Electrolytes

sodium range

135-145 mEq/L

potassium range

3.5-5 mEq/L

calcium range

9-10.5 mg/dL

hypophosphatemia interventions

supplementation (no more than 10 mEq/hr)

monitor

phosphate range

3-4.5 mg/dL

magnesium range

1.3-2.1 mEq/L

what does sodium do

fluid distribution

blood pressure

acid-base balance

what does potassium do

important in cardiac and muscular function

correlates often opposing sodium

what does calcium do

clotting

muscle contractions

enzymes

nerve impulses

bones/teeth durability

what does phosphate do

bone, teeth formation

tissue oxygenation

ATP

DNA, RNA

Ca regulation

cell membrane

what does magnesium do

enzyme systems: protein, blood glucose, BP

strengthen bone and teeth

help with Ca and K transport

role of aldosterone

increase sodium reabsorption

decrease potassium levels

role of ADH

dilutes electrolytes, increases water reabsorbtion

role of PTH

increases serum calcium

decreases serum phosphate

role of calcitonin

decreases serum Calcium

role of vitamin D

required for GI absorption of calcium

relationship between calcium and phosphate

inverse relationship, when Ca is high, phosphate is low

relationship of magnesium w other electrolytes

helps transport Ca+ and K+ across cell membranes

high and low dietary sources of sodium

high: processed food, preserved food, cheese, dry meat, canned food

low: fresh veg/fruit, rice, pasta, oatmeal, fish, low fat milk, yogurt

high and low dietary sources of potassium

high: dry fruit, spinach, beef, chocolate, pork, potatoes, tomatoes, bananas

low: egg, bread, cherries, apple, peach, cauliflower, celery, green bean, pepper, peas

high and low dietary sources of calcium

high: almonds, antacids, creamed soup, dairy, molasses, sardines, turnips, spinach

low: berries, kiwi, papaya, beans, carrot, radish

high and low dietary sources of phosphate

high: dairy, meat, poultry, fish, lentils, peas, chickpeas, almond, sunflower seeds, whole wheat, brown rice, bran, carbonation

low: fruit, veg, grain/starch, white bread/rice, past, egg

high and low dietary sources of magnesium

high: dark chocolate, avocado, nuts, seeds, legumes, tofu, whole gtain, fatty fish, banana, leafy greens

low: dairy, spice, herb, baby foods,, fat, oil, poultry, soup, sausage, lunch meat

role of diuretics on electrolyte balance

cause low potassium, sodium, magnesium, calcium

potassium sparing may cause high potassium

hypermagnesemia intervention

hold Mg products

calcium gluconate

IV hydration and diuretics

role of bisphosphonates on electrolyte balance

can decrease calcium levels

role of phosphate binders on electrolyte balance

decrease phosphate levels

causes of hypernatremia

net water loss or net Na gain

high aldosterone, cushings, diabetes

corticosteroids, hypertonic fluid

water loss, diarrhea, DI

low water intake- elderly, infants, comatose

causes of hyponatremia

SIADH, heart failure, polydipsia

renal loss, GI loss, NG suction

burns, wounds

hypoaldosteronism

extreme hyponatremia range and impact

<120 mEq/L

acute brain swelling

seizures, coma, restlessness, disoriented, lethargy

causes of hypermagnesemia

laxatives, cathartics, IV magnesium

kidney dysfunction

adrenal insuff, hypothyroid, metastatic bone disease, tumor lysis

causes of hypomagnesemia

prolonged fasting or starvation

chronic alcohol use

vomit, diarrhea, NG suction

causes of hyperkalemia

renal failure

low aldosterone (insufficiency or addison’s)

spironolactone

exercise, cell injury, carabolism, diabetes, meds

salt subs, digoxin, beta blockers

causes of hypokalemia

hyperaldosteronism

excessive sweat

vomit, diarrhea, NG suction

K wasting meds (diuretics), corticosteroids

laxative overuse, insulin overuse

causes of hypophosphatemia

malnutrition or parenteral

chronic alcohol use

vomit, anorexia, diarrhea, suction

hyperPTH

causes of hyperphosphatemia

high Vit D

laxatives

cell damage

renal insuff

hypoPTH

thyrotoxicosis

causes of hypercalcemia

RHINO

renal insufficiency

hyperPTH

immobilization

neoplasm

endocrine issues

causes of hypocalcemia

DAILY PIC CAD

diuretics

alcohol

inadequate intake

laxatives

yielded phosphate inc

PTH decrease

IV blood transfusion

calcitonin

calcium deposits

anticonvulsants

D deficiency (vit d)

S/S of low calcium

chvostek’s and trousseau’s sign

mild (<8.8)

CATT- confusion, anxiety, tremors, tingling

palpitations

severe (<7.6)

HILLS hyperreflexia, irritable, LOC change, laryngospasm, seizure

bad clotting, hypotension, tachycardia, vfib

prolong QT

S/S of high calcium

LOC changes, slow GI, depression, weakness, fatigue, dec reflexes, bone pain, kidney stones, polyuria

S/S of high sodium

hypovolemic: tachycardia, low BP, dry membranes

hypervolemic: weight gain, edema, high BP, JVD

S/S of low sodium

cerebral edema, confusion, headache

muscle weakness/fatigue

inc HR, JVD

hypernatremia interventions

isotonic fluids (if hypovolemic)

D5W if hypervolemic plus loop diuretics

hemodialysis if renal failure

restrict NA

diuretics

I/O, daily weight, HCT labs

hyponatremia interventions

hypovolemic: isotonic

hypervolemia: restrict fluid, diuretics

IO, daily weight, LOC, seizure

S/S of low magnesium

positive babinski sign

tremor, tetany, hyperreflexia, paresthesia

personality changes (hallucination, agitation, confusion)

S/S of high magnesium

headache, dizzy, drowsy, confused, resp. depression

nause, vomit, constipation

weakness, loss of reflex, paralysis

urinary retention

vasodilate, facial flush, hypotension, brady, AV block, asystole

S/S of high potassium

tall, peaked T waves

wide QRS

cramping, diarrhea, irritability, anxiety, fatigue, paresthesia, weakness

S/S of low potassium

muscle weakness

decreased deep tendon reflexes

ST depression, U wave, long QRS

S/S of low/high phosphate

high: same as hypocalcemia

low: only in severe- due to impaired cell energy: CNS confusion or coma, renal wasting, arrhythmias, weakness, soft bones, rhabdo

ECG changes w hyperkalemia

tall, tented T waves and wide QRS

ECG changes with hypokalemia

U wave, ST depression, prolonged QRS

ECG changes w calcium

hypocalcemia: Vtach, vfib, prolonged QT interval

ECG changes w magnesium

Torsades de Pointes

arrythmias

interventions for hypomagnesemia

dietary

MgSO4 IM or IVPB

monitor swallow and gag reflex

hyperphosphatemia interventioons

restric dairy

IV fluids and diuretics

phosphate binders (sevelamer)

hypocalcemia interventions

supplements after meals

IV calcium gluconate

Vit D

phosphate binders

seizure and fall precautions

hypercalcemia interventions

3-4 L water daily

calcitonin supplement

strain urine, dec intake, dialysis, avoid Ca meds, no thiazides

interventions for hyperkalemia

eliminate K intake

furosemide, kayexelate

insulin and glucose

calcium gluconate

dialysis if renal failure

interventions for hypokalemia

hydration

K rich diet or supplements

monitor ECG and vitals

safety concerns for hypertonic saline

restrict to CCU, ICU, ED

use smart pump

central line recommended

can cause osmotic demyelination syndrome

monitor for side effects

safety concerns for potassium supplements

NEVER GIVE IV PUSH

must do IV piggyback no more than 10-20 mEq/hr by pump

safety concerns for magnesium supplements