hyperkalemia
Weak, Irregular Pulse
Orthostatic hypotension
WEAK legs,cramps, paresthesia
Fatugue
Respitory Weakness
Constipation
Decreased Deep Tendon Reflexes
Hypokalemia/ Hyperkalemia
Bradycardia
Hypotension
Rhythm changes
Tall - T
Flat - P
Wide - QRS
Hypokalemia
Weak, Irregular Pulse
Orthostatic hypotension
WEAK legs,cramps, paresthesia
Fatugue
Respitory Weakness
Constipation
Decreased Deep Tendon Reflexes
Hyperkalemia
Bradycardia
Hypotension
Rhythm changes
Tall - T
Flat - P
Wide - QRS
Dont give IV rate of Potassium greater than _____ MMOL / HR
LEATHAL!!!!
10
Interventions
Hypokalemia / Hyperkalemia
Dont use Loop Diuretics
Ass Digoxin Level
Replace Mg First
Never Give IV bolus or Push.
Max 10 mEq/hr
ALWAYS USE PUMP
Hypokalemia/ Hyperkalemia
Use Loop diuretics
Dialysis
Sodium polystyrene sulfonate
NaHCO³ Sodium Bicarbonate
Dextrose & Insulin
Albuterol
CaCl or Ca gluconate (combat myocardial effects)
Hypokalemia
Ass Digoxin Level
Replace Mg First
Never Give IV bolus or Push.
Max 10 mEq/hr
ALWAYS USE PUMP
Hyperkalemia
Use Loop diuretics
Dialysis
Sodium polystyrene sulfonate
NaHCO³ Sodium Bicarbonate
Dextrose & Insulin
Albuterol
CaCl or Ca gluconate (combat myocardial effects)
Sodium bicarbonate NaHCO³
Shift potassium ions into cells temporarily, which can be beneficial in addressing hyperkalemia, especially when associated with acidosis.
Diagnostics
Hypokalemia/ Hyperkalemia
K > 5 (severe >7)
Decreased pH (Acidosis)
H+ level High
Hypokalemia/Hyperkalemia
K+ <3.5 (<2.5 is severe)
Lower Mg <1.3
Elevated pH and Bicarb levels
Elevated Glucose
Elevated Digoxin
Hyperkalemia
K > 5 (severe >7)
Decreased pH (Acidosis)
H+ level High
Hypokalemia
K+ <3.5 (<2.5 is severe)
Lower Mg <1.3
Elevated pH and Bicarb levels
Elevated Glucose
Elevated Digoxin
Hypomagnesemia/ Hypermagnesemia
Sepsis
Cirrhosis
Hypocalcemia
DM / DKA
Elderly Increased Risk
TPN (total parenteral nutrition)
Alcohol
Hypomagnesemia/ Hypermagnesemia
Cell damage
Hypothyroid
Hyperparathyroidism
Antacids (Certain types)
Addisons
Hypomagnesemia
Sepsis
Cirrhosis
Hypocalcemia
DM / DKA
Elderly Increased Risk
TPN (total parenteral nutrition)
Alcohol
Hypermagnesemia
Cell damage
Hypothyroid
Hyperparathyroidism
Antacids (Certain types)
Addisons
Hypomagnesemia/ Hypermagnesemia
Trousseau’s sign (Flailing Arm) - Related to Hypocalcemia
Chvostek sign (twitching face) -
Related to Hypocalcemia
Weak respiration
Irritability / Confusion
Torsade de pointes
Cardiac changes
Hypotension (Vasodilation)
Hypomagnesemia/ Hypermagnesemia
Lethary, weak, confusion, depression
Diminished Tendon Reflexes
Diaphoresis
Bradycardia/weak pulse
Respitory / Cardiac Arrest
Hypomagnesemia
Trousseau’s sign (Flailing Arm) - Related to Hypocalcemia
Chvostek sign (twitching face) -
Related to Hypocalcemia
Weak respiration
Irritability / Confusion
Torsade de pointes
Cardiac changes
Hypotension (Vasodilation)
Hypermagnesemia
Lethary, weak, confusion, depression
Diminished Tendon Reflexes
Diaphoresis
Bradycardia/weak pulse
Respitory / Cardiac Arrest
Hypomagnesemia/ Hypermagnesemia
ECG
Wide PR & QT
Prolonged QRS
Mg 2.9 (exp)
Hypomagnesemia/ Hypermagnesemia
ECG
Prolonged PR & QT
Wide QRS
Increased T wave
Mg 1.1 (exp)
May see Low K
Hypermagnesemia
Wide PR & QT
Prolonged QRS
Mg > 2.5
Hypomagnesemia
Prolonged PR & QT
Wide QRS
Increased T wave
Mg < 1.3
May see Low K
Interventions (Name Electrolyte too)
Hypo / Hyper
Give Foods such as: Chocolate, dry beans, peas, leafy vegs, meats nuts
Hypo/ hper
Dialysis
Loop diuretics
Calcium Gluconate IV
Hypomagnesemia
Give Foods such as: Chocolate, dry beans, peas, leafy vegs, meats nuts
Hypermagnesemia
Dialysis
Loop diuretics
Calcium Gluconate IV
Hypocalcemia/ Hypercalcemia
Hyperparathyroidism
Glucocorticoid
Hyperthyroidism
Addisons (Adrenal Insufficiency)
Lithium Use
Hypocalcemia/ Hypercalcemia
Low parathyroid hormone
Alcohol/ Bulimia
Celiacs Disease
Acute Pancreatitis
Increased Phosphorus
Medication (Magnesium & Laxatives)
Mobility Issues
Hypercalcemia
Hyperparathyroidism
Glucocorticoid
Hyperthyroidism
Addisons (Adrenal Insufficiency)
Lithium Use
Hypocalcemia
Low parathyroid hormone
Alcohol/ Bulimia
Celiacs Disease
Acute Pancreatitis
Increased Phosphorus
Medication (Magnesium & Laxatives)
Mobility Issues
Hypocalcemia/ Hypercalcemia
Assessment
Weakness of Muscles (very profound)
EKG: Shortened QT interval and prolonged ST interval
Reflexes absent
Abdominal Distention
Hypoglycemia/ Hypercalcemia
Confusion
Hyperactive reflexes
Arrhythmia (Prolonged QT & ST interval)
Muscle spams & Seizures
Positive Trousseau (BP cuff / hand contracting)
Positive Chvostek (facial nerve hyper)
Hypercalcemia
Weakness of Muscles (very profound)
EKG: Shortened QT interval and prolonged ST interval
Reflexes absent
Abdominal Distention
Hypocalcemia
Confusion
Hyperactive reflexes
Arrhythmia (Prolonged QT & ST interval)
Muscle spams & Seizures
Positive Trousseau (BP cuff / hand contracting)
Positive Chvostek (facial nerve hyper)
Hypocalcemia/ Hypercalcemia
ECG:
Prolonged QT & ST interval
Serum < 8.5
Ionized < 4.5
Hypocalcemia/ Hypercalcemia
ECG:
QT shortened
ST Prolonged
Serum > 10.5
Ionized > 5.1
Hypocalcemia
ECG:
Prolonged QT & ST interval
Serum < 8.5
Ionized < 4.5
Hypercalcemia
ECG:
QT shortened
ST Prolonged
Serum > 10.5
Ionized > 5.1
Hypophosphatemia / Hyperphosphatemia
Causes
Kidney Disease
Hypoparathyroidism
Cell destruction
Enemas
Hypophosphatemia / Hyperphosphatemia
Magnesium based drugs
Hyperglycemia
Alcoholism
Hyperphosphatemia
Kidney Disease
Hypoparathyroidism
Cell destruction
Enemas
Hypophosphatemia
Magnesium based drugs
Hyperglycemia
Alcoholism
What does Aldosterone do to Na and K levels.
The more Aldosterone Higher Na & Lower K
Hyperkalemia >5
Two ECG waves associated
VFIB & VTACH
Steroids have this affect in
Na
K
Ca
Na >145 hyper
K <3.5 hypo
Ca > 10.5 hyper
