Week 1: Electrolytes Flashcards
what is the function of potassium
maintains heart and muscle contraction
how does potassium maintain heart and muscle contraction
keep each muscle cell charged or polarized via the Na-K pump
whats K+ regulated by
kidneys
what is potassium influenced by
aldosterone hormone (renin angiotesnin aldosterone system) and acid base levels
what promotes movement of k+ into cells
insulin
wheres K+ found
intracellular
normal range for K+ levels
3.5-5.0
hyperkalemia
above 5
hypokalemia
below 3.5
what are the causes of hyperkalemia? (MACHINE)
medication
acidosis
cellular destruction
hypoaldesternonism
increase in K+ intake
nephrons broken
excretion issues
what are the signs of hyperkalemia
heart:
irregular HR
hypotension
bradycardia
arrythmias
vfib or cardiac standstill
respiratory: failure
GI: diarrhea hyperactive bowel sounds
Neurologic: confused increased DTR
neuromuscular:
muscle weakness heaviness
paralysis
tinging burning numbness hands feet mouth
how is hyperkalemia managed (MDKID)
monitor EKG
diet- no salf fruit greens
kayexalate
IV solutiosn- sodium bicarb correct acidosis
diuretics and dialysis
what IVs are used to manage hyperkalemia
sodium bicarb for acidosis
calcium gluconate (decrease NM irrit)
insulin and albuterol beta 2 agonist (push K+ in cell)
what diuretics are used to manage hyperkalemia
furosemide loop
hydrochlorothiazide (k wasting)
dialysis for renally impaired
what causes hypokalemia (GOT SHOT)
GI loss- vomit diarrhea
osmotic diuresis- freq pee
thiazide and loop diuretics- hydrochlorothiazide and furosemide k wasting
severe acid base imbalance- alkalosis
hyperaldosteronism
other meds deplete potassium; corticosteroids insulin
transcellular fluid shift: insulin albuterol
signs and symptoms of hypokalemia (LOW and SLOW)
heart:
bradycardia severe tachy early
orthostatic hypotension
arrythmias
respiratory:
slow shallow breathing diminished breath sounds
respiratory arrests with severe hypokalemia
GI:
decreased motility hypoactive bowels
constipation abdominal distention
paralytic ileus small bowel obstruction
neurological:
loss of conciousness
confusion anxiety
lethargy fatigue
neuromuscular:less responsive
low weak DTR muscle cramps
weakness paralyzed limbs
how is hypokalemia managed
admin K-dur
iv potassium chloride,k,kcl in saline
diet
what diet should someone with hypokalemia go on
salt substitutes
fruit
avacado
green leafy veggies
why should u never push straigh k+
causes death intense heart contraction causes it to stop[
where is sodium found
ecf vascular and isf
what follows sodium
water
what is a determinatn of sodium
ecf
bp
how is sodium transported into and out cells
sodium potassium pump
how is sodium regulated
kidneys thorugh ADH and aldosterone
(hold Na in body blocks Na at kidney)
whats normal serum sodium levels
135-145
hypernatremia levels are
sodium level in plasma greater than 145
hyponatremia levels are
sodium level in plasma lower than 135
what causes hypernatremia (FAIR AD)
fluid loss higher than sodium loss- hemoconc (dehydration from infection, sweat, diarrhea)
ADH insufficiency- diabetes insipidus
increase sodium intake- processed food, vitamins
renal issues- imparied excretion of na
aldosterone excess- cushings (hyperaldosteronism)
deprivation of fluids
what are the signs and symptoms of hypernatremia (big and bloated)
heart:
hypertension
bounding pulses
tachycardia and dysrhythmias
respiratory:
shortnesss breath
fluid overload clogs lungs
GI- nausea vomiting
GU- decreased urinary output high urine specific gravity
neurological:
thick salty csf brain cells shrink
muscle fatigue weakness (early)
confusion irritability restlessness hyperreflexia (late)
nausea vomit seizures comas (severe)
neuromuscular:
increased muscle tone
twitching of muscles cramps
hyperreflexia
integumentary:
edema, pitting dry mouth swollen dry tongue
what causes hyponatremia
losses from excessive sweating vomiting diarrhea
use of diuretic drugs with low salt diet
hormonal imbalances
excessive water intake
what hormonal imbalances cause hyponatremia
insufficient aldosterone
adrenal insufficiency
excess adh secretion
what are the 2 types of hyponatremia
hypovolemic- loss of fluid and na+
hypervolemic- increase in body water greater than na+
what are the signs and symptoms of hypovolemic hyponatremia
low fluid and na
increased HR
decreased BP
increased RR
what are the signs and symptoms of hypervolemic hyponatremia
increase HR
increased BP
decreased RR
what does elevated EKG indicate
ventricles cramping up
what are the general signs and symptoms of hyponatremia
lungs;
fluid imbalance improper air exch- shortness of breath and dyspnea
GI;
nausea vomiting abdominal cramping
neurological-
decreased osmotic pressure CSF and cerebral edema
restlessness, confusion seizures and coma
muscular- general weakness
how is hypovolemic hyponatremia treated
administer iv salty solutions
isotonic like NS or LR
diet high in salt canned food processed meat cheese packaged food
what regulates chloride levels
sodium
what is the function of chloride
maintain blood volume
blood pressure
pH of body fluids
what does low chloride lead to
high serum bicarb (alkalosis)
what are normal chloride levels
97-107
hyperchloremia
high chloride in blood higher than 107
hypochloremia
low chloride in blood lower than 97
what causes hyperchloremia
hypernatremia
dehydration & hemoconc- severe diarrhea metabolic acidosis (low hco3)
respiratory alkalosis (hyperventilating blowing off co2)
what are the signs and symptoms of hyperchloremia
same as hypernatremia
-edema
-weight gain
-hypertension
-tachypnea
what are the main causes of hypochloremia (CHAMP)
chloride loss from fluid loss (vomit diarhhea sweat fever burns)
hyponatremia
addisons disease adrenal crisis
meds- diuretics increase excretion of Cl, Na and K
Ph imbalances- metabolic alkalosis
what are the signs and symptoms of hypochloremia
same as hyponatremia- depressed deflated
heart; hypotension dysrhythmia
respiratory; dyspnea short of breath
neurological; aggitation confusion seizures coma
GI; diarrhea
musculoskeletal; tremors twitching muscle cramping
where is calcium found
ecf
where is calcium ingested stored and excreted
food
bone
urine
stool
what is calcium balance controlled by
parathyroid hormone
calcitonin
parathyroid hormone
increases ca conc in blood
calcitonin
puts ca in bones
what promotes ca absorption from intestines
vitamin D
activated in kidneys
ingested/synthesized by UV rays
what is calciums function
blood
bone
beats (heart)
fills function of Mg- linear relation
enemy of phosphate- inverse relation
what are normal calcium levels
9-10.5mg
hypercalcemia
plasma calcium level greater than 10.5
hypocalcemia
plasma calcium level lower than 9
what causes hypercalcemia (HAM-LI)
hyperparathyroidism
Anti acids containing calcium like tums
malignancies- uncontrolled release of ca
low phosphae
immobility- decrease stress on bones leading to bone demineralization
what are the signs and symptoms of hypercalcemia
heart;
decreased hr conduction slows
decreased RR
decreased BP
EKG- arrythmias heartblock
Lungs; shortness of breath weak respiration
GI; hypoactive bowel sounds constipation, nausea vomiting
GU;
kidney stones
interfere with ADH less absorption of water and polyuria
neurologic;
altered mental status
decrease reflexes
loss conciousness
musculoskeletal;
decrease excitability
severe muscle weakness
bone pain
hypocalcaemia causes
hypoparathyroidism
malabsorption syndrome
deficient serum albumin
increased serum pH level
renal failure
what are the symptoms of hypocalcaemia
weak 3 B’s
1. weak bones- fractures
2. weak blood clotting- bleed risk
3. weak heart beats- dysrhythmias
what are the symptoms of hypocalcaemia
excited
heart;
ventricular tachycardia severe
slow clotting factors
congestive heart failure
lungs;
spasm of vocal cords (laryngospasm)
dyspnea and crackles
GI: diarrhea intestinal cramping
neurologic;
confusion
personality changes
seizures
dementia or psychosis
musculoskeletal;
trousseau (arm twerks)
chvostek (twitching when temporal area touched)
what are the functions of phosphate
bone tooth mineralizaiton
metabolism importance for ATP
phosphate buffer system- acid base balance
what does phosphate have a recipricoal relationship with
serum calcium
what is phosphate regulated by
parathyroid hormone and calcitriol
what are normal serum phosphate levels
3-4.5
hyperphosphatemia
high phosphate more than 4.5
hypophosphatemia
low phosphate level less than 3
what causes hyperphosphatemia
excess vitaminD - suppress parathyroid decrease renal excretion of Ph
hypoparathyroidism (causes hypocalcemia)
low ca
decreased excretion by kidneys
what are the signs and symptoms of hyperphosphatemia
same as hypocalcemia
heart: arrythmias
respiratory; crackles
neurological; altered conciousness level confusion seizure
GI; diarrhea
Musculoskeletal; weakness hyperreflexes, troussaeu,chvestok
what causes hypophosphatemia
malabsorption
diarrhea
antacids
alkalosis
low Mg low Potassium
hyperparathyroidism
alc withdrawal
what are the signs and symptoms of hypophosphatemia
same as hypercalcemia- low lonely
heart; slow weak pulses dysrhythmias
respiratory; shallow and rapid respiration
renal; kidney stones
neurologic; altered mental status CNS depression
GI: constipation
musculoskeletal; decreased DTR muscle weakness
what is the function of magnesium
keep peace in muscles
calms muscles down (uterus and heart)
what are normal mg levels
1.3-2.1
hypermagnesemia
serum level more than 2.1
hypomagnesemia
serum level less than 1.3
what is hypermagnesemia caused by
renal failure
what are the signs and symptoms of hypomagnesemia
heart;
bradycardia (60b/min)
hypotension
arrythmias
lungs;
depressed respirations slow and shallow
GI; hypoactive bowel sounds
neurological; drowsiness and lethargy that progress to Coma
musculoskeletal; weakness, diminsihed or absent reflexes
what are the causes of hypomagnesemia
diuretics
diabetic ketoacidosis
hyperparathyroidism
hyperaldosteronism
what are the signs and symptoms of hypomagnesemia
buck wild
heart;
tachycardia
arrhythmias
severe; Vfib
GI; diarrhea
neurologic; confusion, irritability, insomnia
neuromuscular;
increased DTR
hyperflexion (clonus)
muscle twitching
numbness (paresthesia)
neuromuscular; increased DTR
