electrolytes

Sodium and Potassium are key electrolytes that help maintain fluid balance in the body.

Plasma vs. Intracellular Distribution
- Cations: Important positively charged ions.
  - Sodium (Na+)
  - Potassium (K+)
  - Calcium (Ca2+)
  - Magnesium (Mg2+)
- Anions: Important negatively charged ions.
  - Chloride (Cl)
  - Bicarbonate (HCO3¯)
  - Phosphate (PO4³-)
  - Proteins

Sodium helps in moving water in and out of cells (inside vs outside).
It controls the balance of water in the body (how concentrated or diluted the fluids are).
It's important for sending messages in the nerves.
It helps muscles work properly.
It helps keep the body's acid and base (pH) levels balanced.
People get sodium mainly from their food, and the body gets rid of it through urine, sweat, and poop.
The kidneys help manage how much water is kept or removed from the body to keep the balance right.

Hyponatremia (<135 MEQ/L)
- GI loss (vomit, diarrhea)
- Diuretics, adrenal insufficiency
- Burns, draining wounds
- Inadequate diet (rare) – fasting
- Excessive hypotonic IV fluid
- Polydipsia (excessive water intake)
- Diseases causing fluid retention (Heart Failure, Cirrhosis)
Hypernatremia (>145 MEQ/L)
- Hypertonic IV fluid or excessive isotonic solutions
- Hypertonic tube feeding without enough water supplementation
- Near-drowning in salt water
- Insufficient water intake
- Loss of "pure" water (high fever, heatstroke)
- Endocrine disorders (Cushing’s syndrome, Hyperaldosteronism, Diabetes insipidus)

Hyponatremia (<135 MEQ/L)
- Confusion or short temper
- Fatigue
- Convulsions or seizures
- Weakness
Hypernatremia (>145 MEQ/L) - "FRIED SALT"
- F: Flushed skin and fever (low-grade)
- R: Restlessness, irritability, anxiety, confusion
- E: Edema (peripheral and pitting)
- D: Decreased urine output and dry mouth
- S: Skin flushed
- A: Agitation
- L: Low-grade fever
- T: Thirst

Hyponatremia (<135 MEQ/L)
- Fluid restriction
- Isotonic, sodium-containing IV solutions (0.9% Sodium Chloride)
- Encourage oral Na intake
- Severe cases: Hypertonic IV solution (3% Sodium Chloride)
Hypernatremia (>145 MEQ/L)
- Mild case: Isotonic IV solution (0.9% Sodium Chloride)
- Severe case: Hypotonic IV solution (D5 Water)
- Restrict Na in the diet
- Use of diuretics
- Important: Na must be corrected SLOWLY to prevent neurologic damage.

Main factor in resting potential of nerve and muscle cells.
Great impact on neuromuscular and cardiac function.
Important in acid/base balance.
Diet: Main source (50-100 meq/day).
Excretion primarily through urine; kidney function is crucial for proper K+ levels. - Potassium (K+) is very important for nerve and muscle cells when they are at rest. - It significantly affects how our muscles and heart work. - It helps keep the balance of acids and bases in our body. - We mainly get potassium from food, needing about 50-100 meq each day. - The kidneys remove extra potassium through urine, which is essential for maintaining proper potassium levels in our body.

Losing potassium through vomiting or diarrhea.
Losing potassium through sweating.
Losing potassium through urination (kidneys).
Not getting enough potassium from food, possibly from not eating enough (starvation or fasting).
Certain medications can cause low potassium, like diuretics (like Furosemide) and insulin.

Eating too much potassium in food.
Getting potassium too quickly through IV fluids.
Kidney problems that affect potassium levels.
Problems with adrenal glands that manage hormones.
Some medications can cause high potassium, like ACE inhibitors and potassium-sparing diuretics.
Having too little insulin can also contribute to high potassium levels.

Hyperkalemia (>5 MEQ/L)
- Excessive K+ intake
- Rapid IV fluid administration with K+
- Renal disease
- Adrenal insufficiency
- Medications: ACE inhibitors, potassium-sparing diuretics
- Insulin deficiency is also a contributing factor.

Hypokalemia (<3.5 MEQ/L)
- Fatigue, irritability
- Leg cramps/muscle weakness
- Confusion
- EKG changes (Flattened T Wave, prolonged QRS)
- Irregular pulse
- Decreased muscle tone/reflexes
- Shallow respirations
Hyperkalemia (>5 MEQ/L)
- Muscle cramps
- Urine abnormalities (likely oliguria)
- Respiratory distress
- Decreased cardiac contractility
- EKG changes (Tall/Peaked T Waves, wide QRS)

Continuous cardiac monitoring is needed for patients with severe hypo- or hyperkalemia.

Hypokalemia (<3.5 MEQ/L)
- Supplemental K+ if urine production is at least 0.5mL/kg/hour.
- K+ pills or liquid
- Higher K+ diet
- IV K+ infusion (10 meq/hour)
- Note: K+ is a vesicant; assess IV site carefully.
Hyperkalemia (>5 MEQ/L)
- Encourage K+ excretion via diuresis or bowel movement.
- Diuretics (Furosemide)
- Sodium Polystyrene (Kaexylate) for K+ removal.
- Patients with severe kidney failure may require dialysis.
- Low K+ diet.
- Insulin (IV push) to help draw K+ into cells, often with Beta Agonist for enhanced effectiveness.
- Administer D50 with insulin to prevent hypoglycemia.
- Calcium Gluconate does not decrease K+, but protects cardiac cells.
- Caution: NEVER administer K+ IV push or too quickly to prevent cardiac arrest.

Fruits/Vegetables: Apricots, bananas, oranges, prunes, cantaloupe, honeydew, dried fruits, avocados, chocolate, spinach, tomatoes, potatoes, cactus.
Ranking Order: 1. Potato 2. Broccoli 3. Banana 4. Tomato 5. Beans

Cation Exchange Resin that exchanges K+ ions for Na ions in the intestine.
Excretes K+ via the GI tract.
Patient will experience increased bowel movements.
Administration methods: orally, NG tube, or enema.
Key assessments: Output and K+ levels.
Side effects: Abdominal cramping, diarrhea, hypernatremia, loss of magnesium and calcium.

Scenario: Patient has a K+ level of 2.5 meq/L. Calculate the infusion rate for prescribed KCl.