1111 Electrolyte Imbalances Overview

Electrolytes

• Essential minerals in the body that conduct electrical charges and are vital for life.

• Common electrolytes include:

• Potassium (K+)

• Sodium (Na+) -

• Calcium (Ca2+)

• Magnesium (Mg2+)

• Chloride (Cl-)

• Phosphorus

Lab Values

Basic Metabolic Panel (BMP) & Comprehensive Metabolic Panel (CMP)

• BMP includes tests for:

• Blood urea nitrogen (BUN): kidney function

• Creatinine (CR): kidney function

• Glucose: blood sugar level

• Electrolytes: sodium, potassium, calcium, chloride

• CMP includes additional tests for liver function:

• Alkaline phosphatase (ALP)

• Alanine transaminase (ALT)

• Aspartate aminotransferase (AST)

• Bilirubin (total)

• Total protein, Albumin

Electrolyte Values

• Expected Ranges:

• Potassium (K+): 3.5 to 5 mEq/L

• Sodium (Na+): 136 to 145 mEq/L

• Calcium (Ca2+): 9 to 10.5 mg/dL

• Magnesium (Mg2+): 1.3 to 2.1 mEq/L

Sodium Imbalances

• Sodium's Reference Range: 136 to 145 mEq/L critical 120 or below

• Hyponatremia:
  - Sodium level below 136 mEq/L.
  - Symptoms: coma, anorexia, lethargy, muscle weakness, seizures, stomach cramping.
  - Nursing considerations include monitoring I&O, vital signs, encouraging sodium-rich foods, and careful management of fluids. * change positions slowly

• Hypernatremia:
  - Sodium level above 145 mEq/L. critical above 160
  - Symptoms: fever, restlessness, edema, dry mouth, altered LOC.

  - Causes- MODEL

  • Medications, meals

  • Osmotic diuretics

  • Diabetes insipidus

  • excessive h2o loss

  • low h2o intake

  • Nursing considerations include monitoring LOC, encouraging oral fluids, and administering hypotonic solutions if necessary.

Potassium Imbalances

• Potassium's Reference Range: 3.5 to 5 mEq/L

• Hypokalemia:
  - Potassium level below 3.5 mEq/L (critically low if less 3 in adults and less than 2.5 for newborn)

• Symptoms include shallow respirations, irritability, weakness, bradycardia, and ileus.

• Nursing considerations: monitor cardiac status, replace potassium, and educate on dietary sources.

• Hyperkalemia:
  - Potassium level exceeding 5 mEq/L (critical above 7).

• Symptoms: ECG changes (peaked T waves), potential for dysrhythmias. Decreased DTR , cramping, Diarrhea

• Nursing considerations: continuous ECG monitoring, administer sodium polystyrene sulfonate, increase fluid intake.

Calcium Imbalances

• Calcium’s Reference Range: 9 to 10.5 mg/dL (ionized calcium 4.5 to 5.6).

• Hypocalcemia:
  - Serum calcium below 9 mg/dL. ionized levels less than 4.5, Critically low less than 6 or less than 2.2

• Symptoms: Chvostek's ( tapping of facial muscle for twitching)and Trousseau's (BP with spasms of hand, inward/ flexion) signs, seizures, muscle spasms. convulsions , low vitamin D. * Crohn's disease , Osteopenia/Osteoporosis

• Nursing considerations: administer calcium supplements, monitor for seizures, encourage dietary calcium.

• Siezure DO’s

  • Ensure safety by removing harmful objects from the environment

  • Place the patient in a side-lying position to prevent aspiration

  • Do not restrain the patient or put anything in their mouth

  • Monitor the duration of the seizure and patient response

  • Administer prescribed anticonvulsants as needed

  • Document the seizure details and notify the healthcare provide

    • Seizure Donts

      • Avoid placing anything in the patient's mouth during the seizure.

      • Do not restrain the patient physically.

      • Avoid moving the patient unless they are in a dangerous position.

      • Do not administer oral medications during the seizure.

• Hypercalcemia:
  - Serum calcium greater than 10.5 mg/dL. Ionized greater than 5.6. Critical levels greater than 13 or 7

• Symptoms: renal calculi, fatigue, muscle weakness.

• Bones, stones, groans, psychiatric overtones

  • fracture ricks, kidney stones, cramping, nausea, ileus, constipation, lethargy, depressed mood, Psychosis, cognitive dysfunction

• Nursing considerations: encourage hydration, monitor for fractures, administer IV saline and diuretics if needed.

Magnesium Imbalances

• Magnesium’s Reference Range: 1.3 to 2.1 mEq/L

• Hypomagnesemia:
  - Level below 1.3 mEq/L (critical < 0.5).

• Symptoms: hyperreflexia, seizures, irritability, tachycardia. DTR, HR tachycardia, BP Hypertension, shallow respirations

• Nursing considerations: monitor for Chvostek's and Trousseau's signs, administer magnesium supplements IV for severe cases. oral for mild ( can cause diarrhea) IV for severe

• Hypermagnesemia:
  - Level above1.3- 2.1 mEq/L. high levels 10 or greater

• Symptoms: decreased DTR(deep tendon reflexes), bradycardia, hypotension, respiratory depression. Bowel sounds

• Nursing considerations: monitor vital signs, administer calcium gluconate and loop diuretics.

High-Alert Medications

• IV Potassium: High-alert medication with strict guidelines for administration. Always dilute and never administer directly from the vial; monitor ECG continuously.

• IV Magnesium: Also a high-alert medication; requires dilution and monitoring for potential respiratory depression and changes in LOC.(Level of consciousness)