Metabolism Flashcards
Normal sodium range
135-145 mEq/L
What is sodium responsible for in the body?
- Essential for maintaining osmolality, water balance, acid-base balance
- Water travels with or toward sodium
- Sodium movement is linked between water retention, blood volume, and blood pressure
- Regulated by kidneys and aldosterone
- Sodium major electrolyte in extracellular fluid
Hypernatremia range and cause?
— Sodium level above 145 mEq/L
— Most commonly caused by kidney disease
— Sodium accumulates
- Decreased excretion
- High net water loss (watery diarrhea, fever, burns)
- High doses of corticosteroids or estrogen
Physiology of hypernatremia?
- Elevated sodium increases osmolality
— Draws fluid from interstitial space and cells
— Causes cellular dehydration - Signs and symptoms
— Thirst, fatigue, weakness, muscle twitching
— Convulsions, altered mental status, decreased level of consciousness
Treatment of hypernatremia?
- Can be treated with low-salt diet
- Acute hypernatremia treated with hypotonic intravenous fluids (if hypovolemic) or diuretics (if hypervolemic).
Hyponatremia range and cause?
- Sodium level below 135 mEq/L
- Caused by excessive dilution of plasma
— Excess antidiuretic hormone (ADH) secretion
— Excessive administration of hypotonic intravenous solution - Vomiting, diarrhea, gastrointestinal suctioning, diuretic use
Symptoms of hyponatremia?
- Early symptoms
— Nausea, vomiting, anorexia, abdominal cramping - Later signs
— Altered neurologic function such as confusion, lethargy, convulsions, coma, muscle twitching, tremors.
Treatment of hyponatremia?
- Hyponatremia caused by excessive dilution
— Treat with loop diuretics to cause an isotonic diuresis - Hyponatremia caused by sodium loss
— Treat with oral sodium chloride or intravenous fluids containing salt
+++ Normal saline
+++ Lactated ringer’s
What to be alert for and teach patient about Sodium replacement therapy?
- Assess sodium and electrolyte balance
- Be alert for signs of hyponatremia and hypernatremia
- Monitor serum sodium levels, urine specific gravity, serum and urine osmolality
- Teach patient
— To report symptoms that may relate to fluid overload
— To drink water or balanced sports drinks to replenish lost fluids and electrolytes.
Normal potassium range and use?
- Normal range: 3.5 - 5 mEq/L
- Essential for proper nerve and muscle function.
- Maintaining acid-base balance
- Influenced by aldosterone
— For each sodium ion reabsorbed, one potassium ion is secreted into renal tubes - Imbalances can be serious, even fatal
Hyperkalemia range and cause?
- Potassium level above 5 mEq/L
- Caused by high consumption of potassium-rich food, dietary supplements
- Risk with patient taking potassium-sparing diuretics
- Accumulates when renal disease causes decreased excretion
Symptoms of hyperkalemia?
- Most serious are dysrhythmias and heart block
- Other symptoms are muscle twitching, fatigue, paresthesias, dyspnea, cramping, and diarrhea
Treatment of hyperkalemia?
- Restrict dietary source
- Decrease dose of potassium-sparing diuretics
- Administer glucose and insulin
- Administer calcium to counteract potassium toxicity on heart
- Administer polystyrene sulfonate and sorbitol to decrease potassium levels
Hypokalemia range and cause?
- Potassium level below 3.5 mEq/L
- Caused by:
— High doses of loop diuretics
— Strenuous muscle activity
— Severe vomiting or diarrhea
Symptoms of hypokalemia?
- Neurons and muscle fibers most sensitive to potassium loss
- Muscle weakness, lethargy, anorexia, dysrhythmias, cardiac arrest
Treatment of hypokalemia?
- Mild: increase dietary intake
- Severe: give oral or parenteral potassium supplements
What to monitor for with potassium replacement therapy?
Contraindications?
- Monitor for cardiac abnormalities
- Contraindicated in cases of severe renal impairment
- Do not use with potassium-sparring diuretics
- Contraindicated in acute dehydration, heat cramps, patients with digoxin intoxication with AV node disturbance
- Take with meals to avoid irritating GI tract
Calcium normal range
Normal: 9 - 10.5 mg/dl
Hypocalcemia range, cause, S/S, treatment?
- < 9mg/dl
- S/S: anxiety, irritability, twitching, muscle cramps
- Treatment: oral (+vit D) or IV calcium
Hypercalcemia range, cause, s/s, treatment?
- > 10.5 mg/dl
- Cause: hyperparathyroidism, hypophosphatemia, tumors of the bone, immobilization, immobilization, fractures, thiazide diuretics
- S/S: flabby muscles, pain over bony areas, kidney stones
- Treatment: calcitonin or IV NS followed by loop diuretics
Magnesium normal range?
Normal: 1.3 - 2.1 mEq/L
Hypomagnesemia range, cause, s/s, treatment?
- Most undiagnosed; asymptomatic until <1 mEq/L
- Cause: Long term NS, diuretics, laxatives, steroids
- S/S: Cardiac dysrhythmias
- Treatment: IV magnesium sulfate, antacids
Hypermagnesemia range, cause, s/s, treatment?
- Range: > 2.1 mEq/L
- Cause: Excessive intake, antacids
- S/S: hypotension, heart block
- Treatment: calcium gluconate
A patient is receiving medication therapy to correct the condition of hypokalemia. Which is an important nursing consideration for administration of potassium therapy? (select all that apply)
A) Do not administer IV preparations as a bolus dose
B) Have the patient sit upright when giving an oral dose
C) Dilute liquid forms of the medication in juice or water
D) Instruct the patient to swallow capsules or tablets whole
E) Monitor the serum potassium 30 minutes after giving the oral dose
A, B, C, D.
