Hyponatremia, Hypernatremia, and Electrolyte Imbalances: Causes, Treatments, and Precautions

Hyponatremia

Low sodium level in the blood.

Hyponatremia causes

Excessive sweating, loop/thiazide diuretics, NPO status, low-salt diet, excessive fluid intake, and kidney disease.

Excessive sweating and hyponatremia

Sweating causes sodium loss, which can decrease serum sodium.

Diuretics and hyponatremia

Loop and thiazide diuretics can cause sodium loss through the urine.

Excessive fluid intake and hyponatremia

Too much fluid dilutes sodium in the blood.

Hyponatremia treatment

Treat the cause, discontinue diuretics if prescribed, and give 3% or 5% saline as ordered.

Hyponatremia precautions

Seizure precautions and fall precautions due to muscle weakness.

Hyponatremia diet teaching

Increase salt intake if prescribed.

Hyponatremia correction

Sodium levels must always be corrected gradually.

Hypernatremia

High sodium level in the blood.

Hypernatremia causes

Corticosteroids, excessive PO or IV sodium intake, dehydration, kidney failure, and heart failure.

Dehydration and hypernatremia

Dehydration causes hemoconcentration, making sodium more concentrated in the blood.

Kidney failure and hypernatremia

Kidney failure can cause sodium retention.

Heart failure and hypernatremia

Heart failure can cause sodium and fluid retention.

Hypernatremia treatment

Treat the cause, give normal saline as prescribed, and use loop diuretics if ordered.

Hypernatremia diet teaching

Follow a low-salt diet.

Hypernatremia correction

Sodium levels must always be corrected gradually.

Hypokalemia

Low potassium level in the blood.

Hypokalemia causes

Diuretics, insulin, corticosteroids, NPO status, low-potassium diet, diarrhea, vomiting, NG suctioning, and elevated aldosterone.

Diuretics and hypokalemia

Diuretics can cause potassium loss through the urine.

Insulin and hypokalemia

Insulin shifts potassium into cells, lowering potassium in the blood.

Corticosteroids and hypokalemia

Corticosteroids can increase potassium loss through the kidneys.

GI losses and hypokalemia

Diarrhea, vomiting, and NG suctioning can cause potassium loss.

Elevated aldosterone and hypokalemia

Aldosterone causes sodium retention and potassium excretion.

Hypokalemia treatment

Treat the cause, discontinue diuretics if prescribed, and give potassium supplements.

Hypokalemia diet teaching

Increase potassium-rich foods such as avocados, bananas, potatoes, spinach, and citrus juices.

Hypokalemia and digoxin

Monitor digoxin levels because hypokalemia increases risk for digoxin toxicity.

Hypokalemia safety

Fall precautions are needed due to muscle weakness.

Hypokalemia priority assessments

Prioritize respiratory and cardiac assessments.

IV potassium safety

Potassium is never given IV push.

IV potassium infusion rate

IV potassium is always diluted and given no faster than 20 mEq/hour.

Hyperkalemia

High potassium level in the blood.

Hyperkalemia causes

ACE inhibitors, spironolactone, excess potassium intake, salt substitutes, kidney failure, trauma, burns, and acidosis.

ACE inhibitors and hyperkalemia

ACE inhibitors can increase potassium levels.

Spironolactone and hyperkalemia

Spironolactone is potassium-sparing and can increase potassium levels.

Salt substitutes and hyperkalemia

Salt substitutes often contain potassium and can raise potassium levels.

Kidney failure and hyperkalemia

Failing kidneys cannot remove potassium effectively.

Trauma, burns, and hyperkalemia

Cell injury releases potassium into the bloodstream.

Acidosis and hyperkalemia

Acidosis can shift potassium out of cells and into the blood.

Hyperkalemia treatment

Treat the cause, give loop/thiazide diuretics, sodium polystyrene sulfonate, or insulin with 50% dextrose as ordered.

Kayexalate

Sodium polystyrene sulfonate removes potassium from the body.

Insulin and D50 for hyperkalemia

Insulin shifts potassium into cells, and D50 prevents hypoglycemia.

Hyperkalemia diet teaching

Follow a low-potassium diet.

Hyperkalemia priority assessment

Prioritize cardiac assessment.

Hyperkalemia safety

Fall precautions are needed.

Foods to avoid with hyperkalemia

Avoid potassium-rich foods such as avocados, bananas, potatoes, spinach, and citrus juices.

Hypocalcemia

Low calcium level in the blood.

Hypocalcemia causes

Decreased calcium or vitamin D intake, lactose intolerance, malabsorption, kidney disease, diarrhea, elevated phosphorus, and hypoparathyroidism.

Vitamin D and hypocalcemia

Low vitamin D decreases calcium absorption.

Lactose intolerance and hypocalcemia

Lactose intolerance may reduce dairy intake, lowering calcium intake.

Malabsorption and hypocalcemia

Malabsorption prevents proper absorption of calcium and vitamin D.

Kidney disease and hypocalcemia

Kidney disease can impair vitamin D activation and calcium regulation.

Elevated phosphorus and hypocalcemia

High phosphorus lowers calcium levels.

Hypoparathyroidism and hypocalcemia

Low parathyroid hormone decreases calcium levels.

Hypocalcemia treatment

Treat the cause, give calcium gluconate, and provide PO calcium and vitamin D supplements.

Calcium gluconate

Medication used to treat hypocalcemia.

Hypocalcemia nursing consideration

Minimize stimulation.

Hypocalcemia diet teaching

Increase calcium-rich foods such as dairy, soy, nuts, green leafy vegetables, and fish with edible bones.

Hypercalcemia

High calcium level in the blood.

Hypercalcemia causes

Excessive calcium or vitamin D intake, thiazide diuretics, kidney failure, and hyperparathyroidism.

Thiazide diuretics and hypercalcemia

Thiazide diuretics can increase calcium levels.

Hyperparathyroidism and hypercalcemia

Excess parathyroid hormone raises calcium levels.

Hypercalcemia treatment

Treat the cause, give loop diuretics, calcitonin, phosphorus, and normal saline as ordered.

Calcitonin

Medication that "tones down" calcium levels.

Hypercalcemia medication safety

Discontinue medications that contain or raise calcium.

Hypercalcemia priority assessment

Prioritize cardiac assessment.

Hypomagnesemia

Low magnesium level in the blood.

Hypomagnesemia causes

Diuretics, malnutrition, diarrhea, and alcoholism.

Diuretics and hypomagnesemia

Diuretics can cause magnesium loss.

Malnutrition and hypomagnesemia

Poor intake can decrease magnesium levels.

Diarrhea and hypomagnesemia

Diarrhea can cause magnesium loss.

Alcoholism and hypomagnesemia

Alcoholism is associated with low magnesium levels.

Hypomagnesemia treatment

Treat the cause, discontinue diuretics if prescribed, and give IV magnesium sulfate.

Magnesium sulfate

IV medication used to treat hypomagnesemia.

Hypomagnesemia nursing consideration

Monitor deep tendon reflexes regularly while correcting magnesium.

Magnesium-rich foods

Nuts and seeds, soybeans, avocados, potatoes, and green leafy vegetables like spinach.

Hypermagnesemia

High magnesium level in the blood.

Hypermagnesemia causes

Increased magnesium intake, Maalox, milk of magnesia, and IV magnesium replacement.

Maalox and hypermagnesemia

Maalox contains magnesium and can increase magnesium levels.

Milk of magnesia and hypermagnesemia

Milk of magnesia contains magnesium and can increase magnesium levels.

Hypermagnesemia treatment

Treat the cause, discontinue magnesium supplements, give normal saline, loop diuretics, and IV calcium gluconate as ordered.

IV calcium gluconate for hypermagnesemia

Calcium gluconate helps oppose the effects of excess magnesium.

Hypermagnesemia diet teaching

Avoid magnesium-rich foods such as nuts, seeds, soybeans, avocados, potatoes, and spinach.