electrolytes review

postassium (k+)

-3.5-5 MEQ/L

-ICF electrolytes

-cardiac and skeletal muscle contraction

-sodium/potassium pump- constant exchnage

-excreted by renal system 80% and bowel/skin 20%

-can be caused by neurologic and respiratory failure

-kidneys do not conserve potassium well

causes of hyperkalemia

-excessive intake

-K sparing diuretics

-CKI

-addisons/adrenal insufficiency

what are the symptoms of hyperkalemia?

St elevation, peaked T waves, hypotension, bradycardia, severe VFib/asystole, diarrhea, hyperactive BS, extremity paralysis, increased DTR, profound muscle weakness/heaviness and cramps

management of hyperkalemia?

-IV administration: sodium bicarbonate

-other oral treatments: glucose and insulin therapy, loop diuretics (temporarily shift K into cells)

-Dialysis: hemodialysis or peritoneal dialysis (if renal function is compromised)

causes of hypokalemia?

GI loss, anorexia/bulimia, steroid therapy, hyperaldosteronism, resp or methanolic alkalosis, diuretics, digoxin toxicity

side effects of hypokalemia?

ST depression, flat T wave, u wave, hyporeflexia, muscle cramping, flaccid paralysis, decreased motility, hypoactive BS, constipation, abdominal distention, paralytic ileus

management of hypokalemia?

-dietary potassium of 40 to 80 MEQ/day

-can be oral supplements or parenteral supplements depending on the ability to orally intake appropriate nutrition

-prevention is the best treatment

sodium (na)

135-145 MEQ/L

-most common in ECF

-important in controlling water distribution in the body

-regulated by ADH, thirst and renin-angiotensin-aldosterone system

-loss or gain of sodium is usually associated with loss or gain of water

-important in muscle contraction and nerve impulses

-controlling BV, VP and pH balance

causes of hypernatremia?

hypoaldosteronism, hypertonic solutions, steroids, GI feedings without water, cushings

symptoms of hypernatremia?

flushed skin, fever, restlessness, irritable, anxious, confused, increased BP, fluid retention, edema, decreased urine output, dry mouth

late signs: swollen dry tongue, nausea and vomiting, increased muscle tone

management of hypernatremia?

-lower sodium gradually hypotonic solution or isotonic solution

-serum sodium levels should be reduced gradually no faster than 0.5-1 MEQ/L/H to prevent too rapid of diffusion and can cause cerebral edema

causes of hyponatremia?

GI loss, adrenal insuffciency, renal disease, SIADH conditions (head trauma), hyperglycemia, medications (SSRIs, anticonvulsants, diuretics, tranquilizers)

-hypotonic tube feedings

side effects of hyponatremia?

stupor/coma, anorexia, nausea, vomiting, lethargy, tendon reflexes, limp muscles, orthostatic hypotension, seizures/headache, stomach cramping

management of hyponatremia?

-slowly correct no more than 12 MEQ/L in 24 hours

chloride (Cl)

97-107MEQ/L

-anion of ECF, found in interstitial and lymph fluid

-also found in GI secretions, pancreatic juices, Bile, sweat, and saliva

-excretion and reabsorption by the kidneys

-Serum fluid level chloride is directly related to sodium level

-muscle contraction, nerve impulses

-controls BV, BP and pH balance

causes of hypercholemia

follows Na

-renal injury, head injury, dehydration, diarrhea, diuretics, overdose of salicylates, kayexalate, hyperparathyroidism

side effects of hypercholemia?

flushed skin, fever, restlessness, irritable, anxious, confused, increased BP, fluid retention, edema, decreased urine output, dry mouth

management of hyperchloremia?

-treatment targets correction of cause:

-hypotonic/lactated ringers (LR) solution to convert bicard in the liver and correct acidosis

-oral diuretics

causes of hypocholemia?

Addison's disease, DKA, chronic respiratory acidosis/metabolic alkalosis, sweating, GI losses/ostomies, heart failure, cystic fibrosis

side effects of hypocholemia?

stupor/coma, anorexia, nausea, vomiting, lethargy, tendon reflexes, limp muscles, orthostatic hypotension, seizures/headache, stomach cramping

management of hypochloremia?

-treatment targets correction of cause:

-IV infusion of 0.9% normal saline or 0.45% normal saline

-cessation of diuretics if on any

magnesium (mg)

1.3-2.1

-abundant in ICF and an activator for many intracellular enzyme systems, and major role in carb and pro metabolism

-needed for calcium and vitamin D absorption

-important in neuromuscular function and inhibits the release of acetylcholine

-affects the cardiovascular system, produces vasodilation and decreased PVR

causes of hypermagnesemia?

renal impairment and injury, DKA (untreated), addisons disease, hypothermia, magnesium based laxatives that affect GI motility, lithium toxicity, soft tissue necrosis; cardiac arrest, severe burns, hyperkalemia and hypercalcemia

side effects of hypermagnesemia?

heart block, prolonged pr interval, bradycardia, hypotension, depressed shallow respirations, hypoactive BS, hyporeflexia

management of hypermagnesemia?

-prevention is the best treatment

-avoidance of the administration of magnesium with CKI patients

-usually treatment is IV calcium gluconate and associated organ involvement (ventilation, cardiac monitoring) if severe and symptomatic

-IV lactated ringers

causes of hypomagnesemia?

malabsorption issues, chronic ethanol abuse, hyperparathyroidism, DKA, laxative use, hypokalemia, hypocalcemia

side effects of hypomagnesemia?

torsades de pointes, ST depression, T wave inversion, VFIB, tachycardia, hyperreflexia, nystagmus, chvostek, trosseau, insomnia, diarrhea

management of hypomagnesemia?

-mild magnesium deficiency can be treated with diet alone

-oral replacement: magnesium oxide or magnesium gluconate (can cause diarrhea)

-IV therapy: magnesium bolus but must be given slowly as to not cause heart block or asystole

calcium (Ca)

8.6-10.2

-99% bone

-involved in nerve impulses, muscular contraction and relaxation, and controlling-> bone, blood and beats

-activates enzymes

-absorbed from foods via gastric acidity and normal vitamin D levels

-excreted in feces and urine

-level is controlled by PTH and calcitonin

causes of hypercalcemia?

calcium supplements, hyperparathyroidism, iatrogenic, immobilization, multiple myeloma, parathyroid hyperplasia, alcohol, neoplasm

side effects of hypercalcemia?

bone pain, arrhythmias, cardiac arrest, kidney stones, muscle weakness, excessive urination

causes of hypocalcemia?

hypoparathyroidism, malabsorption/celiac/chrons, pancreatitis, Vitamin D deficiency, burns, ethanol abuse, elevated phosphate, CKI

side effects of hypocalcemia?

convulsion, arrythmias, tetany, stridor and spasms, trousseau sign, chvosteks sign and circumoral tingling diarrhea

management of hypocalcemia?

-ER treatment: can be life-threatening so parenteral Ca infusion- Ca gluconate or Ca chloride

-needs slow administration must be bedrest (must be diluted and slowly)

-nonemergency treatment: Vitamin D therapy to increase calcium absorption from Gi tract, anti-acids over the counter, increase calcium intake 1000-1500Mg/day( only 500mg at a time

phosphorus (P)

2.5-4.5

-primary anion in ICF

-muscle function/nervous system function

-maintenance of acid-base balance

-metabolism of protein, carbs and fat

-bones and teeth formation

-calcium regulation

causes of hyperphoshatemia?

renal injury, increased intake/decreased output, chemo, vitamin D toxicity/hypoparathyroidism, metabolic/respiratory acidosis

side effects of hyperphosphatemia?

convulsions, arrhythmias, tetany, stridor, spasms, trousseaus and Chvostek's sign

management of hyperphosphatemia?

-treatment directed at the cause

-if elevated PTH, then it binds in GI tract orally with calcitriol or amphogel

-IV calcitriol- more aggressive treatment

-dialysis if has CKI levels in critical

causes of hypophosphatemia?

anorexia, alcoholics, debilitated patients, DKA, resp/metabolic alkalosis, hypomagnesemia/hypokalemia/hyperparathyroidism, malabsorption issues, vitamin D deficiency

side effects of hypophosphatemia?

bone pains, arrhythmias, cardiac arrest, kidney stones, muscle weakness, excessive urination (opposite of calcium)

management of hypophosphatemia?

-Prevention is best

-monitor phosphate nutrition with parenteral feedings

-can be treated orally

-IV phosphorus is indicated if severe deficiency <1 and gastric dysmotility

sodium, chloride, potassium, magnesium relationship

if sodium and chloride increase then potassium and magnesium decrease

nursing management?

-monitor Is and Os

-monitor vital signs

-daily weights

-physical assessment

-review h/p, rx medication hx and OTC medication hx

-obtain ekg/telemetry

-detect and prevent fluid loss

-abgs to evaluate ph levels

-educate about diet

-monitor for AMS/neuro changes/seizures

-monitor for dysphagia-hypomagnesemia

-monitor for respiratory distress/changes

-assess risk groups

-educate about nutrition

-educate about alcohol/caffeine/tobacco use

-educate about OTC meds

-encourage mobility

-encourage appropriate oral fluids

-avoid constipation

-pay attention to diagnostics and exam