NURS347 Exam 2 - Electrolytes

Sodium

Major extracellular electrolyte.
Most of it is in the ECF and controls osmolarity.
Contributes to nervous system function.
Normal serum range (135/145 mEq)
Eliminated through Kidneys (predominantly), vomiting/diarrhea, and sweat.
Kidneys retain this electrolyte when BP lowers.
Inversely proportionate to Potassium.
What am I?

Hyponatremia causes

Loss of sodium (

Hyponatremia S/S

Dry skin, hypotension, confusion, cerebral edema, muscle cramps, lethargy, headache, coma.
Serious threat to endurance athletes.
Increased risk for seizures.

Hyponatremia Tx

Electrolyte imbalance treated with small volume hypertonic IVF. Increased salt intake (or NaCl tablets)

Hypernatremia causes

Gain of Na+ (>145mEq), causing fluid shift from ICF to ECF, by osmosis. Causes cells to shrink.
Fluid deprivation, lack of thirst, excessive insensible water loss (burns, hyperventilation)
*remember you lose electrolytes through respiration, this is why hyperventilation is relevant.
Neuro effects

Hypernatremia S/S

Neuro deficits.
Delusion, restless, confusion, weakness, disorientation, & hallucinations.
Cells in CNS especially vulnerable.
Possible permanent brain damage.
Life-threatening.

Hypernatremia Tx

Electrolyte imbalance treated with hypotonic IVF to correct water deficit.
Restrict salt ingestion.

Potassium

Major intracellular electrolyte (predominant in ICF)
Controls excitability of skeletal, cardiac, and smooth muscle.
Contributes to cardiac function.
Normal serum range (3.5 - 5 mEq/L)
Elimated through stool & emesis (GI), sweat (skin), 90% by kidneys.
Regulated by renal ICF-ECF fluid shifts.
Inversely proportionate to Sodium.

Hypokalemia causes

K+ is lost in ECF, thus, K+ moves out of ICF to cover that deficiency. This causes a new ICF deficiency.
When Na+ is high, this one is low.
Vomiting, NG suction, alkalosis, & loop diuretics.
Cardiac effects.

Hypokalemia S/S

A SIC WALT
Alkalosis
Shallow respiration
Irritability
Confusion and drowsiness
Weakness and fatigue
Arrhythmias- irregular heart rate, tachycardia
Lethargy
Thready pulse
decrease intestinal mobility, nausea and vomiting.
Effects on cardiac rhythm and muscle can be life-threatening.

Hypokalemia Tx

Gradual K+ replacement w/IVF's. (too much K+ all at once will paralyze the diaphragm and lead to R.I.P.).
Encourage diet rich in K+
By increasing ECF levels of K+, this will return into ICF spaces.

Hyperkalemia causes

Gain of K+ in ECF can cause toxicity. Excess does not move into ICF, because these cells are already at capacity.

M.A.C.H.I.N.E.
M - Medications - ACE inhibitors, NSAIDS
A - Acidosis - Metabolic and respiratory
C - Cellular destruction - Burns, traumatic injury
H - Hypoaldosteronism, hemolysis
I - Intake - Excesssive
N - Nephrons, renal failure
E - Excretion - Impaired
Cardiac effects

Hyperkalemia S/S

M.U.R.D.E.R.
M - Muscle weakness and cramping --> Paralysis.
U - Urine, oliguria, anuria
R- Respiratory distress
D - Decreased cardiac contractility
E - EKG changes
R - Reflexes, hyperreflexia, or areflexia (flaccid)

Hyperkalemia Tx

Treat with insulin + IV D50.
Diuretics, dialysis, calcium supplements, and albuterol.
Reverse K+ levels in EFC, lowering toxicity.

Calcium

Most abundant electrolyte in body.
99% stored in bones; 0.1% in EFC.
Role in blood coagulation, nerve transmission, & muscle contraction.
Normal serum range (8.6 - 10.2 mg/dL).
Major component of bones and teeth.
It is inversely proportionate to P+ and PTH.

Hypocalcemia causes

Loss of this electrolyte causes an increase in P+ and PTH.
Renal failure, loop diuretics, antiepileptics.
Lost through feces and urine.

Hypocalcemia S/S

C.A.T.S. (convulsions, arrythmias, tetany, spasms & seizures), muscle cramps.

Chvostek sign
Trousseau sign

Hypocalcemia Tx

Acute: IV calcium gluconate.
Chronic: PO (by mouth) calcium supplements.

Hypercalcemia causes

Gain of this electrolyte in ECF causes decreased P+ and PTH.
Excess vitamin D, hyperparathyroidism.
When drawing blood, if torniquette is too tight, it can cause this imbalance.

Hypercalcemia S/S

Decreased neuromuscular excitability. Weak and flacid muscles. Diminished reflexes, decreased LOC, & cardiac dysrhythmias (shortened QT segments and depressed T waves).
This imbalance is a medical emergency.

Hypercalcemia Tx

Rehydration with IVF replacement; diuretics to increase urinary excretion.

Magnesium

Second most abundant divalent cation. Only 2% found in ECF (mostly in ICF) .
Absorbed by intestines and excrted by kidneys. Required for cellular energy and DNA transcription.
Normal serum range (1.3 - 2.1 mg/dL).

Hypomagnesemia causes

Loss by insufficient intake. Movement of this electrolyte from ECF to ICF through shifting.
Also caused by diarrhea, starvation, laxative abuse, ETOH withdrawal.

Hypomagnesemia S/S

Neuronmuscular excitability, hyperactive DTR (deep tendon reflexes), paresthesia, CV arrythmia, respiratory paralysis.
EKG shows R-wave inversion.

Hypomagnesemia Tx

Mg replacement through IVF.
Electrolyte used to treat eclampsia and pre-eclampsia, bronchial asthma, cardiac arrythmias, and angina.

Hypermagnesemia causes

Electrolyte moves from ICF to ECF, causing toxicity.
Caused by ESRD, renal failure reducing its excretion, excessive intake through antiacids and laxatives.
Rare condition; found mostly in the elderly population.

Hypermagnesemia S/S

Can induce life-threatening coma.
Nausea, vominting, loss of deep tendon reflexes. Respiratory depression, flushing.
Hypotension & MI (heart attack) w/EKG abnormalities.

(**Relaxes muscles and reduces contractions during labor)

Hypermagnesemia Tx

Cessation of Mg administration. IV Ca administered as antagonist. Dialysis.

Electrolyte used to treat tozemia and premature labor in pregnancy (relaxes muscles and reduces contractions).

Phosphorus

Critical element in all body tissues. Mainly found in bone (85%).
Inorganic circulates in ECF. Organic circulates in ICF.
Normal inorganic serum range (2.5 - 4.5 mg/dL)
Necessary for O2 delivery & normal function of platelets.
Regulated by kidneys (overflow mechanism).
Inversely proportionate to Calcium.

Hypophosphatemia causes

When calcium is above normal range, this electrolyte is lowered.
Low concentration in EFC (inorganic version).
Can result from administration of calories to malnourished patients, alcohol withdrawal, diabetic ketoacidosis, hyperventilation, insulin release, absorption problems, and diuretic use.

Hypophosphatemia S/S

Manifestations include irritability, fatigue, weakness, rickets, paresthesias, confusion, seizures, and coma.
Results from lack of ATP and reduced RBC production. Causes altered neural function and hematologic disorders.

Hypophosphatemia Tx

Dietary repletion (milk w/250mg of P+) or IVF's with sodium phosphate.

Hyperphosphatemia causes

Caused by above-normal concentrations of phosphorus in the ECF, or sudden ICF to ECF shifting.
Kidney failure, high P+ intake.
Excess use of antacids, laxatives , and enemas.

Hyperphosphatemia S/S

Leads to low calcium levels (inversely proportionate).
Can result in tetany, anorexia, nausea, muscle weakness, and tachycardia.
Fatality can occur with over-administration of phosphate enemas.
High phosphorus leads to low calcium levels.

Hyperphosphatemia Tx

Treated by calcium-based antacids, dietary restriction of high phosphorus foods.
Sevelamer, dialysis.

Chloride

Major anion in ECF. One of the most important electrolytes in the body. Maintain hydration and charge neutrality.
Normal serum range (96 - 106 mEq/L)
Helps maintain osmotic pressure and body pH.
Excreted by vomiting, diarrhea, excessive perspiration.

Hypochloremia causes

Severe vomiting, diarrhea, GI drain, metabolic acidosis, diuretic therapy, dehydration, and excessive sweating.
Below-normal level in ECF.

Hypochloremia S/S

Hyperexcitability of muscles, tetany, hyperactive DTRs, muscle weakness, cramps.

Hypochloremia Tx

Increase dietary intake of NaCl.
0.9% IVF replacement.
Correct metabolic acidosis imbalance.

Hyperchloremia causes

Gain of chloride in ECF due to increased intake & reduced excretion.

Hyperchloremia S/S

Tachypnea, dysrhythmias,
generalized weakness, lethargy, loss of cognitive ability, decreased cardiac output, dysrhythmias, and
coma

Hyperchloremia Tx

Decrease intake of Sodium and Chloride when this imbalance occurs.
Correct acidosis imbalance by adding bicarbonate.

Sodium

Normal serum range (135 -145 mEq/L).
Which electrolyte am I?

Potassium

Normal serum range (3.5 - 5 mEq/L).
Which balanced electrolyte am I?

Calcium

Normal serum range (8.6 - 10.2 mg/dL).
Which electrolyte balance am I?

Magnesium

Normal serum range (1.3 - 2.1 mg/dL).
Which electrolyte am I?

Phosphorus

Normal serum range (2.5 - 4.5 mg/dL).
Which electrolyte am I?

Chloride

Normal serum range (96 - 106 mEq/L).
Which electrolyte am I?

Hypervolemia

Fluid volume excess. What condition am I?

Hypovolemia

Fluid volume deficit.
What condition am I?

NS 0.9% NaCl

I'm an isotonic solution (meaning I have the same osmolarity as body fluids) used to expand volume, dilute medications, and keep the veins open. What fluid am I?

Lactated Ringers

I'm an isotonic solution (meaning I have the same osmolarity as body fluids) commonly used for fluid resuscitation. What fluid am I?

D5 1/2 NS D5NS

I'm a hypertonic solution, used for Na and volume replacement. CAUTION - go slow.. monitor BP, pulse, and quality of lung sounds as well as serum Na and urine output.

D5W

Initially I'm an isotonic solution, until I enter the body. Then I turn into a Hypotonic solution, because I metabolize glucose.
CAUTION - Don't give me to babies and people w/head injuries, as I can cause cerebral edema.