Med-Surg 1: electrolytes (exam 1)

LAB VALUES: sodium

135-145

what is sodium closely related to

the movement of chloride and water (water follows salt)

function of sodium

maintains fluid volume

regulates osmolarity/concentration

what vital sign does sodium affect

blood pressure

regulation of sodium

reabsorbed and excreted through the kidneys

sources of sodium

- salt

- canned items

- pickles

- pizza

hyponatremia

sodium level less than 135

what is depleted hyponatremia

The body has actually lost sodium (often along with water), but proportionally more sodium has been lost.

what can cause DEPLETED hyponatremia

- diuretics

- GI fluid loss

- excessive sweating

what does depleted hyponatremia often cause

FVD

what is diluted hyponatremia

There's too much water compared with sodium. The sodium is being diluted.

what can cause DILUTED hyponatremia

- excessive water intake

- excessive iVF

- SIADH (syndrome of inappropriate antidiuretic hormone)

- heart failure

what does diluted hyponatremia often cause

FVE

neurological manifestations of hyponatremia

- confusion

- seizures

- muscles cramps

- lethargy

why does hyponatremia cause neuro effects

there is a lower concentration of sodium in the blood than normal, making the blood more dilute (lower osmolality) compared with the fluid inside the cells. Because water moves by osmosis from the more dilute area to the more concentrated area, water moves from the blood into the cells to try to balance the concentrations. This causes the cells to swell. When this happens to brain cells it causes neuro issues

GI issues caused by hyponatremia

anorexia, n/v, and weakness

why does hyponatremia cause GI issues

low sodium disrupts the normal electrical activity of nerve and muscle cells, including the nerves and smooth muscles that control the GI tract

treatment for depleted hyponatremia

- give salty foods

- NS or LR

- seizure precautions

- monitor labs, I&O, weights

- symptoms of both FVD and FVE

treatment for diluted hyponatremia

- restrict fluids

- give hypertonic solution (3% NS) and a loop diuretic in severe cases (adds sodium but pulls of excess water)

- monitor labs, I&O, weights

- symptoms of both FVD and FVE

which diuretic most commonly causes depleted hyponatremia

thiazide

what is hypernatremia

sodium level above 145

what can cause hypernatremia

medications

excess salt

osmotic diuretics

diabetes insipidus

excessive water loss

low water intake

How can medications cause hypernatremia

many OTC meds contain high amounts of salt

how can diabetes insipidus cause hypernatremia

Decreased ADH which causes them to lose water but retain sodium

what labs will be elevated in hypernatremia

serum osmolarity and urine specific gravity

clincal manifestations of hypernatremia

fever

restlessness

increased fluid retention

high BP

edema (pitting and peripheral)

decreased UO

dry mouth

why can hypernatremia cause neuro effects

the cells in the brain become dehydrated

treatment for hypernatremia

- restrict sodium and increase water intake

- give diuretic

- administer IVF without sodium like hypotonic or D5W

if you give hypotonic fluids to someone with hypernatremia what should you monitor

lung sounds

symptoms of increased ICP

symptoms of FVE

LAB VALUE: potassium

3.5-5.0

what body system does potassium primarily affect

cardiac

potassium has an inverse relationship with which electrolyte

sodium

potassium has a direct relationship with which electrolyte

magnesium

what is the function of potassium

- maintains ICF osmolarity

- regulates conduction of cardiac rhythm

- transmits electrical impulses

- cellular function

how is potassium regulated

-excreted through kidneys

- lost through GI fluid loss since GI fluid has a very high concentration of potassium

foods high in potassium

- avocado

- bananas

- spinach

- citrus juices

- fish

what is hypokalemia

potassium levels below 3.5

what can cause hypokalemia

- GI fluid loss

- diuretics

- inadequate intake

- alkalosis

how can alkalosis cause hypokalemia

H⁺ moves OUT of cell → K⁺ moves IN → ↓ K⁺ in blood

cardiac manifestations of hypokalemia

- weak irregular pulse

- dysrhythmias and EKG changes

- increased sensitivity to digoxin

Neuromuscular manifestations of hypokalemia

- fatigue

- muscle weakness

- leg cramps

- paresthesias (numbness and tingling)

- decreased GI motility

treatment of hypokalemia

- increased potassium intake

- K supplements (PO or IV)

- monitor for digoxin toxicity (if appropriate)

what is hyperkalemia

Potassium levels about 5.0

what can cause hyperkalemia

- medications

- acidosis

- cellular destruction (ex. burns or trauma)

- hypoaldosteronism

- hemolysis (destruction of RBC from anemia or HELLP)

- excessive intake

- renal failure

what medications can cause hyperkalemia

potassium-sparing diuretics, ACE inhibitors, and potassium supplements

how can acidosis cause hyperkalemia

H⁺ moves INTO cell → K⁺ moves OUT → ↑ K⁺ in blood

how can hypoaldosteronism cause hyperkalemia

aldosterone causes sodium reabsorption but since there is a lack of that, sodium drops and so that makes potassium go up due to the inverse relationship

clinical manifestations of hyperkalemia

muscle cramps and weakness

oliguia/anuria

resp distress

decreased cardiac contractility

EKG changes

hyperreflexia or areflexia

treatment for hyperkalemia

- restrict potassium intake (includes salt substitutions)

- stop meds with potassium

- use kayexelate or patiromer

- continuous EKG monitoring

who should we be careful giving patiromer to

those with HF bc it causes a quick switch in levels which can be hard on the heart

emergency treatment of hyperkalemia

regular insulin with 50% dextrose

calcium gluconate

sodium bicarbonate

why is regular insulin with 50% dextrose used for hyperkalemia

insulin pushes potassium back into the cell and the glucose helps keep the BG steady after the insulin

why is calcium gluconate used for hyperkalemia

stabilizes cardiac function

why is sodium bicarbonate used for hyperkalemia

(IN ACIDOSIS) its a absic med to it balances it out

LAB VALUE: calcium

8.2-10.2

what does calcium have an inverse relationship with

phosphorus

functions of calcium

- nerve impulses

- regulates skeletal and cardiac muscle contractions

- major component of bone and teeth

- essential factor in blood clot formation

what vitamin is needed for calcium to be used

vitamin D

regulation of calcium

excreted in urine, bile, and feces

what is hypocalcemia

calcium levels under 8.2

what can cause hypocalcemia

Inadequate intake (or malnutrition)

hypoparathyroidism

malabsoprtion

pancreatitis

vitamin D deficiency

how can hypoparathyroidism cause hypocalcemia

Hypoparathyroidism causes hypocalcemia because a shortage of parathyroid hormone stops the body from releasing calcium from bones, keeping it in the kidneys, and absorbing it from food.

how does alcoholism, laxatives, and antacids relate to hypocalcemia

they cause malabsorption which decreases calcoium absorption as well

how does pancreatitis contribute to hypocalcemia

it causes proteins and lipids to be broken down and this depletes calcium

clincial manifestations of hypocalcemia

convolsuions

chvosteks signs

arrythmias

tetany

hyperreflexoia

trousseaus sign

spasms

laryngospasm

chvosteks sign

Cheek, facial spasm when Cheek is tapped associates with hypocalcemia

Trousseau's sign

A sign of hypocalcemia . Carpal spasm caused by inflating a blood pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes.

treatment of hypocalcemia

- increase Ca intake

- give Ca supplements

- monitor airway

- IV Ca (if severe)

- seizure precautions

- FALL RISK

what is hypercalcemia

calcium about 10.2

causes of hypercalcemia

- hyperparathyroidism

- malignant bone disease

how can hyperparathyroidism cause hypercalcemia

Hyperparathyroidism causes hypercalcemia because an overproduction of parathyroid hormone forces the body to constantly release calcium from bones, pull extra calcium back into the bloodstream through the kidneys, and over-absorb calcium in the gut

clinical manifestations of hypercalcemia

- muscle weakness

- anorexia and n/v

- fatigue

- polyuria and polydipsia

- dehydration

- kidney stones

- EKG changes

- bizarre behavior (due to neuro effects)

treatment of hypercalcemia

- IVF

- PO fluid or NS

- fiber (helps constipation)

- calcitonin (IN HYPERPARATHYROIDISM)

- dialysis (if severe)

LAB VALUE: magnesium

1.3-2.1

where is magnesium distributed

skeleton and ICF

functions of magnesium

- protein and carb metabolism

- maintains normal amounts of K in the blood

- electrical activity in neuromuscular junctions

regulation of magnesium

- excreted through kidneys

what does magnesium have a direct relationship with

calcium and potassium

sources of magnesium

brown rice

whole grains

buckwheat groats

peanuts

spinach

bananas and oranges

mackerel

hypomagnesmia

- Chronic alcoholism (causes malabsorption)

- DKA

- GI fluid loss (rare)

how can DKA cause hypomagnesemia

Glucose enters the cell and Mg gets flushed out

manifestations of hypomagnesmia

- neuromuscular irritability

- seizures

- disorientation and changes in LOC

- mood changes

- dysrhythmias

treatment of hypomagnesemia

- Encourage Mg intake

- IV replacement

- assess and correct calcium and potassium levels

- avoid alcohol

what should you assess in hypomagnesemia treatment

reflexes (decreased DTR can mean magnesium toxicity)

IV replacement for hypomagnesemia

magnesium sulfate

HIGH RISK DRUG

push slowly

What is hypermagnesemia

too much Mg

causes of hypermagnesemia

- renal failure

- excess replacement (PO or IV)

manifestations of hypermagnesemia

- flushing (vasodilation)

- decreased VS (increased risk for cardiac arrest)

- drowsiness/lethargy/ decreased LOC

- hypoactive reflexes

treatment of hypermagnesemia

- avoid Mg based antacids and laxatives

- IVF

- diuretics (IF NOT IN RENAL FAIURE)

- dialysis

what to monitor in hypermagnesemia

- DTR

- VS

- EKG (continuous)

what kind of IVF is used in hypermagnesemia and why

often with calcium salts to "calm" there hearts impulses

LAB VALUE: phosphorus

2.5-4.5

how is phosphorus distributed

major anion within the cell

what does phosphorus have an inverse relationship with

calcium

function of phosphorus

- promotes muscle and nerve action

- bone and teeth formation

regulation of phosphorus

- regulated by parathyroid gland

- excreted by kidneys

sources of phosphorus

- meat

- dairy

- fast food

- soda

- seeds

- canned fish

what is hypophosphatemia

Too Little Phosphorus

you will see signs of this low electrolyte before hypophosphatemia

calcium

causes of hypophosphatemia

- malabsorption (ex. from alcoholism)

- increased renal excretion

- respiratory alkalosis