n325 electrolytes

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what are electrolytes?

• essential ions found in the body

• positively charged (+, cation)

• negatively charged (-, anion)

cations

• positive charge

• ex)

  • Na+

  • K+

  • Ca+2

  • Mg+2

anions

• negative charge

• ex)

  • chloride:Cl-

  • bicarbonate: HCO3-

  • phosphate: PO4-3

  • sulfate: SO4-2

functions of electrolytes

• nerve conduction

• muscle function

• fluid balance

• acid-base balance

• cellular function

normal Na+ lab values

• 135 - 145 mEq/L

normal Cl- lab values

• 98 - 106 mEq/L

normal K+ lab values

• 3.5 - 5.0 mEq/L

normal Ca+2 lab values

• 9.0 - 10.5 mEq/L

normal Mg+ lab values

• 1.3 - 2.1 mEq/L

normal PO4-3 lab values

• 3 - 4.5 mg/dL

Na+ functions

• normal range: 135 - 145 mEq/L

• influences fluid distribution

• influences blood pressure

• acid-base balance

• muscle contraction

• nerve impulse transmission

• regulated by kidneys

• nutrient transport

Cl- functions

• normal range: 98 - 106 mEq/L

• direct relationship with Na+

• nerve conduction

• acid-base balance

• lost in sweat

• part of stomach acid, pancreatic enzymes

• nutrient transport

dietary intake - Na+

• higher sodium

  • processed foods

  • preserved foods

  • cheese

  • dried meats

  • canned foods (not fruits)

• lower sodium

  • fresh/frozen veggies and fruits

  • dried druits

  • canned fruit

  • rice, pasta

  • unsweetened oatmeal

  • fish, shellfish

  • fat-free/low-fat milk & yogurt

hypernatremia

• serum sodium: >145 mEq/L

• losing water → sodium is now more conc in the blood

• or gaining more sodium than water → hypertonic fluid IV or eating crazy sodium

• water shifting into the bloodstream and out of cells → sodium more concentrated in the blood → cells shrink

patients at risk for hypernatremia

• Na+ retention

  • hyper-aldosteronism → aldosterone incr sodium/water retention

  • cushing’s

  • uncontrolled diabetes mellitus

• Na+ intake

  • lots of dietary Na+

  • corticosteroids → incr sodium/water rentention

  • IV fluids

  • hypertonic tube feedings w/o free H2O

• water loss

  • H2O deprivation

  • increased insensible water loss (fever)

  • diarrhea

  • diabetes insipidus (DI) → peeing out body’s volume

• inadequate water intake

  • elderly

  • infants

  • comatose pts

  • pts with cognitive dysfunction

hypernatremia: assessment findings

• extremely rapid shift/extremely high Na+

  • brain cell shrinkage

  • vascular rupture

  • cerebral bleeding

  • neurological damage

  • death

• increased Na+ = thirst

  • CNS signs → confusion, restless, agitation, seizures, coma, death

• hypovolemic hypernatremia

  • see this w dehydrated ppl → see neurosymptoms and hypovolemia symptoms

  • tachycardia

  • decreased BP

  • dry mucous membranes

• hypervolemic hypernatremia

  • see neuro symptoms + hypervolemia symptoms

  • weight gain

  • peripheral/pulmonary edema

  • increased BP

  • increased JVD

hypernatremia: interventions

• hypovolemic

  • NS or LR until hypovolemia improves

  • provider will calculate H2O deficit

  • if necessary, then admin hypotonic fluid (1/2 NS, D5W, or PO H2O) to replace fluid deficit

  • rehydrate them by giving fluids

• euvolemic

  • provider will calculate H2O deficit

  • adminster hypotonic fluid (1/2 NS, D5W, or H2O) to replace water deficit

  • give hypotonic fluid bc that will balance sodium level faster without adding too much volume

• hypervolemic

  • free water replacement (D5W) + loop diuretics

  • hemodialysis if renal failure

• dietary

  • restrict Na+

• meds

  • diuretics

  • no meds that contain sodium

• monitor

  • physical assessment findings

  • Is & Os

  • daily weights

  • labs: HCT, glucose, electrolytes

• comfort

  • mouth, lip care

  • alcohol-free mouthwash

  • skin care

• education

  • teach abt sodium in foods (<2000 mg/day)

  • OTC meds that contain Na+ should be stopped

  • body positioning if FVE