M1L3: Electrolyte Imbalances

135 - 145 mEq/L

135 - 145 mEq/L

(Serum electrolytes)

Na+

Table salt

(Serum electrolytes)

Na+ major dietary source

3.5 - 5.0 mEq/L

(Serum electrolytes)

K+

Fruits

(Serum electrolytes)

K+ major dietary sources

1.5 - 2.5 mEq/L

(Serum electrolytes)

Mg++

Seafood

(Serum electrolytes)

Mg++ major dietary sources

4.5 - 5.5 mEq/L

(Serum electrolytes)

Ca++

Dairy products

(Serum electrolytes)

Ca++ major dietary sources

1.8 - 2.5 mEq/L

(Serum electrolytes)

PO4

Eggs

(Serum electrolytes)

PO4 major dietary sources

96 - 105 mEq/L

(Serum electrolytes)

Cl-

Neuromuscular activity

Primary intracellular cation

(Potassium)

Main function

Neuromuscular activity

(Potassium)

Sodium-potassium pump.

Responsible for the movement, irritability, and activity of the body

K+

(Potassium: neuromuscular activity)

Primary intracellular cation

Na+

(Potassium: neuromuscular activity)

Primary extracellular cation

directly

(Potassium)

The normal values, 3.5 - 5.0 mEq/L, are ___ proportional to the NM irritability

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Decreased NM irritability

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Skeletal muscle
- Muscle weakness

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Skeletal muscle
- Flaccid paralysis

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Skeletal muscle
- Mostly observed in the arm

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Smooth muscle
- decreased peristalsis

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Smooth muscle
- dry, hard stools

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Smooth muscle
- paralytic ileus

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Smooth muscle
- hypoactive bowel sound

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Cardiac muscle
- Decreased HR/bradycardia

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Cardiac muscle
- Cardiac standstill

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Increased NM irritability

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Skeletal muscle
- Muscle cramps

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Skeletal muscle
- Spasms

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Smooth muscle
- Increased peristalsis (“butterflies in stomach”)

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Smooth muscle
- Loose bowel movements

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Smooth muscle
- Intestinal colic

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Smooth muscle
- Hyperactive bowel sounds

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Cardiac muscle
- Increased HR, Tachycardia

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Signs and symptoms
Cardiac muscle
- Cardiac arrest (“my chest is going to burst”)

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Nutrition and metabolism
- malnutrition

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Nutrition and metabolism
- starvation

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Nutrition and metabolism
- crash diets

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Nutrition and metabolism
- alcoholism

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Nutrition and metabolism
- anorexia nervosa

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Nutrition and metabolism
- stress

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
GI losses
- Vomiting

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
GI losses
- Diarrhea

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
GI losses
- Intestinal suctioning

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
GI losses
- NPO

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
GI losses
- Intestinal fistula

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
GI losses
- Diabetes

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Elimination
- Laxative abuse (furosemide: loop diuretics)

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Elimination
- Enemas

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Elimination
- K+ depleting diuretics

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Elimination
- Diuretics phase - dialysis

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Elimination
- Steroids

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Elimination
- Cushing syndrome

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Skin/cellular integrity
- Trauma

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Skin/cellular integrity
- Tissue injury

Hypokalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Skin/cellular integrity
- Surgery

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Nutrition and metabolism
- Oral K+ supplement

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Nutrition and metabolism
- IV K+ replacement

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Elimination
- Acute/chronic renal failure

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Elimination
- K+ sparing diuretics

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Skin/cellular integrity
- Massive trauma

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Skin/cellular integrity
- Crushing injury

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Skin/cellular integrity
- Hemolysis

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Skin/cellular integrity
- Phlebotomy

Hyperkalemia

(Potassium: Hypokalemia or Hyperkalemia)

Causes
Skin/cellular integrity
- Burns

Potassium acetate

Potassium bicarbonate

Potassium citrate

Potassium chloride

(Potassium: Hypokalemia)

Management (4)

Loop diuretics

Cation exchange resin (kayexalate)

Dialysis

(Potassium: Hyperkalemia)

Management (3)

Loop diuretics (furosemide)

(Potassium: Hyperkalemia - Management)

Promote renal excretion of K+

Cation exchange resin (kayexalate)

(Potassium: Hyperkalemia - Management)

Remove excess K+ by exchanging Na+ in the intestinal tract

Dialysis

(Potassium: Hyperkalemia - Management)

For renal failure

40 mEq/20 ml

(Potassium: Hypokalemia - Management)

Universal unit of potassium chloride (KCl)

Potassium chloride (KCl)

(Potassium: Hypokalemia - Management)

Can be lethal if given in extreme doses

Usually used in death penalties

Calcium

The hard electrolyte : needed absorption utilization

Vitamin D

(Calcium)

Facilitator of ___ ___

Iron (Fe)

Facilitator of Vitamin C

bones

teeth

blood clotting

normal heart beat

hormone secretion

(Calcium)

Function
- Essential for the formation and maintenance of ___ and ___, ___ ___, ___ ___ ___, ___ ___

inversely

(Calcium)

The normal values, 4.5 - 5.5 mEq/L, are ___ proportional to the NM irritability

Hypocalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Increase in NM irritability

Hypocalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Signs and symptoms
- Tremors, spasms, cramps

Hypocalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Signs and symptoms
- Twitching, paresthesias

Hypocalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Signs and symptoms
- + Tetany (chvostek sign & trousseau sign)

Hypocalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Signs and symptoms
- Seizure, convulsions

Chvostek sign

(Calcium: Hypocalcemia)

Signs and symptoms
- Facial muscle twitches after facial nerve is tapped lightly

Trousseau sign

(Calcium: Hypocalcemia)

Signs and symptoms
- Contraction of the muscles in the hand and wrist (i.e. carpopedal spasm)
- Seen after you put a blood pressure cuff on a client (2-3 min)

Hypercalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Decrease in NM irritability

Hypercalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Signs and symptoms
- Lethargy, movement limitation

Lethargy

(Calcium: Hypercalcemia)

Signs and symptoms
- Sleeping most of the time but responds to verbal stimulation

Hypercalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Signs and symptoms
- Bone pains (usually in the spinal column)

Hypercalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Signs and symptoms
- Constipation (dry, hard stools)

Hypercalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Signs and symptoms
- Urinary stones

Hypocalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Causes
Nutrition and Metabolism
- Inadequate dietary intake of Ca++ rich foods

Hypocalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Causes
Nutrition and Metabolism
- Poor vitamin D intake and absorption

Hypocalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Causes
Nutrition and Metabolism
- Accidental removal of parathyroid glands during thyroidectomy

Hypocalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Causes
Elimination
- Diarrhea

Hypocalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Causes
Elimination
- Wound drainage

Hypocalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Causes
Elimination
- Steroid therapy

Hypercalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Causes
Nutrition and Metabolism
- Overconsumption of milk/dietary salts

Hypercalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Causes
Nutrition and Metabolism
- Overactivity of the parathyroid glands

Hypercalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Causes
Activity and mobility
- Excessive movement of Ca++ out of bones = multiple fractures, bone tumors, immobility

Hypercalcemia

(Calcium: Hypocalcemia or Hypercalcemia)

Causes
Elimination
- Renal impairment