Chapter 10: Fluid and Electrolytes (Part 5)

Hypomagnesemia: Serum level less than

1.8 mg/dL

Hypomagnesemia: Associated with

hypokalemia and hypocalcemia

Hypomagnesemia: Pathophysiology

alcoholism, GI losses, enteral or parenteral feeding deficient in magnesium, medications, rapid administration of citrated blood

Hypomagnesemia: Clinical manifestations

Chvostek and Trousseau signs, apathy, depressed mood, psychosis, neuromuscular irritability, ataxia, insomnia, confusion, muscle weakness, tremors, ECG changes and dysrhythmias

Hypomagnesemia: Important

Ionized serum magnesium level

Hypomagnesemia: What is administered

Magnesium sulfate IV is administered with an infusion pump; monitor vital signs and urine output

Hypomagnesemia: What can be used

Calcium gluconate or hypocalcemic tetany or hypermagnesemia

Hypomagnesemia: Oral

magnesium

Hypomagnesemia: Monitor for

dysphagia

Hypomagnesemia: Precautions

Seizure

Hypomagnesemia: Dietary teaching

green, leafy vegetables; beans, lentils, almonds, peanut butter

Hypermagnesemia: Serum level greater than

2.6 mg/dL

Hypermagnesemia: Rare electrolyte abnormality, because the

kidneys efficiently excrete magnesium

Hypermagnesemia: Falsely elevated levels with

a hemolyzed blood sample

Hypermagnesemia: Pathophysiology

kidney injury, diabetic ketoacidosis, excessive administration of magnesium, extensive soft tissue injury

Hypermagnesemia: Clinical manifestations

hypoactive reflexes, drowsiness, muscle weakness, depressed respirations, ECG changes, dysrhythmias, and cardiac arrest

Hypermagnesemia: IV

calcium gluconate

Hypermagnesemia: Ventilatory support for

respiratory depression

Hypermagnesemia: Important Nursing management

Hemodialysis

Hypermagnesemia: Administration of loop

diuretics, sodium chloride, and LR

Hypermagnesemia: Avoid medications containing

magnesium

Hypermagnesemia: Patient teaching regarding

magnesium-containing over-the-counter medications

Hypermagnesemia: Observe for

DTRs and changes in LOC

Hypophosphatemia: Serum level below

2.7 mg/dL

Hypophosphatemia: can occur when

total‐body phosphorus stores area normal

Hypophosphatemia: pathophysiology

alcoholism, refeeding of patients after starvation, pain, heat  stroke, respiratory alkalosis, hyperventilation, diabetic ketoacidosis, hepatic encephalopathy, major burns, hyperparathyroidism, low magnesium, low potassium, diarrhea, vitamin D deficiency, use of diuretic and antacids

Hypophosphatemia: Clinical manifestations

neurologic symptoms, confusion, muscle weakness, tissue hypoxia, muscle and bone pain, increased susceptibility to infection

Hypophosphatemia: time sensitive

24-hour urine collection

Hypophosphatemia: Elevated

PTH levels

Hypophosphatemia: Goal

Prevention

Hypophosphatemia: Oral or IV phosphorus replacement only for patients with

serum phosphorus levels less than 1 mg/dL not to exceed 3 mmol/hr (Burosumab, correct underlying cause)

Hypophosphatemia: Monitor IV site for

extravasation

Hypophosphatemia: Monitor levels of

phosphorus, vitamin D and calcium

Hypophosphatemia: Encourage foods high in

phosphorus, gradually introduce calories for malnourished patients receiving parenteral nutrition

phosphorus foods

milk, organ meats, beans nuts, fish, poultry

Hyperphosphatemia: Serum levels above

4.5 mg/dL

Hyperphosphatemia: can occur with

increased intake, decreased excretion, or shifting of phosphate from intracellular to extracellular spaces

Hyperphosphatemia: Pathophysiology

kidney injury, excess phosphorus, excess vitamin D, acidosis, hypoparathyroidism, chemotherapy

Hyperphosphatemia: Clinical manifestations

few symptoms; soft tissue calcifications, symptoms occur due to associated hypocalcemia

Hyperphosphatemia: signs and symptoms

X-rays, Decreased PTH levels, BUN, Creatinine

Hyperphosphatemia: what do the x-rays show

abnormal bone development

Hyperphosphatemia: Treat

underlying disorder

Hyperphosphatemia: Vitamin D preparations

calcium-binding antacids, phosphate-binding gels or antacids, loop diuretics, IV fluids (Normal Saline), dialysis

Hyperphosphatemia: Monitor

phosphorus and calcium levels

Hyperphosphatemia: Avoid

high-phosphorus foods

Hyperphosphatemia: Patient teaching related to

diet, phosphate-containing substances, signs of hypocalcemia