CHA Fluid&Electrolytes

Hyperkalemia EKG change

Absent P wave, prolonged QRS, peaked T wave

Hypokalemia EKG change

Inverted or flattened T wave, prominent U wave, depressed ST segment

Hypercalcemia ekg changes

Shortened QT and ST segment, widened T wave

Hypocalcemia ekg changes

Prolonged QT, ST, V-Tach

Hypermagnesemia ekg changes

Widened QRS, prolonged PR interval

Hypomagnesemia ekg changes

Depressed ST segment, inverted T wave, prolonged QT

Hypercalcemia symptoms

Bone pain, arrhythmia, cardiac arrest, kidney stones, muscle weakness, excessive urination

Hypocalcemia symptoms

Convulsions, arrhythmias, tetany, stridor, numbness, chvostek’s, trousseau’s

Hyperkalemia symptoms

Muscle cramps, urine output decreased, respiratory depression, decreased hr/bp, ekg changes, reflexes decreased

Hypokalemia symptoms

Muscle weakness, irregular ekg, n/v/bloating, trouble breathing (shallow respirations), constipation (hypoactive bowel sounds), decreased BP.

Hypernatremia symptoms

Flushed skin, restlessness, increased BP, edema, decreased urine output, skin dry, agitation, low grade fever, thirst

Hyponatremia symptoms

Seizures, anorexia (n/v), lethargy, tachycardia, limp muscles, orthostatic hypotension, stupor, stomach cramps

Hypermagnesemia symptoms

Low everything: energy, hr, bp, rr, bowel sounds, shallow respirations. EKG cahnges

Hypomagnesemia symptoms

High everything: hr, reflexes, bp. Shallow respirations, twitches/paraesthias, tetany. Postive trousseau’s/chvosteks (Increased Mg=Increased Ca)

Hyperphosphatemia symptoms

Spams/tetany, arrhythmias, seizures, brittle skin/nail, itchy skin, bone pain

Hypophosphatemia symptoms

fatigue, weakness, poor bone density/fractures, loss of appetite, arrhythmias, confusion, low oxygen delivery, chest pain, low hr

Inverse relationships

Increased phosphorus=decreased Ca.

Direct relationships

Increased Na=Increased Cl. Increased Mg=Increased Ca.

Hyperchloremia symptoms

Hypertension, swelling, arrhythmias (direct relationship with Na)

Hypochloremia symptoms

Hypotension/tachycardia, AMS, muscle weakness, fatigue

Hypovolemia symptoms

flat neck veins, increased HR/decreased BP, increased respirations, concentrated urine. Decreased CVP, weight, skin turgor, urine output. dry membranes, thirst

Hypervolemia symptoms

JVD, Increased: hr, bp, weight, cvp, edema, urine output. Lung crackles/dyspnea. decreased HCT, BUN, Na, urine gravity

Mg fx

supports muscle and nerve fx, regulates blood surgar and pressure

mg sources

leafy greens, nuts, seeds, whole grains, legumes, avocados, bananas, seafood

Ca fx

Bone and teeth health, muscle contraction/relaxation, blood clotting, nerve fx, cardiac fx

Ca sources

diary, tofu, leafy greens, broccoli

K fx

Maintains resting membrane potential in cell, regulate muscle and heart fx, nerve impulses, acid base balance

K sources

bananas, oranges, potatoes, spinach, tomatoes, avocados, nuts

Cl fx

maintain fluid balance and osmotic pressure, acid base balance.

Cl sources

table salt, seaweed, tomatoes, lettuce, olives, celery

Na Fx

Regulates fluid/bp balance, nerve and muscle fx, acid base balance. Balance of Na affects fluid in brain cells!

Na sources

Table salt, processed foods, canned soups, cheese, pickles, bread

Phosphate fx

Bones and teeth, ATP production, acid base balance

Phosphate sources

Meat, poultry, fish, dairy, beans, nuts, whole grains

Hypernatremia interventions

Increase PO water, decrease na intake. Hypotonic IVF, diruetics. I&O, seizure precautions.

Hyponatremia interventions

Isotonic IVF if d/t sodium loss. If d/t excess water intake use diruetics, fluid restrictions. increase sodium in diet, na tab, 3% NaCl IVF. I&O, daily wt, seizure precautions.

Hyperchloremia interventions

Sodium bicarb, isotonic IVF, avoid sodium

Hypochloremia intervention

oral potassium chloride or na cl, hydrochloric acid, rehydrate, isotonic IVF, increase na intake, monitor cardiac fx

Hyperkalemia interventions

calcium gluconate, reg insulin, sodium bicarb, na polystyrene sulfonate, diruetics, dialysis, monitor ekg.

Hypokalemia intervention

oral potassium, iv potassium, use salt substitutes, monitor ekg

hypercalcemia intervention

calcitonin, diuretics, biphosphates, iv na or K phosphate, isotonic IVF. Low ca diet. monitor cardiac, fall risk, screen for kidney stones

Hypocalcemia interventions

oral ca and vit D, iv ca, increase ca intake. manage airway, quiet room, cardiac monitoring, seizure precautions

Hypermagnesemia intervention

ca gluconate, dialysis (if renal failure), low mg diet, cardiac monitoring, risk for injury.

Hypomagnesemia interventions

oral or iv mg, increase mg intake. cardiac monitoring.

Hyperphosphatemia intervention

correct Ca level, low phosphate diet, high ca, dialysis (if needed), isotonic IVF, encourage fluid intake

Hypophosphatemia interventions

oral/iv phosphate, increase phosphorus intake, limit alcohol. monitor cardiac and respiratory, impaired mobility, risk for injury.

Isotonic IVF

0.9NS/LR Burns/blood loss, anaphylaxis/sepsis, dehydration. r, fluid overload. Do not use LR for pts with liver disease.

Hypotonic IVF

0.45NS DKA, increase total fluid, gastric fluid loss. fluid goes INTO cells.

Hypertonic IVF

3NS. hyponatremia, fluid overload, cerebral edema, ketosis. fluid goes OUT of cells.

Electrolytes with isotonic IVF correction

hyper/hypochloremia, hypercalcemia, hyperphosphatemia

electrolytes with hypotonic IVF correction

Hypernatremia

electrolytes with Hypertonic IVF

hyponatremia