Patho: Electrolyte Imbalances

exam 3 content (14 questions)

Electrolytes

Found in body's fluids and facilitate bodily function

Electrolyte Imbalance

Abnormal electrolyte levels (too high / too low)

Leads to cellular dysfunction

Can be life threatening

Basic Metabolic Pannel (BMP) or Complete Metabolic Pannel (CMP) consists of the lab values for

Sodium (Na)

Potassium (K+)

Calcium (Ca+)

Magnesium (Mg+)

Sodium normal range

135–145 mEq/L

Potassium normal range

3.5 – 5 mEq/L

Calcium normal range

8.5 – 10.5mEq/dL

Magnesium normal range

1.5 – 2.5 mg/dL

Sodium role/function

Controls serum osmolality and water balance

Contributes to osmotic pressure

Facilitates muscles and nerve impulses

How do people intake sodium

Main source is dietary

Processed/packaged foods

Salt/seasonings

How do people output sodium

Excreted through the kidneys and gastrointestinal tract

Perspiration

Hyponatremia: low sodium

Neurological symptoms, fluid loss, hemodilution

Hypernatremia: high sodium

Neurological symptoms, increased thirst

Hyponatremia: deficient sodium, Too much out =

Na loss through diuretics, GI Loss, Diaphoresis

Hyponatremia: deficient sodium, Not enough in =

Na restriction

Hyponatremia: excessive H2O, too much in =

Overhydration (IV or PO)

Hyponatremia: excessive H2O, not enough out =

Renal or heart failure, SIADH

Hypernatremia: excessive sodium

Diet, Hypertonic IV solutions, Cushing’s, Corticosteroids

Hypernatremia: deficient H2O, excessive loss

diarrhea, Diabetes Insipidus

Hypernatremia: deficient H2O, insufficient intake

NPO, unconscious

Hyponatremia: lower sodium in the extracellular fluid causes H2O to move via osmosis, too much water entering the cells =

edema at the cellular level

Hypernatremia: higher sodium increases extracellular osmolality which pulls H20 out of cells and into extracellular space =

cellular dehydration

Hyponatremia: clinical presentation

Edema

GI Upset

Lethargy

Confusion

↓ Deep Tendon Reflexes

Muscle Weakness

Seizures

Coma

Hypernatremia: clinical presentation

Polydipsia ↑ Thirst

Oliguria ↓ Urine Output

Irritability/agitation

Muscle Weakness

Headache

↓ Reflexes

Seizures

Coma

Hyponatremia treatment: normal fluid status

Increase Dietary Na

Na tablets

Saline solution

Hyponatremia: treatment for hemodilution

Fluid Restriction

Diuretics

Hypernatremia: treatment for normal fluid status

Na restriction

Hypernatremia: treatment for dehydration

drink water

Potassium role/function

Nerve and muscle impulses assisting with skeletal contraction

Cardiac muscle contraction and electrical conductivity

How do people intake potassium

Main source = dietary

Meats, fruits (bananas), vegetables (potatoes), beans

How do people output potassium

Excreted through the kidneys and gastrointestinal tract

Shift into cells

Hypokalemia: can be caused by deficient intake

Diet, eating disorders

Hypokalemia: can be caused by excessive loss

Vomiting, diarrhea, NG tube suctioning, laxatives

Hypokalemia: can be caused by medications

Potassium-loosing diuretics

Insulin – shifts K+ into the cells out of the extracellular space

Hyperkalemia: can be caused by inadequate excretion

renal failure

Hyperkalemia: can be caused by what medications

K+ sparing diuretics

ACE inhibitors

Angiotensin II receptor blockers (ARBs)

Hyperkalemia: can be caused by excessive intake

Oral K+ supplements

Rapid IV K+ infusion

Hypokalemia: low K levels result in a _______resting membrane potential in muscle cells, this makes it harder for muscle cells to depolarize naturally which disrupts muscle function

negative

Hyperkalemia: high K levels result in a _______resting membrane potential in muscle cells, this makes it harder for muscle cells to depolarize naturally which disrupts muscle function

positive

Hypokalemia: clinical presentation

Polyuria & Polydipsia

Anorexia

Nausea & Vomiting

Constipation

Paralytic Ileus

Dysrhythmias

Cardiac Arrest

Muscle Weakness

Paresthesia

Confusion

Hyperkalemia: clinical presentation

Paresthesia

Muscle Weakness

Respiratory Depression

Dysrhythmias

Cardiac Arrest

Abdominal Cramping

N/V/D

Hypokalemia treatment

Replacement

Oral

IV

Discontinue potassium-loosing diuretics

Hyperkalemia treatment

Is dependent on the degree. All patients with potassium imbalances should be placed on telemetry to monitor for cardiac dysrhythmias.

Mild Hyperkalemia treatment

Limit Dietary Potassium and hold Potassium Supplements and Potassium Sparing Diuretics

Moderate to Severe Hyperkalemia treatment

Potassium-loosing Diuretic

Kayexalate (those with renal compromise that binds to K and helps remove it from body in form of feces)

Regular Insulin

Severe Hyperkalemia treatment

Pts may need to undergo dialysis to help remove K from the body.

calcium role/function

Formation/Structure Bone & Teeth

Blood Clotting

Nerve Transmission & Muscle Contraction

how do people intake calcium

Main source is dietary intake (vitamin D aids absorption)

Absorbed through the gastrointestinal tract (small intestine)

how do people output calcium

Excreted in urine and stool

Hypocalcemia: low calcium

muscle cramping, long term bone loss

Hypercalcemia: high calcium

Weakness, changes in LOC

Hypocalcemia can be caused by

Excessive Loss

Renal failure

Laxatives

Diarrhea

Vitamin D deficiency

Hypercalcemia can be caused by

Increased intake

Excessive Vitamin D and/or Ca+

Increased parathyroid hormone (PTH)

Prolonged Immobilization

Thiazide diuretics

Hypocalcemia: neurons are ____ excitable leading to neuromuscular irritability, resulting in clinical manifestations

more

Hypercalcemia: neurons are ____ excitable leading to decreased neuromuscular activity, resulting in clinical manifestations

less

Trousseaus Sign

Inflate a BP cuff 10 mmHg above pts systolic BP for 3 minutes, if the pt has hypocalcemia the hand and fingers will spas. You will see contraction of the fingers and hands (palmar flexion)

Chvostek's Sign

Tap the face just below and in front of the ear. Facial twitching (spasm of lip, nose or face) indicates a positive tests which could indicate a calcium deficit

Hypocalcemia clinical presentation

Paresthesia

Muscle Cramps

↑ Deep Tendon Reflexes

Hyperresponsive reflexes

Tetany (muscle spasm)

+ Trousseau’s Sign

+ Chvostek’s Sign

Hypercalcemia clinical presentation

Confusion

Muscle Weakness

Bone tenderness

Lethargy

Stuporous

↓ Deep Tendon Reflexes

Anorexia

Constipation

Hypocalcemia treatment

Calcium Replacement

Oral

IV

Vitamin D supplementation

Hypercalcemia treatment

Identify the underlying cause and manage

Increase mobility

Calcitonin

Intravenous fluids

Diuretics

Hypomagnesemia: low magnesium

regulation of cellular electrical activity, can cause hypocalcemia

Hypermagnesemia: can be caused by

IV magnesium

Laxatives

Antacids

Renal failure

Hypomagnesemia: can be caused by

Diet

Alcoholism

Malnutrition

Diarrhea

Diuretics

Hypomagnesemia: lower serum magnesium =

excitable nerve and muscle cells

Hypermagnesemia: high serum magnesium =

suppressed electrical activity in nerve and muscle cells

Hypomagnesemia: clinical manifestations

Similar to hypocalcemia

Muscle weakness

Personality changes

Cardiac dysrhythmias

Hypermagnesemia: clinical manifestations

Similar to hypercalcemia

Hypotension

Respiratory depression

Hypermagnesemia treatment

Diuretics

Dialysis

Intravenous calcium

Antagonist of Mg

Hypomagnesemia treatment

Magnesium replacement

Oral or IV