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Sodium
ECF; major cation of the ECF, and maintains ECF osmolarity
- Na imbalances most often occur with fluid volume imbalances
- "where Na goes, waer follows"
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Hyponatreimia
- Low sodium <136mEq/L
- Mechanism: decreased excitable depolarization/cellular swelling
Assessment: confusion, general muscle weakness, increase motility in intestines=nausea, diarrhea abd cramping
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Hypernatremia
High sodium <145mEq/L
- Mechanism: excitable tissues increase excitability
- Assessments: agitated, confused seizures, irregular muscle contractions and twisching, decreased contracility of heart
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Causes for hyponatremia
- Fluid volume excess
- Use/overuse of diuretics
- Loss of Na
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Causes for hypernatremia
- Fluid volume deficit
- Excess diaphorsis
- Renal failure (fluid overload)
- Increased Na intake
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Potassium (K+)
- ICF
- Kidney responsible for removing most excess K
- sSudden changes in K are more devastating and less tolerated then slow changes
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Hypokalemia
- *life threatening
- low Potassium <35mEq/L
- Mechanism: decreased exitability of all tissues
- Assessments: Muscle weakness=shallow breathing; decreased intestine peristalsis; thready weak pulse; altered mental status; coma
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Hyperkalemia
- High Potassium >5.0mEq/L
- Mechanism: increased cell excitability (esp heart)
- Assessments: cardiovascular irregularities, muscle twitching progessing to muscle weakness, increased intesting motility
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Causes of hypokalmemia
- Loss of K-->diuretics
- Water intoxication
- K loss in urine increases with older adults
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Causes for hyperkalemia
- Renal failure
- Ksparing diuretics
- Uncontrolled diabetes mellittus
- Dehydration
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Calcium (Ca2+)
- ECF
- Functions closesly related to phosphorus and magnesium
- Ca absorption requres vit D
- sotred in bones
- Stabilizes excitable membranes (ex: decreased Na movement)
- Sudden changes in Ca are more devastating and less tolerated then slow changes.
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Hypocalcemia
- Low calcium <9.0mg/dL
- Mechanism: Increaed Na movement across membranes = too much excitement
- Assessment: painful muscle spasms; trousseau's and chvostek's signs, increased intestine peristalsis, loss in bone density
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Hypercalcemia
- High calcium >10.5mg/dL
- Mechanism: Decrease sensitivity of excitable membranes; increaced blood clotting
- Assessments: Increased heart rate and BP later progressing to depressed HR, increased clotting esp legs, muscle weakness, decreased intestine peristalisis, lethargy, coma
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Causes of hypocalcemia
- Decreased in parathyroid gland (does not relase Ca from bones)
- Ca poor diet
- Acute pancreatitis
- Renal failure
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Causes for hypercalcemia
- Excessive intake of Ca/Vit D
- Renal failure
- Malgnacies
- Hyperthyroidism
- Dehydration
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