Electrolytes

HYPOnatremia [NEURO, fluid]
VIP Cation in EXTRAcellular fluid
Important for muscle contraction (including
cardiac) and nerve impulses. Water follows Na
Kidneys regulate sodium levels by adjusting
water in the body
Below 135
Signs and symptoms: Cellular edema [confusion, coma, seizures]

• Kidneys excrete lower specific gravity urine

(get rid water)

*Remember that the fluid level is going to

determine symptoms!

Hypervolemic (dilution)- bounding pulses, high

Hypovolemic- tachycardia, rapid pulse,

hypotension, poor peripheral pulses

Specific gravity- you expect it to be LOW or

liquidy urine
Causes: Actual Na Loss= Sweating, diuretics, kidney

disease, high blood sugar, not enough intake

Dilution issue= too much hypotonic fluid, kidney

failure, SIADH

Treatment: Increase Na intake

• Fluid restriction

• Raise Na level slowly
Nursing things: Seizure precautions
• Don’t raise Na level too quickly!
• Check BMP
• Daily weight
• Neuro check

HYPERnatremia [NEURO, fluid]
VIP Cation in EXTRAcellular fluid

Important for muscle contraction (including

cardiac) and nerve impulses. HIGH salt

causes water to leave the cells and come

out into the vascular space (osmosis)

Above 145
Signs and symptoms: • THIRSTY!!

• Hyperthermia (HOT)

• Tachycardia

• BP changes

• Decreased DTR

• Seizures/coma

• Dry

High specific gravity (thick/heavy urine)

Causes: Actual Na excess= kidney failure, Cushing’s

syndrome, excessive Na intake

Decreased fluid volume= dehydrated/less

intake, Diabetes insipidus, Burns, excess

sweating

Treatment: Actual Na excess- Drink more water, take in

less Na

Decreased fluid volume- Dextrose

containing hypotonic fluid or dextrose

containing isotonic fluid

Nursing things: Low sodium diet

• Daily weight

• Neuro check

HYPERkalemia [CARDIAC]

Major cation in INTRAcellular fluid

Important for nerve impulse, cardiac,

lung and muscle tissue. Also helps

regulate acid base balance

Reciprocal with Na

*Risk for cardiac arrest

Above 5.0

Signs and symptoms: Irregular HR

• Hypotension

• Peaked T waves

• Wider QRS

• PVCs

• Diarrhea

• Abd. Pain

• Oliguria

• Weakness

Causes: Decreased renin/aldosterone

Use of Salt substitute (high in K)

RBC transfusions

Kidney failure

Potassium sparing diuretics

ACE inhibitors

Decreased insulin production

Acidosis

Tissue damage (trauma, burns)

Treatment: IV fluids with dextrose and IV

insulin

• Sodium bicarb

• Avoid high K foods

• Loop diuretics

• Albuterol

Nursing things: ABG/treat acidosis

• Tele/EKG

• Check kidney function

HYPOkalemia {CARDIAC}

Major cation in INTRAcellular fluid

Important for nerve impulse,

cardiac, lung and muscle tissue.

Also helps regulate acid base

balance

Reciprocal with Na

Below 3.5

Signs and symptoms: Decreased BP

• Weak pulses

• Lethargy

• Depressed or flat T wave

• Hypoactive bowel sounds

• Constipation

• Vomiting

• Decreased DTR possible

Causes: Overuse of diuretics

Digoxin use

Cushing’s

Diarrhea/vomiting, prolonged NG

suctioning

Excess laxative use

Kidney disease

Alkalosis

Treatment: Replace PO potassium or IV

potassium (never IM or IV

push) 10meq/hr IV

• Increase K containing foods

(bananas, potatoes, avocados,

broccoli)
Nursing things: Tele/EKG

• Check kidney function, I/O

• Fall precautions due to

weakness

• Tissue irritant, central line is

ideal but can be run through

peripheral

Hypocalcemia [Tetany, paresthesia]
Ca is a membrane stabilizer (decreases sodium

movement across excitable membranes to slow

rate of depolarization)

Less than 9.0

Signs and symptoms: Paresthesia (fingers and mouth especially)

• Muscle twitching

• Seizure

• Painful muscle spasms

• Chvostek + Trousseau

• Prolonged QT interval

• Diarrhea, abd. Cramping

• Weak bones (fractures)

Causes: Poor calcium intake

• Poor Vitamin D intake

• Kidney disease

• Thyroid removal/damage

• Low albumin

• Immobility (no weight bearing activity)

Treatments: Oral supplements (With VIT. D to

enhance absorption)

• Seizure precautions

• Calcium gluconate or calcium chloride

Nursing things: Reduce stimulation (quiet, dark)

• Cardiac monitoring

Hypercalcemia [Slow, weak, pain

(stones/bones)
High calcium cases excitable tissues to be less

sensitive (so it takes more stimulus to

function).

Above 10.5-11

Signs and symptoms: Increased HR and BP (at first)

• Decreased DTR

• Confusion

• Constipation/decreased peristalsis

• Short QT interval (because more Ca= more

cardiac contraction)

• Kidney stones

• Bone pain

Causes: Excessive oral intake

• Kidney disease

• Thiazide diuretics

• Hyperparathyroidism

• Dehydration

Treatments: Regular isotonic fluid

• Replace thiazide diuretics with loops

• Increase phosphorus levels

Nurse things: Assess for poor perfusion

• Assess for blood clots (higher risk

with hypercalcemia)

• Cardiac monitoring is needed.

Hypermagnesemia [Weak muscles]
Everything is going to be

SLOW/depressed

*Risk for cardiac arrest at very high

levels

Levels above 2.1

Signs and symptoms: Bradycardia

• Vasodilation (low BP)

• Prolonged QT interval

• Decreased or Absent DTRs

• Weak respiratory muscles

Causes: too much Mag administered

• Kidney disease

Treatment: Calcium gluconate

• IV fluid

• Loop diuretics

Nurse things: If on a mag drip- assess

DTR and respirations!

• Get rid of mag containing

meds or foods

• Tele/EKG/BP monitoring

• Respiratory assessment

Hypomagnesemia [Excited muscles]
Increased membrane excitability

(accompanied with calcium and K

imbalances)

Everything will be excited and

elevated

Less than 1.3

Follows K levels typically

Signs and symptoms: Dysrhythmias, torsades de

pointes, TACHYcardia

• Hyperactive DTRs (increased

nerve transmission)

• Muscle tetany

• Constipation, hypoactive

bowels

• Painful muscle contractions

• Seizures

Causes: Ethanol ingestion

• Malnutrition

• Diarrhea

• Prolonged GI suction

• MI or heart failure

Treatments: Supplement mag (IV or

PO)

• D/c loop diuretics

• Correct other electrolyte

imbalances

Nurse things: High risk for cardiac

dysrhythmias