electrolyte imbalance

describe Na

normal range: 135-145

primary regulator of volume, osmolality, and distribution

important in maintaining neuromuscular activity

what is hypernatremia?

Na greater than 145

causes: water deprivation, water loss (fever, hyperventilation, burns, diarrhea), osmotic diuresis, excessive sodium intake

results in hyperosmolality and cellular dehydration

list the signs and symptoms of hypernatremia

increase thirst, serum osmolality, and hematocrit and BUN

oliguria, dry membranes, decreased turgor, tachy, hypotension

neuro: headache, restlessness, confusion, seizures, coma (primary manifestations)

what is the treatment for hypernatremia?

oral, enteral, or IV water replacement

hypotonic fluids: half NS, or 5% dextrose

monitor labs, I/O, neuro status

describe hyponatremia

less than 135 Na

results in decreased serum osmolality and swelling of cells

depletional (excess loss): diuretics, kidney disease, etc.

dilutional (excess water gain): heart failure, liver disease, self induced

what are manifestations and diagnostics test for hyponatremia?

manifestations: biggest is neuro. headache, lethargy, stupor, dull sensorium, tremors, muscle twitching, hyperflexia, very low can cause coma

diagnostics tests: serum sodium and osmolality low, 24 hours urine eval for excretion (SIADH or decreased loss of isotonic fluid)

what is treatment for hyponatremia?

depletional: Na and water loss would be lactated ringers or NS. Just Na then 3% but carefully

dilutional: diuretics, free water restriction, sodium tablets

describe potassium

range: 3.5-5

primary cation in intracellular fluid

plays critical role in conducting nerve impulses and excitability of skeletal, cardiac, and smooth muscle

what are the causes of hyperkalemia?

inadequate excretion from kidneys, high intake, shift from intra to extra cellular fluid

what are manifestations of hyperkalemia?

cardiac: peaked T waves, prolonged PR, and QRS interval, Brady, heart block, v tach, and cardiac arrest

neuromuscular: paresthesia, muscle tremors, twitching, and weakness

describe treatment for hyperkalemia

diuretics: potassium wasting

kayexalate, veitess, lokelma

insulin, hypertonic dextrose: increase cellular uptake reducing in serum

dialysis

calcium glutinate and calcium chloride

diet restriction

what causes hypokalemia?

loop diuretics, inadequate intake of K, excessive renal or intestinal loss, redistribution between intracellular and extracellular fluid

what are the cardiac effects of hypokalemia?

interferes with regulation and transmission of cardiac impulse

decrease contractibility of muscle

ECG issues

decreased CO

increase risk of digoxin toxicity

what is the treatment for hypokalemia?

PO and/or IV supplements, monitor electrolytes, monitor VS and pulses, monitor for orthostatic BP

describe Ca

8\.5-10

most is in bone and teeth

supports structure and function, vascular contraction/dilation, muscle function, nerve transmission, intracellular signaling, hormonal secretion

what is the cause of hypercalcemia?

increased resorption of calcium from bones: hyperparathyroidism, malignancies, prolonged immobility

excessive GI absorption

decreased renal excretion of Ca

excessive levels of vitamin D

what are some manifestations of hypercalcemia?

kidney stones, muscle weakness, fatigue, increased thirst and urine output, bone weakness

describe treatment of hypercalcemia

depends on severity

mild: less than 12 mg/dL

moderate: 12-14 mg/dL

severe: > 14 mg/dL

no symptoms: weight bearing activities, increased fluid intake

symptoms: isotonic fluids, calcitonin, bisphophonates

what are some things that pts should avoid if they have hypercalcemia?

thiazide diuretics, lithium carbonate therapy, volume depletion, prolonged bed rest or inactivity, limit over the counter calcium

what are the causes and manifestations of hypocalcemia?

cause: decreased total calcium stores, low levels of extracellular calcium with normal levels of calcium in bones

manifestations: numbness, tingling, muscle cramping, hyperactive reflexes, tetany, carpopedal/laryngeal spasms, bone pain, fractures, osteoporosis

what is cyvostek’s and trousseaus signs?

cyostecks: spasm of facial muscle elicited by tapping facial nerve at front of ear

trousseaus: inflation above BP cuff and held for at least 2 min causing a carpal spasm

both manifestations of hypocalcemia

what is treatment for hypocalcemia?

calcium supplement, vitamin d, monitor airway and resp status

encourage bone screening

describe phosphate

2\.5-4.5

essential for: the production of ATP, RBC function, O2 delivery, nervous system and muscular function, metabolism for fats, carbs, and proteins, assist in acid base balance

has an inverse relationship with Ca

what causes hyperphosphatemia?

impaired secretion from renal issues

excessive intake

shift from intracellular to extracellular fluid: chemo, sepsis, trauma, heat stroke, hypothermia

lowering serum Ca levels

serum phosphate combines with Ca to decrease serum Ca levels

what are the signs and symptoms of hyperphosphatemia?

similar to those of hypocalcemia

muscle cramps, paresthesia, tingling around mouth, muscle spasms, tetany, decreased BP, and cardiac dysrhythmias

what do you do for a pt with hyperphosphatemia?

monitor their labs, VS, airway and resp status, neuromuscular status, and treating the cause

list the causes of hypophosphatemia

total body deficit: GI absorption, increased renal excretion

shift to intracellular space

iatrogenic (related to treatment): IV glucose, antacids, steroids, diuretics

alcoholism

most symptoms caused by depletion of ATP and O2 delivery to cells

list manifestations of hypophophatemia

every organ can be affected

intention tremor, paresthesia

bone pain, joint stiffness

confusion, stupor, stiffness

bleeding disorders, impaired WBC function, decreased O2 delivery due to RBC destruction

decrease O2 to heart muscle

what is treatment for hypophosphatemia?

treat underlying cause

phosphate supplements

avoid phosphate binding antacids

describe magnesium

1\.8-2.5

function: intracellular processes, enzyme reaction, synthesis of proteins, exerts sedative process at neuromuscular junction, decrease acetylcholine release, essential for neuromuscular and cardiac function

describe hypermagnesium

cause: renal failure or OTC laxatives

results in: depresses CNS, compromised cardiac function (cardiac arrest)

manifestations: confusion, lethargy, weak or absent deep tendon reflexes, resp depression, hypotension, dysrhythmia, heart block, Brady, cardiac arrest

treatment: calcium gluconate to reverse effects, withhold magnesium, resp support, pacer for heart block

what causes hypo magnesium?

deficit mag intake

excessive losses

shift between cellular fluids

anti-rejection drug

excessive urination

occurs with low serum K and Ca

list the manifestations of hypo magnesium

cardiac dysrhythmias (tornadoes de pointes), mental chances, seizures, hyperactive reflexes, positive babinski, cyvostek, trousseau, nystagmus, HTN, tachy