electrolytes

Sodium

135-145

Na

neuro

sodium fxn

-maintains fluid volume (water follows salt)

-regulates osmolarity (main solute in the body)

vital signs to watch w/ sodium

-BP (water follows salt)

-HR (pumps the volume)

sodium regulation

reabsorbed an excreted thru kidneys

hidden high Na

-over the counter meds

-cough syrup

-tums

-msg

-baking powder/soda

hyponatremia

<135

hyponatremia is either

depleted or diluted

depleted Na causes

-direutics

-GI fluid loss

-excessive sweating

diluted Na loss

-excessive water intake

-excessive IVF

-SIADH (syndrome of inappropriate antidiuretic hormone)

-heart failure

symptoms of hyponatremia

-confusion

-seizures

-muscle cramps/twitching

-legarthy

-n/v/d

treatment of hyponatremia

-increase oral intake

-administer IVF

-seizure precautions

-I&Os

-daily weight

greatly cause hyponatremia

thiazide

dramatic increase/decrease in weight

2.2 lbs

hypernatremia

>145

cause of hypernatremia

-medications, meals

-osmotic diuretics

-diabetes insipidus (decreased ADH)m

-excessive water loss

-low water intake

signs of hypernatremia

-fever, and flushed skin

-restlessness

-increased fluid retention and bP

-edema

-decreased UOP, dry mouth

treatment of hypernatremia

-restrict Na

-increase water intake

-administer diruetic w/ increase of PO fluids/hypotonic fluids

-admin IVF without Na

potassium

3.5-5

k fxn

-maintins icf osmolaity

-regulates conduction of cardiac rhythm (tells heart to pump thru signals)

-transmits electrical impulses

-often found in gut

regulation of k+

-excreted thru kidneys (traded w/ salt

-lost through vomiting and diarrhea and use of diuretics

high in potassium

salt substitutes

potassium sources

-avocados

-banna

-potatoes skin

-spinach

-beans

-citrus juices

-fish

hypokalemia

<3.5

hypokalemia causes

-gi fluid loss

-diuretics

-inadequate food intake (anorexia, bulimia )

-alkalosis

alkalosis and potassium

hydrogen moves into cells to maintain balance, causes blood to become too basic

signs of hypokalemia

-weak, irregular pulse

-dysrhythmias/EKG changes

-increased sensitivity to digoxin

-fatigue

-muscle weakness/leg cramps

-paresthesias

-decreased GI motility

potassium and digoxin

causes toxicity, monitor med levels

treatment for hypokalemia

-increase oral k+ intake

-administer k+ supplements

-monitor for digoxin toxicity

severe hypokalemia symptoms

cardiac symptoms. dysrhythmias and weak irregular pulses. put on continuous ekg

check for kidney fxn before giving IV k+

-BUN

-creatinine

iv push for K+

causes the heart to stop. use a pump

hyperkalemia

>5

causes of hyperkalemia machine

-medications

-acidosis

-cellular destructions(bruns, traumatic)

-hypoaldosteronism, hemolysis

-excessive intake

-renal failure (nephrons)

-impaired excretion

potassium sparing diruetics

-sprinolactone

-ACE inhibitors (for BP)

signs of hyperkalemia

-muscle cramps/weakenss

-oliguria/anuria

-distress

-decreased cardiac contractility (contract)

-EKG changes

-hyperreflexia or areflexia

hemolysis and hyperkalemia

RBC break down, releases potassium into blood

treatment of hyperkalemia

-restrict K+ intake

-cation exchange (gives more sodium so potassium is excreted) (kayexelate/patiromer)

-conintous EKG monitoring

hyperkalemia emergency treatment

-regular insulin/50% dextrose

-calcium gluconate

-sodium bicarbonate

-metabolic acidosis

Amp of D50

regular insulin with 50% dextrose

calcium level

8.2-10.2

regulation of ca+

excreted in urine, bile, and feces

fxn of ca+

-promotes transmission of never impulses

-regulates skeletal and cardiac muscle contractions

-major component of bone and teeth

-essential factors in the formation of blood clots

most abundant electrolyte in the body

calcium

has an inverse relationship with phosphorus

calcium

calcium affects

-neuromuslcaur

-cardiac

-bones

pth

tells bone calcium to go to blood stream

-orange juice

-dark leafy greens

-yogurt

hypocalcemia

<8.2

causes of hypocalcemia

-inadequate intake

-hypoparathyroidism

-malabsorption(alcholoism & malnutrition)

-pancreatitis

-vit d deficiency

signs of hypocalcemia "cats"

-convulsions & chvosteks sign

-arrhythmias

-tetany and hyperreflexia & trousseau sign

-spasms and laryngospasm with stridor

treatment of hypocalcemia

-increase cat+ intake

-admin ca+ supplements

-if severe, monitor airway, seizure precautions, fall precautions

-administer IV ca+ (thru central line only)

tetnay

entire symptom complex induced by increase in neural excitably. leads to extreme spasms

chvostek sign

Facial/cheek twitching indicating hypocalcemia

trousseaus sign

blood pressure cuff & wrist test

hypercalcemia levels

>10.2

causes of hypercalcemia

-hyperparathyroidism

-malignant bone disease

-RARE=prolonged immobilization, excess ca+ supplementations, thiazides diuretics

signs of hypercalcemia

-muscle weakness

-anorexia, n/v, fatigue

-constipation

-polyuria/polydipsia

-dehydration

-kidney stones

-ekg changes

-bizarre behavior

treatment for hypercalcemia

-ivf

-encourage fluids and fiber

-eliminate ca+ supplements, limit ca+ intake

-calcitonin

-dialysis

immobility

causes the calcium once used for maintenance to be put into the bloodstream

magnesium

1.3-2.1

regulation of mg+

-excreted through the kidneys

-dietary ingestion needed

fxn of mg+

-protein and carbohydrate metabolism

-maintains normal intracellular levels of k+

-involved in electrical activity in neuromuscular junctions

calcitonin

only for patients with hyperparathyroidism

direct relationship

magnesium, calcium, potassium

foods high in magnesium

-brown rice

-peanuts

-spinach

-whole wheat bread

-mackerel

-buckwheat groats

hypomagensium

<1.3

hypomagnesemia causes

-chronic alcoholism (malabsorption)

-DKA(diabetic keto acidosis)

-GI fluid loss

signs of hypomagnesemia

-neuromuscular irritability/seizures (ca+)

-disorientation

-mood changes

-dysrhythmias (ca+)

treatment for hypomagnesemia

-check vitals

-encourage foods high in mg+

-iv replacement

-check calcium and potassium levels

-assess and correct k+ and ca+ imbalances

-avoid alcohol

-calcium gluconate (second check, high alert, central line)

-seizures and heart monitoring

to much calcium gluconate can lead to

cardiac arrest. check deep tendon reflexes (2+ is normal)

lower GI has a

higher concentration of mg+

upper GI has a

lower concentration of mg+

magnesium fuels the

sodiuma dn potassium pump. stabilizes potassium balance

magnesium enables PTH release which

stabilizes calcium balance

hypermagnesemia

>2.1

hypermagnesemia causes

-renal failure

-excess replacement

signs of hypermagnesemia

-flushing and warmth of skin

-hypotension, bradypnea, bradycardia

-drowsiness lethargy

-hypoactive reflexes

treatment of hypermagnesemia

-ekg monitoring

-monitor reflexes/respirations

-avoid mg+ based antacids/laxatives

-restrict dietary intake of mg+

-ivf/diruetics

-dialysis

contain magnesium

antacids and laxatives

phosphorus

2.5-4.5

inverse relationship with calcium

phosphorus

fxn of po4

-promotes muscle and nerve action

-bone and teeth formation

-cellular metabolism (essential for muscle and RBC fxn of ATP)

regulation of po4

-regulated by parathyroid gland

-excreted by kidneys

sources of po4

-meat (a preservative)

-milk

-fast food

-seeds

-canned fish

-cola

-cheese

hypophosphatemia

<2.5

hypophosphatemia causes

-malabsorption

-increased renal excretion (diruetics)

-respiratory alkalosis

hypophosphatemia signs

-confusion/apprehension

-seizures

-muscle weakness/paresthesias

-respiratory muscle fatigue

hypophosphatemia treatment

-sezuires precautions

-oral supplement

-iv supplements (from potassium phosphate)

-monitor ca+

-cardiac monitor

vit d. also regulates absorption of

calcium

hyperphosphatemia levels

>4.5

hyperphosphatemia causes

-renal failure

-chemotheraphy

-excess use of phospahtebased antacids

signs of hyperphosphatemia= short term

-tetany

-anorexia

-n/v

signs of hyperphosphatemia= long term

calcification of tissues

treatment of hyperphosphatemia

-restrict dietary intake

-avoid laxatives

-if severe, admin aluminum hydroxide to bind to po4

-monitor ca+

increase of phosphate causes decrease of (po4 causes increase of parathyroid hormone)

calcium

chloride levels

98-107

cl- fxn

-works with na+ to maintain osmotic pressure between fluid compartments

-functions as a buffer in oxygen carbon dioxide exchange in RBC

chloride has an inverse relationship with

bicarbonate

regulation of cl-

reabsorbed and excreted thru the kidneys along with na+