fluid + electrolytes

what are normal sodium levels

135-145 mEq/L

hyponatremia

more water than sodium, TOO DILUTE

cause? more water consumption than salt, excessive release of ADH, loss of salt through sweating, thiazide diuretics

pathogenesis? lack of sodium in ECF causes a shift of water into cells causing cell swelling and rupture

s&s? think of CNS dysfunctions… anorexia, n/v, confusion, lethargy, seizures, coma`

hypernatremia

more sodium than water, TOO CONCENTRATED

cause? gain salt or loose water = too much concentration 

s&s: think of dehydration… oliguria, thirst, confusion to coma

plasma potassium

3.5-5

hyperkalemia

excess potassium in ECF (above 5)

cause? think of what could increase potassium, shift it, and reduce excretion… blood transfusions, cell death, crush injury, chemo, kidney disease (RAAS), oliguria

pathogenesis: muscle dysfunction from hypo polarization causing too much “excitement”, cannot reset and ultimately cannot fire anymore

s&s: think muscle… diarrhea, intestinal cramping → weakness → paralysis

think cardiac… dysrhythmias → cardiac arrest

hypokalemia

low serum potassium (below 3.5)

cause? potassium wasting diuretics, corticosteroids, increased aldersterone (HF and cirrhosis), black licorice

pathogenesis: hyper polarized muscles = less activity

s&s: think low and slow to react… diminished bowel sounds, paralytic ileum → abdominal distention, WEAKNESS, dysrhythmias

calcium

9-10.5 mg/dL

hypocalcemia

decreased unbound ionized calcium from bounding to ions or plasma proteins

cause? impaired fat digestion (pancreatitis) → calcium binds to fat and excreted w feces, CKD, hypoparathyroidism

s&s: think of exaggerated neuron excitement… twitching, cramping, hyper reflexes, spasms, paresthesia, positive Chvostek and Trousseau

hypercalcemia

elevated calcium in ECF

cause? calcium shifting out of bone from PTH → hyperparathyroidism, prostaglandins

s&s: think of decreased and slow excitement… constipation, n/v, weakness, slow reflex, lethargy, dysrhythmias, personality change, confusion

magneisum

1.5-2.5 mEq/L

hypomagnesia

low magnesium in ECF

can cause hypokalemia and hypocalcemia

cause: alcoholism (excessive use and excretion of mg),

s&s: think of not calm, excited nerves… hyper reflex, insomnia, cramps, twitching

hypermagnesia

too much mg in ECF

cause: hyperparathyroidism, oliguria, CKD, too much intake

s&s: think of overly calm nerves… lethargy, depressed reflex, bradycardia, bradypnea

hypermagnesia

too much mg in ECF

cause: hyperparathyroidism, oliguria, CKD, too much intake

s&s: think of overly calm nerves… lethargy, depressed reflex, bradycardia, bradypnea

phosphate

3.0-4.5

hypophosphatemia

low phosphate levels

may be asymptomatic, late clinical signs are fatal

cause: rapid increase of cellular metabolism (cancer, malnourished, anorexia, advanced diseases)

s&s: think of decreased ATP… malaise, hemolysis, decreased muscle strength and reflex, confusion, stupor, repiratory failure, impaired cardiac function

hyperphosphatemia

too much phosphate

cause: oliguria, CKD

s&s: think of hypercalcemia… aching, stiffening, itching