sodium Flashcards
sodium - found where?
MOST ABUNDANT CATION IN ECF
* ONLY SMALL AMT FOUND IN ICF
Na role (think contractions)
IMPORTANT ROLE IN GENERATION AND TRANSMISSION
OF IMPULSES IN NERVES AND MUSCLES
HELPS REGULATE ACID-BASE BALANCE
Na regulation (TAAA da - don’t forget the heart)
- THIRST
- ADH
- ALDOSTERONE
- ANP
hyponaturemia - most common what?
- MOST COMMON ELECTROLYTE IMBALANCE SEEN IN HOSPITALIZED PATIENTS
Hyponaturemia - RISK FACTORS (SGS give me low salt)
- SODIUM LOSS
- GAIN OF WATER - hypotonic solution, rare but hypotonic solution for enteral feedings. Hazing. marathon runner.
- SIADH - risk factor is pneumonia
D5 creates a hypotonic situation - check this
brain cells most (overload the brain)
susceptible to fluid overload - cerebral edema
hyponatremia - clinical manifestations (think how you feel when you don’t have salt)
N/V, loss of energy, muscle weakness, seizures.
- DEPENDENT ON RAPIDITY & SEVERITY OF HYPONATREMIA
- MOST COMMON SX RELATED TO H2O SHIFT FROM VASCULAR SPACE INTO
CELLS AND NA+ ROLE IN NERVE IMPULSE TRANSMISSION AND MUSCLE CTX
Hyponaturemia - NEUROLOGIC SYMPTOMS DON’T DEVELOP UNTIL NA+ VALUE APPROX (low salt brain at 120 min)
120-125
* SEIZURES OCCUR WHEN LEVELS REACH 115
hyponaturemia - LAB VALUES (think of normal values) and when Oz is low he makes a 280 degree)
- NA+ LESS THAN 135MEQ/L
- SERUM OSMOLALITY LESS THAN 280MOSM/KG
- SG DECREASED (EXCEPT WITH SIADH)
INTERVENTIONS - hyponaturemia - assess what? (same stuff)
- ASSESS AND DOCUMENT LOC,
ORIENTATION, NEURO STATUS WITH
VS - I & O DAILY WTS
- MONITOR SERUM LEVELS
CLOSELY - FREE FLUID RESTRICTION
hyponaturemia - DON’T CORRECT TOO
QUICKLY to prevent…(salt in the brain)
NEUROLOGIC DAMAGE
SECONDARY TO LYSIS OF
MYELIN
normal saline percent (saline is small)
.9%
hyponatermia - intervention - just one…and when it gets to what number?
ADMINISTER HYPERTONIC 3%
SALINE SOLUTION ONLY IF
DANGEROUSLY LOW (AT
LEAST 118 OR LOWER VALUE)
increased water
higher bp, if you have hyponateremia
- GREATER THAN NORMAL CONCENTRATION OF NA+ IN ECF caused by..
EXCESS WATER LOSS OR OVERALL SODIUM EXCESS
* MAY OCCUR WITH WATER LOSS, WATER DEPRIVATION, OR NA+ GAIN
who is usually admitted for hypernaturemia?
elderly - don’t want to drink
hypernatermia - causes (hyper is anything without enough H20)
- INCREASED SENSIBLE AND INSENSIBLE H2O LOSS
- DIARRHEA (hypo AND hyper)
- WATER DEPRIVATION/SODIUM GAIN
- DIABETES INSIPIDUS (you aren’t absorbing water, so Na levels get too high)
- EXCESS ALDOSTERONE SECRETION (gain of Na)
free water prevents hyperosmolar state
hypernaturemia - CLINICAL MANIFESTATIONS related to…
WATER SHIFT FROM CELLS (CELLULAR DEHYDRATION) INTO
VASCULAR SPACE
* ALSO RELATED TO NA+ ROLE IN NERVE IMPULSE TRANSMISSION AND MUSCLE
CONTRACTION
DIAGNOSTIC TESTS - hypernaturemia - numbers (just think of normal range for Na - over is hyper) and osmolality above what? (os is 3 less than 300)
- SODIUM GREATER THAN 145
- SERUM OSMOLALITY ABOVE 297
- SG INCREASED, EXCEPT WITH DIABETES INSIPIDUS
HYPERNATREMIA interventions (basically just water)
- I&O
- DAILY WTS
- ASSESS AND DOCUMENT LOC, NEURO STATUS AND ORIENTATION WITH VS
- IV OR ORAL H2O REPLACEMENT
INTERVENTIONS - hypernaturemia - how many days needed to correct hypernaturemia? and why? (salt needs 2 days)
(DESMOPRESSIN ACETATE)
* REORIENT PT AS NEEDED
* DECREASE DIETARY NA+ INTAKE
* CORRECT HYPERNATREMIA SLOWLY (to prevent cerebral edema), OVER 2 DAYS
chloride is ICF or ECF?
- MOST ABUNDANT EXTRACELLULAR ANION AND MAKES UP FOR TWO THIRDS
PLASMA ANIONS
chloride absorption, production, and excretion where?
- REGULATION
- GI - MOST ABSORBED IN INTESTINES. CHLORIDE PRODUCED MAINLY IN
STOMACH AS HYDROCHLORIC ACID (run the risk of alkalosis with loss of hydrochloric acid) - KIDNEYS - EXCRETED AND REABSORBED IN KIDNEYS
headache characteristic of
hyponaturemia
treatment hyponaturemia - stop drinking
fluid restriction, stop low sodium diet. maybe change diuretic.
potassium - located where?
- MAJOR CATION IN ICF
low potassium causes what heart problem?
dysrthmia
K+ regulation (Alden is a KID who regulates K+)
- DIETARY INTAKE
- KIDNEYS - PRIMARY REGULATORS
OF K+ BALANCE - ALDOSTERONE
- INSULIN
HYPOKALEMIA - common or not? (little Kalema is common)
- ONE OF THE MOST COMMON ELECTROLYTE IMBALANCES
- CHANGES IN SERUM K+ REFLECTIVE OF ECF VALUES NOT TOTAL BODY
VALUES
hypokalemia - causes - eating? (can never eat enough potassium)
ETIOLOGY
* DUE TO LOSS FROM BODY OR MOVEMENT OF K+ INTO CELLS
* RARELY RESULT OF INADEQUATE INTAKE
which diuretic for hyperkalemia? (you know the one)
lasix and furosemide
CLINICAL MANIFESTATIONS of hypokalemia CLINICAL MANIFESTATIONS
RARELY DEVELOP UNLESS K+ DROPS below…(think of normal values)
3.0
hypokalemia - DIAGNOSTIC TESTS - what is decreased on blood test? (when kalema is low, she needs maggie and milk)
- ECG: MAY SEE ST SEGMENT DEPRESSION, FLATTENED T
WAVE, PRESENCE OF U WAVE & VENTRICULAR
DYSRHYTHMIAS - DECREASED MG+ OR DECREASED CA++
if Mg is low, what else is usually low? (when maggie gets low, she needs milk and salt to pick her up)
Ca is and Na are usually low as well
INTERVENTIONS - hypokalemia - how much K+ supplement is usually ordered? (need vitamin K from 40 - 80)
- ADMINISTER K+ SUPPLEMENT AS
ORDERED - USUAL DOSE = 40-80MEQ
hypokalemia INTERVENTIONS - encourage foods…
- ENCOURAGE FOODS HIGH IN K+
INTERVENTIONS - hypokalemia - monitor what vital signs?
- MONITOR FOR IRREGULAR PULSE (monitor Apical pulse*****) tachycardia
PULSE DEFICIT, BP, RESP STATUS - MONITOR ECG
- MONITOR PTS RECEIVING DIG FOR
SIGNS OF INCREASED DIG EFFECT
digoxin (dig the extra sodium)
increases contraction. Stops Na to the cell, increases Ca in the cell so heart contraction is increased.
K+ slight increase can have…and is hyper or hypo worse?
SLIGHT INCREASE CAN HAVE PROFOUND CONSEQUENCES
* LESS COMMON THAN HYPOKALEMIA, BUT MORE SERIOUS.
hyperkalemia etiology/causes (kalema gets hyper and lyses when she doesn’t have insulin
- INCREASED INTAKE OF POTASSIUM
- SHIFT OF K+ FROM ICF
- INSULIN DEFICIENCY
- DECREASED RENAL EXCRETION (renal failure at risk for hyperkalemia)
- CELL TRAUMA (and K+ spills out)
hyper is (my plasma is hyper)
plasma
crush injury and tumor lysis syndrome
hyperkalemia
hyperkalemia - usually only apparent with…
EXTREME ELEVATIONS
* INCREASED K+ MUSCLE CELLS MORE EXCITABLE
* DIFFICULT TO DIFFERENTIATE K+ IMBALANCE BY SX ALONE
hyperkalemia DIAGNOSTIC TESTS - numbers (hyper kalema diagnosed at 5)
- SERUM K+ GREATER THAN 5MEQ/L
- BE CAREFUL NOT TO LEAVE TOURNIQUET ON TOO LONG
- ABGS: MAY SEE ACIDOSIS
- ECG: TALL THIN T WAVES, PROLONGED PR INTERVAL, ST
DEPRESSION, WIDENED QRS & LOSS OF P WAVE
K+ excreted via
kidneys, need to check I & O
kayexalate (kay needs to poop potassium)
reduction of K+ levels. increases fecal potassium excretion through binding of potassium in the lumen of the gastrointestinal tract.
correct imbalance - hyperkalemia (when kalema is hyper, giver her insulin)
with inuslin and glucose, and last resort dialysis
hyperkalemia - INTERVENTIONS - monitor the usual and increase what?
INTERVENTIONS
* I&O
* LOW K+ DIET
* INCREASE URINE OUTPUT (K+
WASTING DIURETICS)
* MONITOR ECG IF INDICATED
hyperkalemia - how to correct? (antagonist forcing me to eliminate hyper)
- ANTAGONIZE EFFECT OF POTASSIUM ON CELL MEMBRANE
- FORCE POTASSIUM INTO CELL
- ELIMINATE FROM BODY
- CORRECT CAUSE
hold
lisinipro
ASSESSMENT BEFORE AND DURING K+ INFUSION (vesicant)
check labs, HR, urine output, monitor for hyperkalemia. K+ is a vesicant drug so monitor insertion site.
Na value range (went to Na at age 35)
- NORMAL SERUM VALUE 135-145 MEQ/L
Na+ where is it absorbed and eliminated? (where everything is)
- ABSORBED VIA GI AND ELIMINATED THROUGH URINE
Na - most important for what?
- MOST IMPORTANT ELECTROLYTE REGULATING OSMOLALITY
hyponaturemia * TYPICALLY ASSOCIATED WITH ecf or icf imbalances?
ECF IMBALANCES
* INADEQUATE SODIUM INTAKE
* INCREASED EXCRETION - (kidney problems, diarrhea)
* DILUTIONAL (WATER EXCESS, USUALLY ASSOC WITH HYPERVOLEMIA)
hyponaturemia - clinical problems are largely from intra or extracellular shifts? (low sodium in the cell is the problem)
INTRACELLULAR SHIFT OF WATER
chloride - where is it located and what percent?
- 80% TOTAL BODY CHLORIDE FOUND IN ECF
role of chloride?
REGULATION OF OSMOTIC PRESSURE AND WATER BALANCE (ALONG
WITH NA)
chloride normal values (chloride for the pool is $100)
- NORMAL SERUM VALUES 100-106MEQ/L
K+ - normal values
- NORMAL VALUE IS 3.5-5.0
K+ regulates (K+ regulates the conductions in my heart and muscle)
METABOLIC ACTIVITIES
* ESSENTIAL FOR TRANSMISSION AND CONDUCTION OF
NERVE IMPULSES, NORMAL CARDIAC RHYTHMS, AND
SKELETAL AND SMOOTH MUSCLE CTX
- WHEN SEVERE, HYPOKALEMIA CAN AFFECT
CARDIAC CONDUCTION
- PRIMARY PROTECTION AGAINST DEVELOPMENT OF HYPEROSMOLALITY AND
HYPERNATREMIA is (what you have alllll daaay long)
THIRST
hypokalemia - how fast to administer? (K+ is 10, 20, 30, 40)
- SHOULD NOT ADMINISTER K+ FASTER
THAN 10-20MEQ/HR OR IN
CONCENTRATION HIGHER THAN 30-
40MEQ IN DEXTROSE FREE IV - IF GIVING MORE THAN (don’t give faster than) 10MEQ/HR = CARDIAC MONITOR. If more than 10MEQ/HR, need to be on a cardiac monitor.
never give K+ how?***
- NEVER GIVE IV PUSH OR IM!!!! You will kill them.
hypokalemia - monitor what? And when to hold?
- I&O. * MONITOR URINE OUTPUT
if no urine output, HOLD potassium
hypokalemia - how much to administer for lost urine? (40 yrs. of urine)
40MEQ OF K+ LOST/ L OF URINE
hyponaturemia - encourage foods…and what meds to take? (Demi need salt)
- ENCOURAGE FOODS HIGH IN
NA+ (cheese, look at the LIST of food - you need to memorize it) - MEDICATIONS I.E.
DEMECLOCYCLINE, SALT
TABS (works on kidneys)
- SODIUM-POTASSIUM PUMP CRITICAL TO MAINTAINING
BALANCE BETWEEN
INTRACELLULAR & EXTRACELLULAR
K+
PRIMARY PROTECTION AGAINST DEVELOPMENT OF HYPEROSMOLALITY AND HYPERNATREMIA
THIRST
tx for diabetes insipidious (hypernatremia) - (desmosomes are insipidous)
TX DIABETES INSIPIDUS (DESMOPRESSIN ACETATE)
which one can have profound consequences with a slight increase? (mina)
hyperkalemia
with sodium, think…
potassium, think..
water and neuro changes.
K = cardiac
most important in regulating osmolality?
sodium
the more sodium, the more..
solute
diarrhea can cause
hyponaturemia
SIADH - serum gravity will
not be decreased bc the patient is holding onto water and putting out concentrated urine
free fluid restrictions for what patients?
hypontremia
3% saline is hypo or hyper?
hypertonic.
what prevents hyperosmolar (condition in which the blood has a high concentration of salt (sodium), glucose, etc) state?
free water
hypernatremia - hypo or hypertonic solution?
hypo - but be very very careful.
ECG hyper and hypokalemia
just know that there are changes
don’t ever crush what type of tablet?
potassium
calcium gluconate for what? (kalema needs glue also)
quiets cardiac muscle if pt has hyperkalemia
hyperkalemia - kalema is so hyper she actually slows down
bradycardia
hypermagnesium (big guns)
heart is calm and quiet
hypercalcemia (hyper california is still slow)
everything is slow
hyperphosphatemia
french also
DTR (kalema and floss are high, ca and maggie are slow)
hyperkalemia (tight) - high
hypermagnesia - slow (sheriff)
hypercalcemia - slow
hyperphosphatemia - high
hyperkalemia - tight
slow heart HR, diarrhea, and paralysis
hypernatremia and high calcium (sister) same symptoms - big and slow
bloated, N/V
intracellular shift
something moving into the intracellular space
