QUIZ 6 REVIEW

electrolytes

Minerals in the body that conduct electricity.

basic metabolic panel (BMP)

A blood test that provides information regarding electrolyte and fluid balance and includes information regarding renal function and glucose levels.

* determine if electrolyte levels are outside of the expected reference range

complete metabolic panel (CMP)

A blood test that provides information regarding electrolyte and fluid balance. In addition to those findings included in the BMP, the CMP also includes information regarding the body's metabolism, including protein and liver function.

* determine if electrolyte levels are outside of the expected reference range

Blood urea nitrogen (BUN)  

tests for kidney function

Carbon dioxide (CO2)  

tests for blood bicarbonate level

Creatinine (CR)  

tests for kidney function

glucose

tests for blood sugar level

Chloride (Cl-–)  

tests for blood chloride level

Potassium (K+)  

supports the transmission of electrical impulses of the body’s nerves and muscles; also plays a major role in conduction of nerve cells within the heart

* **Potassium is Priority since it Pumps the muscles (heart electrolyte)**
* **MAIN JOB IS TO MAINTAIN HEART AND MUSCLE CONTRACTION**


* the body’s largest intracellular electrolyte #1
* intake occurs through food, drinks, and supplements
* kidneys are responsible for (90%) of excretion, rest is lost through sweat and GI tract

recommended dietary allowance (RDA) for potassium (K+)

* adult male: 3,400 mg
* adult female: 2,600 mg

Sodium (Na+)  

the body’s most common extracellular electrolyte

* supports proper neurologic & neuromuscular function, regulates the body’s fluid balance and **helps maintain BP, blood volume and PH**
* ingested into the body through food and drink
* excreted primarily through urine and sweat

recommended dietary allowance (RDA) for sodium (Na)

less than 2,300 mg per day (approx. 1 teaspoon)

* most Americans get more than what’s needed

Comprehensive Metabolic Panel for liver function

* Calcium (Ca+)
* Liver enzymes  
* Alkaline phosphate (ALP)  
* Alanine transaminase (ALT)  
* Aspartate aminotransferase (AST)  
* Bilirubin (total)
* Albumin

electrolytes are responsible for the following functions within the body:

* Maintaining the balance of water in the body
* Balancing the blood pH (acid–base) level
* Moving nutrients into the cells
* Moving wastes out of the cells
* Maintaining proper function of the body’s muscles, heart, nerves, and brain)

tachycardia

increased HR above normal range (>60-100bmp)

tachypnea

increased respiratory rate (>12-20 breaths per min)

kidneys

organs that filter blood and excrete wastes as urine

dehydration

excess water loss w/out loss of sodium (HYPERNATREMIA)

hypovolemia

decrease in blood volume due to body fluid or blood loss.

homeostasis

A state of equilibrium by keeping water and electrolytes at a constant level in the blood

* can be monitored by determining serum osmolality of the blood

osmoality

measurement of solutes within a solution

* indicator of body’s fluid status
* range: 285-295 mOsm/kg

as body water decreases

the concentration of solutes increase (increase in serum osmolality → decrease in hydration)

range for urine osmolality

50-1,200 mOsm/kg

three main fluid compartments

* intracellular space
* extracellular space
* intravascular space

intracellular space

holds 67% of body’s water

extracellular space

space outside the cells; includes: interstitial and intravascular areas

* holds 25% of body’s water

intravascular space

holds remaining 8% of body water

osmosis

the movement of water across a semipermeable membrane from an area of higher concentration to one of lower concentration, such as fluid moving into or out of a cell, in an effort to maintain homeostasis

* keeps fluid and electrolyte levels balanced and the body functioning properly

as serum osmolality rises the hypothalamus stimulates the posterior pituitary to release

antidiuretic hormone (ADH) (vasopressin); acts on the nephrons of the kidneys

* collecting ducts of kidneys respond to ADH by increasing reabsorption of water, decreasing the excretion of urine, and increasing the fluid vol. of body

antidiuretic hormone (ADH)/vasopressin

a hormone excreted by the hypothalamus in the brain that maintains blood pressure and fluid volume

* AKA vasopressin

Potassium (K+) expected range values

3\.5 - 5 mEq/L

Sodium (Na+) expected range values

136 - 145 mEq/L

Calcium (Ca2+)

9 - 10.5 mg/dL

* most abundant mineral in the body w multiple functions
* **helps muscles move, and nerves to carry messages between brain and body, and blood vessels to move blood throughout the body**
* **plays essential role in blood clotting**
* found in blood and cells, **99% is stored in bones and teeth**
* absorption of calcium by intestines depends on an adequate supply of vit D
* excretion of calcium occurs through kidneys and is controlled by action of parathyroid hormone (PTH)

RDA for calcium

depends on age

* young children and adolescents need more calcium than young adults
* older adults especially women need to increase calcium intake to decrease risk of developing osteoporosis

ionized calcium

4\.5-5.6 mg/dL for an adult

* ionized calcium level is generally estimated to be about 50% of their total calcium


* ionized calcium is more accurate analysis provided by assessing ionized calcium as much of calcium in the body is bound to protein
* ionized calcium represents active unbound amount of calcium in the blood

calcium plays a role in

* mineralization of bone
* muscle contraction
* nerve transmission
* clotting of blood
* hormone secretion
* normal functioning of the heart

Magnesium (Mg2+)

1\.3 - 2.1 mEq/L

* the body’s 2nd most common intracellular electrolyte
* 50% to 60% is located in the bones
* intake of magnesium occurs through the digestion of whole foods
* can also be obtained through multivitamins, supplements, laxatives, and medications for GI symptoms such as heartburn and indigestion
* excreted through urine and feces

role of magnesium is to

* assist in the regulation of nerve and muscle function
* maintain BP and serum glucose levels
* support bone and teeth health
* synthesize protein, DNA, and RNA

RDA for Magnesium

depends on age and sex

* adult males: 400 to 420 mg/day
* adult females: 310 to 320 mg/day

diffusion

movement of solutes from an area of higher concentration to one of lower concentration

* does not require use of energy (passive process)
* continues until there are equal # of solutes inside and outside the cell

active transport

the movement of electrolytes or molecules across a cell membrane from a lower area of concentration to a higher area of concentration with the use of energy in the form of enzymes

* ex: sodium-potassium pump

hypokalemia causes

* Medications
* Certain cardiac conditions
* Gastrointestinal losses
* Metabolic alkalosis
* Decreased oral intake of potassium
* Excessive alcohol use
* Chronic kidney disease
* Diabetic ketoacidosis
* Excessive sweating
* Folic acid deficiency

most common cause of hypokalemia is

loss of potassium from the kidneys of GI tract

* prolonged diarrhea, vomiting, chronic laxative use, bowel diversion, or gastric suctioning

meds than can lead to decreased potassium levels

* potassium-wasting diuretics (loop, thiazide, and osmotic)
* amphotericin B
* high doses of penicillin
* theophyline

mild hypokalemia S/S

3 - 3.5 mEq/L

**LOW ALL (neuro, lungs, bowel [hypoactive bowel sounds], muscle) EXCEPT HR & URINE**

* may or may not present with any signs
* **muscle weakness**
* **cardiac arrhythmias**
* constipation
* **fatigue**
* **leg cramps**
* **paresthesias**

nursing action for potassium

any potassium abnormality our first nursing action is to place the patient on a cardiac monitor (ECG/EKG)

important nursing action for potassium IV

we **NEVER** give potassium IV push, only over an IV bag with IV pump and infuse over an hour or more

severe-life threatening hypokalemia S/S

less and 2.5 mEq/L

* respiratory paralysis & failure
* paralytic ileus (obsctruction in intestine)
* hypotension
* tetany
* rhabdomyolysis (muscle tissue breakdown)
* **life-threatening cardiac arrhythmias**
* can affect renal function (recurrent hypokalemic episodes)

potassium-sparing diuretic

a medication that promotes the excretion of urine while retaining potassium

treatment for hypokalemia

HIGH ALERT MEDICATION

* always be diluted if given IV (100-1,000mL)

foods high in potassium

* baked potato (HIGHEST VEGETABLE)
* prune juice (HIGHEST FRUIT JUICE)
* carrot juice
* white beans
* plain, non-fat yogurt (HIGHEST DAIRY PRODUCT)
* sweet potato
* salmon (HIGHEST FISH)
* banana (HIGHEST FRUIT)
* spinach
* avocado

hyperkalemia causes

* Renal failure
* Dehydration
* Diabetes mellitus
* Medications
* Trauma
* Excess intake of potassium
* Burns
* Transfusions of packed red blood cells
* Acidosis
* Sepsis

most common cause of hyperkalemia is

renal failure

most common meds that cause hyperkalemia

* Potassium-sparing diuretics
* nonsteroidal anti-inflammatory medications (NSAIDs)
* angiotensin-converting enzyme (ACE) inhibitors 

mild hyperkalemia S/S (>5 mEq/L)

**HIGH ALL (neuro, lungs, bowel, muscle) EXCEPT HR & URINE OUTPUT**

* nausea
* vomiting
* muscle aches
* weakness
* decreased deep tendon reflexes
* paralysis
* **dysrhythmias**
* palpations

severe life-threatening hyperkalemia S/S (>7 mEq/L)

**HIGH ALL (neuro, lungs, bowel [hyperactive bowel sounds, muscle) EXCEPT HR & URINE OUTPUT**

* can lead to significant neurologic, respiratory, or cardiac consequences


* paralysis
* **HF (cardiac arrest)**
* death (if untreated)

treatment for hyperkalemia

starts w identifying cause then removing excess and stabilizing the heart

* hemodialysis (if due to renal failure)
* calcium gluconate & diuretics
* decrease the effects of excess K levels on the heart
* Loop and thiazide diuretics
* cause excess excretion of K through urination
* insulin administration
* resin medication

resin medication

help decrease potassium levels → resins bind to the potassium in the body and are then excreted through the stool

* ex: sodium polystyrene sulfonate

insulin administration for hyperkalemia

causes potassium to enter the cells, which lowers the serum potassium level

* pt’s should have blood glucose monitoring because of the increased risk of hypoglycemia (blood glucose level < 74 to 106 mg/dL)

salt substitutes

commonly used by clients who have to limit their sodium intake; can contain potassium chloride, increases a client’s potassium level

* pts should monitor their use of salt substitutes since many of these products contain potassium.

hyponatremia ranges

less than 136 mEq/L

* critical values occur at less than 120 mEq/L

risk factors for hyponatremia

* medications
* chronic or severe vomiting or diarrhea
* drinking excess amounts of water
* excess alcohol intake
* heart & liver problems (increased fluid retention → dilutes sodium)
* kidney problems (can lead to excess excretion of sodium)
* severe burns
* drinking too much water

most common cause of hyponatremia

excess water in the body (rather than a lack of sodium → too much water dilutes sodium levels)

meds that most commonly cause hyponatremia

thiazide diuretics

* cause loss of sodium through urinary loss

hyponatremia s/s

* nausea
* feeling of general unwellness
* lethargy
* confusion

neurologic manifestations of hyponatremia

related to fluid shifts in the brain (can lead to cerebral edema)

* headache
* restlessness
* irritability

severe hyponatremia s/s

* muscle twitching
* further decreases in level of consciousness (LOC)
* **tachycardia**
* **weak thread pulse**
* respiratory arrest
* **seizures**
* **coma**
* if hyponatremia is not revered pt can become unrousable, and death may occur

treatment of hyponatremia

* begins with identifying cause & determining level of Na deficiency
* important raise Na levels slowly to prevent further neurologic complications
* if hyponatremia is caused by medications therapies may be modified or discontinued
* if hyponatremia results from a disease (heart failure or cirrhosis) the client’s treatment may need to be changed.

if the cause of the low sodium level is related to excessive water intake or an alteration in fluid balance

the treatment may include fluid restriction to correct the dilutional effect of too much body water

if the cause of hyponatremia is related to sodium and fluid losses

IV fluids are administered to restore sodium and water balance

if the hyponatremia is caused by medications

therapies may be modified or discontinued

if hyponatremia results from a disease

, such as heart failure or cirrhosis, the client’s treatment may need to be changed.

nursing considerations

* drink water in moderation
* check urine for a pale yellow color to indicate adequate hydration
* discuss w the provider need to consume sports drinks w electrolytes when participating in demanding physical activities
* use thirst as an indicator as to whether or not drinking water is necessary

older adults are more prone to hyponatremia due to

* physiological aspects of aging
* the increased number of comorbidities in this population
* greater use of medications

hypernatremia values

greater than 145 mEq/L

* critical values > 160 mEq/L

causes of hypernatremia

* too little water or too much sodium or combination of the two
* loss of body water
* meds
* gastroenteritis
* vomiting
* prolonged suction
* bruns
* excessive sweating
* chronic kidney diseases
* impaired thirst response

most common cause of hypernatremia

loss of body water

* as water is removed from the body dehydration occurs which stimulates thirst response

hypernatremia s/s

* **big and bloated**
* **edema**
* **flushed skin**
* **polydipsia (excess thirst)**
* confusion
* lethargy
* irritability

severe hypernatremia s/s

* **muscle twitching**
* **swollen dry tongue**
* **increased muscle tone**
* **nausea**
* **vomiting**
* further changes in LOC
* seizures
* coma
* can lead to death if untreated

hypernatremia is diagnosed

by eval of a BMP or CMP

* plasma osmolality test can also be preformed; will indicate elevated blood viscosity above the expected reference level of 295 mOsm/kg.

treatment for hypernatremia

begins w identifying the cause and initiating IV fluid replacement containing water and a small amount of sodium

* important to decrease sodium levels slowly to prevent cerebral edema
* may instruct the client to lower the sodium level on an ongoing basis by decreasing dietary consumption of sodium

foods high in sodium

* roasted ham
* shrimp-frozen, nonbreaded
* shrimp-fresh caught
* frozen pizza
* canned soup
* vegetable juice
* vegetable juice-low sodium
* cottage cheese
* instant vanilla pudding
* regular vanilla pudding

hypocalcemia ranges

* less than 9 mg/dL
* ionized levels less than 4.5 mg/dL
* critical values occur at less than 6 mg/dL and less than 2.2 mg/dL for ionized calcium

hypocalcemia causes

* meds that decrease the body’s absorption of calcium
* inadequate amount of vitD
* hormonal changes (menopause)
* decreased estrogen production can inhibit absorption of calcium as well as the speed up resorption or loss of bone
* hypoparathyroidism
* renal disease
* multiple blood transfusions
* electrolyte imbalances of magnesium or phosphate
* sepsis
* low albumin levels

meds that can lead to hypocalcemia

* stimulant laxatives
* decrease absorption of calcium
* long term use of glucocorticoids
* can deplete calcium stores by increasing risk of developing osteoporosis
* loop diuretics
* can lead to excess calcium excretion by kidneys
* meds used to decrease body’s gastric acid (ex: proton-pump inhibitors & histamine 2-blockers)
* decreases breakdown of fat which is an important factor for calcium absorption

hypoparathyroidsim

function of PTH is to maintain the proper amount of calcium in the body

* decrease in PTH may lead to the need for lifetime supplementation of calcium
* most common causes of decreased PTH in the body are thyroid and neck surgery → parathyroid glands located in the neck behind the thyroid gland

osteopenia

low bone mass

* can be caused by hypocalcemia
* increase the risk of bone fractures and osteoporosis

body systems affected by hypocalcemia

* respiratory
* cardiac
* neurologic
* sensory
* neuromuscular
* integumentary system

acute hypocalcemia s/s

* chest pain


* HF
* syncope
* numbness and tingling of fingers and toes and around the mouth
* muscle cramping
* spasms (back and lower extremities)
* confusion
* depression
* psychosis
* dementia
* lethargy
* seizures
* personality changes
* wheezing
* spasms of larynx and airway
* dysphagia
* changes to the voice
* coarseness of hair
* hair loss (alopecia)
* brittle nails
* dry skin
* itching
* development of vision difficulties
* dental problems
* diarrhea
* **circumoral tingling**
* **positive Chvosteks signs**
* **positive Trosseau sign**
* **cardiac dysrhythmias**
* **fractures**
* **bleeding**

people at greater risk for hypocalcemia include

neonates and infants who are born to mothers who have diabetes, pre-eclampsia or hyperparathyroidism

Chvostek sign

use the fingertips to tap the facial nerve, which is located 2 cm in front of the tragus of the ear

* a twitching of the facial muscles on the same side being tapped is a positive Chvostek sign

Trosseau sign

place a blood pressure cuff on the client’s arm and inflate it 20 mm Hg above the client’s systolic blood pressure for 3 to 5 minutes, which will cause irritability of the nerves in the arm

* a positive result occurs with flexion of the wrist, thumb, and first joints of the fingers, combined with hyperextension of the fingers
* more specific indicator of hypocalcemia than the Chvostek sign

treatment for hypocalcemia

may resolve on its own or treatment may be required which can include the following:

* calcium & vitD supplements
* dietary changes
* calcium injections
* limit calcium supplement intake to less than 600 mg per dose to promote absorption

foods high in calcium

* american cheese (HIGHEST PROTIEN)
* parmesean cheese
* plain yogurt, nonfat
* almond milk (HIGHEST MILK)
* orange juice, calcium fortified
* soy milk (all flavors)
* low-fat milk (1%)
* cheddar cheese
* whole chocolate milk
* whole milk

hypercalcemia ranges

greater than 10.5 mg/dL

greater than 13 mg/dL for ionized calcium levels

* critical values: greater than 13 mg/dL and 7 mg/dL for ionized calcium

elevated serum calcium levels can lead to development of

* kidney stones
* weakened bones
* affect the function of the heart and brain

causes of hypercalcemia

* cancer
* hyperparathyroidism
* vitD toxicity
* meds
* renal failure

most common cause of hypercalcemia

hyperparathyroidism and cancer

* result in excessive calcium being drawn from the bones into the bloodstream

hyperparathyroidism

* parathyroid glands secrete excessive amount of PTH
* elevated PTH levels in the body lead to increased absorption by the kidneys, and increased bone resorption → leads to hypercalcemia

cancer causes hypercalcemia due to

bones being invaded as cancer progresses; bone resorption occurs → cancer tumors release hormone similar to PTH → leads to hypercalcemia