F&E2

Fluid & Electrolytes Overview

  • Electrolytes to Focus On:

    • Chloride

    • Sodium

    • Potassium

    • Phosphorus

    • Magnesium

    • Calcium

Learning Objectives

  • Identify six electrolytes and presentation signs in hypo- and hyper- states.

  • List nursing diagnoses for unbalanced states of electrolytes.

  • Identify food sources rich in specific electrolytes.

  • Select appropriate treatments for unbalanced states (IV fluids, diet, medication).

Electrolytes Quick Review

  • Ions: Electrically charged particles.

    • Cations (positively charged): K, Na, Ca, Mg.

    • Anions (negatively charged): Bicarbonates, Chloride (Cl), Phosphates, Proteins.

  • Concentration expressed in milliequivalents (mEq/L).

  • Actions of Electrolytes: Opposite between cations and anions.

Most Common Electrolyte Losses

  • Sweat: chloride, potassium, sodium.

  • Urine: calcium, chloride, potassium, sodium.

  • Vomiting: chloride, potassium, sodium, bicarbonate.

  • Diarrhea: sodium, potassium, magnesium, chloride.

  • Main electrolytes in blood: Sodium, Potassium, Chloride, Bicarbonate. Calcium, Magnesium, Phosphorus present in lesser amounts.

Pathophysiology of Electrolyte Imbalances

  • Occurs from excess or deficiency of electrolytes, indicating kidney issues.

  • Electrolytes dissociate in urine/blood to give electrical charge.

  • Sourced from diet, fluids, IV supplements.

  • Essential for fluid balance, heart rhythm regulation, and muscle/nerve function.

Specific Electrolyte Functions

Sodium

  • Role: Fluid balance, nerve, and muscle function.

  • Maintains concentration gradients for cellular processes.

Potassium

  • Role: Critical for heart and muscle function.

    • Normal Levels: 3.5-5.0 mEq/L.

    • Functions: Transmission of nerve impulses, nutrient movement into cells.

  • Dietary Requirement: 3500-4700 mg/day , sources include: spinach, yams, avocados, bananas.

Calcium

  • Role: Bone health, blood clotting, nerve signaling.

  • Normal Levels: 9-10.5 mg/dL.

  • Importance: Stabilizes blood functions and supports metabolic processes.

Magnesium

  • Role: Muscle contractions, nerve function, essential for calcium utilization.

  • Normal Levels: 1.3-2.1 mEq/L.

Phosphorus

  • Role: Bone formation, energy transfer, helps maintain acid-base balance.

  • Normal Levels: 3.5-4.5 mEq/L.

Imbalances and Presentations

Hyperkalemia

  • Signs: Cardiac dysrhythmias, leg cramping, muscle weakness, abdominal cramping.

  • EKG changes include P wave flattening and QRS widening.

Hypokalemia

  • Causes: Vomiting, diarrhea, adrenal issues, diuretics.

Hypercalcemia

  • Signs: Renal calculi, constipation, decreased reflexes, severe weakness.

Hypocalcemia

  • Signs: Trousseau’s and Chvostek’s signs, risk for fractures, cardiac dysrhythmias.

Common Foods High in Electrolytes

  • Potassium: Bananas, oranges, spinach, sauces.

  • Calcium: Dairy products, leafy greens, beans.

  • Magnesium: Nuts, seeds, whole grains.

  • Chloride: Table salt, sea salt, tomatoes.

Treatment Strategies

Hyperkalemia

  • Interventions include stopping potassium intake, promoting potassium elimination, and giving calcium gluconate for cardiac protection.

  • High potassium sources should be avoided.

Hypokalemia

  • Treatment includes potassium supplements and dietary adjustments.

Hypercalcemia

  • Treated with hydration, diuretics, and medications to inhibit bone resorption.

Hypocalcemia

  • Dietary calcium supplements, IV calcium gluconate as necessary.

Hyperphosphatemia

  • Management might involve dietary restrictions, renal replacement therapy, calcium binders.

Hypophosphatemia

  • Treatment typically involves dietary phosphorous supplementation.

Electrolyte Relationships

  • Sodium and Potassium have an inverse relationship in renal function.

  • Calcium/Vitamin D levels increase concurrently.

  • Magnesium and Phosphate inversely relate: decreased magnesium results in increased phosphate.

Nursing Diagnoses

  • For all imbalances: Risk for electrolyte imbalance, risk for falls/injury, risk for acute confusion, cardiac dysrhythmias.

Conclusion

Understanding the roles, sources, and implications of electrolyte imbalances is critical for nursing care and patient management.