Electrolyte imbalances

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dxc358
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Electrolyte imbalances
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2015-09-18 21:47:10
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Electrolyte imbalances
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Electrolyte imbalances
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  1. Hyponatremia: serum sodium < 135 mEq/L
    Causes?
    • Adrenal insufficiency
    • water toxicity
    • losses by vomiting, diarrhea, sweating and diuretics
    • Renal disease
    • administration of D5W and water supplements.
    • SIADH from head trauma and cell lung tumor.
    • meds with water retention (oxytocin and certain tranquilizers).
    • polydipsia.
    • hyperglycemia and heart failure cause a loss of sodium.
  2. Manifestations of Hyponatremia:
    • Poor skin turgor
    • dry mucosa,
    • headache,
    • nausea/vomiting,
    • decreased salivation,
    • decreased BP,
    • increase pulse
    • abdominal cramping
    • neurological changes
    • Anorexia,
    • lethargy
    • dizziness,
    • confusion
    • muscle cramps and weakness.
    • muscular twitching.
    • seizures
    • dry skin
    • weight gain,
    • edema
  3. Medical Management of Hyponatremia:
    Water restriction, Sodium replacement
  4. Hypernatremia:serum sodium > 145 mEq/L
    cause?
    • Excess water loss,
    • excess sodium administration,
    • diabetes insipidus,
    • heat stroke,
    • water deprivation unable to drink.
    • hypertonic tube feeding without adequate water supplement.
    • hyperventilation,
    • watery diarrhea.
    • burns
    • diaphoresis
    • excess corticosteroid,
    • sodium bicarbonate and sodium chloride administration
  5. Manifestations of Hypernatremia:
    • Thirst;
    • elevated temperature;
    • dry, swollen tongue;
    • sticky mucosa;
    • neurologic symptoms;
    • restlessness;
    • weakness
    • Hallucination.
    • lethargy,
    • Irritability.
    • pulmonary edema.
    • hyperreflexia,
    • twitching.
    • N/V,
    • anorexia.
    • Increase pulse.
    • Increase BP.
  6. Manifestations of Hypernatremia: special note
    thirst may be impaired in elderly or the ill
  7. Medical Management of Hypernatremia:
    Hypotonic electrolyte solution or D5W
  8. Hypokalemia: serum potassium < 3.5 mEq/L:
    cause:?
    • GI loses,
    • medications,
    • alterations of acid-base balance, hyperaldosterism,
    • poor dietary intake
    • Diarrhea, vomiting.
    • Gastric suction.
    • corticosteroid administration.
    • Hyperaldosteronism.
    • carbenicillin, amphotericin B, Bulimia.
    • osmotic diuresis.
    • alkalosis starvation
    • diuretic and digoxin toxicity
  9. Manifestations of Hypokalemia:
    • Fatigue,
    • anorexia,
    • nausea,
    • vomiting,
    • dysrhythmias,
    • muscles weakness and cramps,
    • paresthesias,
    • glucose intolerance,
    • decreased muscle strength,
    • decreased DTRs
    • polyuria.
    • decrease bowel motility.
    • Ventricular asystole or fibrillation.
    • leg cramps.
    • decrease BP.
    • ileus, abdominal distention.
    • Hypoactive reflexes.
  10. Medical Management of Hypokalemia:
    Increased dietary potassium, potassium replacement, Intravenous for severe deficit
  11. Hyperkalemia:serum potassium > 5.0 mEq/L
    cause?
    • Usually treatment related;
    • impaired renal function;
    • hypoaldosteronism;
    • tissue trauma;
    • acidosis
    • Pseudohyperkalemia.
    • Oliguric renal failure.
    • potassium-conserving diuretics for pt. with renal insufficiency.
    • metabolic acidosis.
    • Addison's disease, Crush disease,
    • Burns
    • rapid IV administration of potassium
    • ACE inhibitors,
    • NSAIDs, cyclosporine
  12. Manifestations of Hyperkalemia:
    • Cardiac changes and dysrhythmias,
    • muscle weakness with potenial respiratory impairment,
    • parethesis,
    • anxiety,
    • GI manifestations
    • Tachycardia>bradycardia.
    • Flaccid paralysis,
    • Intestinal colic, cramps, abdominal distention.
    • irritability,
    • anxiety.
    • EKG changes.
  13. Medical Management of Hyperkalemia
    • Monitor ECG,
    • limitation of dietary potassium,
    • cation-exchange resin (Kayexalate),
    • Intravenous sodium bicarbonate,
    • calcium gluconate,
    • regular insulin and hypertonic dextrose Intravenous ,
    • beta-2 agonists,
    • dialysis
  14. Nursing management: note Hyperkalemia
    • Hemolysis of blood specimen or drawing of blood above IV site may result in false laboratory result
    • Salt substitutes,
    • medications may contain potassiumPotassium-sparing diuretics may cause elevation of potassium
  15. Hypocalcemia:Serum calcium < 8.5 mg/d
    cause?
    • Serum level less than 8.6 mg/dL, must be considered in conjunction with serum albumin level
    • Hypoparathyroidism,
    • malabsorption,
    • pancreatitis,
    • alkalosis,
    • massive transfusion of citrated blood,
    • renal failure,
    • medications, 
    • Vitamin D deficiency
    • massive subcutaneous infection,
    • generalized peritonitis
    • chronic diarrhea,
    • Increase PO4,
    • fistula
    • burns
    • alcoholism
  16. Manifestations of Hypocalcemia:
    • Tetany,
    • circumoral numbness,
    • paresthesias,
    • hyperactive DTRs,
    • Trousseau's sign, Chovstek's sign,
    • seizures,
    • respiratory symptoms of dyspnea and laryngospasm,
    • abnormal clotting,
    • anxiety
    • Numbness, tingling of fingers, toes Carpopedal spasms,
    • irritability,
    • anxiety
    • Bronchospasm
    • decrease prothrombin
    • diarrhea,
    • Decrease BP,
    • EKG changes
  17. Medical Management of Hypocalcemia:
    Intravenous of calcium gluconate, calcium and vitamin D supplements; diet
  18. Hypercalcemia: serum calcium: > 10.5 mg/dl
    cause?
    • Malignancy and hyperparathyroidism,
    • prolonged immobilization,
    • overuse of calcium supplements,
    • vitamin D excess,acidosis,
    • corticoid steroid therapy,
    • thiazide diuretic use,
    • increase parathyroid hormone,
    • digoxin toxicity
  19. Manifestations of Hypercalcemia:
    • Muscle weakness,
    • incoordination,
    • anorexia,
    • constipation,
    • nausea and vomiting,
    • abdominal and bone pain,
    • polyuria,
    • thirst,
    • ECG changes,
    • dysrhythmias
    • polydipsia,
    • dehydration,
    • Hypoactive deep tendon reflexes,
    • lethargy
    • pathologic fractures,
    • flank pain,
    • calcium stones,
    • hypertension,
    • EKG changes
  20. Medical Management of Hypercalcemia:
    Treat underlying cause, fluids, furosemide, phosphates, calcitonin, biphosphonates
  21. Nursing Management of Hypercalcemia:
    • Assessment, this crisis has high mortality, encourage ambulation,
    • fluids of 3 to 4 L/d, provide fluids containing sodium unless contraindicated,
    • fiber for constipation, ensure safety
  22. Hypomagnesemia:serum magnesium < 1.8 mg/dl  
    cause?
    • Alcoholism;
    • GI losses;
    • enteral or parenteral feeding deficient in this;
    • medications;
    • rapid administration of citrated blood;
    • contributing causes include diabetic ketoacidosis;
    • sepsis;
    • burns;
    • hypothermia
    • hyperparathyroidism, hyperaldosteronism,
    • malabsortive disorders,
    • refeeding after starvation,
    • parenteral nutrition,
    • chronic laxative use,
    • diarrhea,
    • acute myocardial infarction,
    • heart failure,
    • decreased serum K+ (potassium) and calcium
  23. Manifestations of Hypomagnesemia:
    • Neuromuscular irritability,
    • muscle weakness,
    • tremors,
    • athetoid movements,
    • ECG changes and dysrhythmias,
    • alterations in mood and level of consciousness
    • positive Trousseau's sign and Chvostek's sign,
    • insomnia,
    • mood changes,
    • anorexia,vomiting,
    • increase tendon reflexes
    • Increase BP.
    • EkG changes
  24. Medical Management of Hypomagnesemia:
    Diet, oral magnesium, magnesium sulfate Intravenous.
  25. Nursing Management of Hypomagnesemia:
    • Hypomagnesemia often accompanied by hypocalcemia
    • Need to monitor, treat potential hypocalcemia
    • Dysphasia common in magnesium-depleted patients
    • Assess ability to swallow with water before administering food or medications
  26. Hypermagnesmia:serum magnesium >2.7 mg/dl
    cause?
    • Renal failure,
    • diabetic ketoacidosis,
    • excessive administration of magnesium
    • Oliguric phase of renal failure,
    • adrenal insufficiency,
    • Hypothyroidism
  27. Manifestations of Hypermagnesemia:
    • Flushing,
    • lowered blood pressure,
    • nausea, vomiting,
    • hypoactive reflexes,
    • drowsiness,
    • muscle weakness,
    • depressed respirations,
    • ECG changes,
    • arhythmias
  28. Medical Management of Hypermagnesemia:
    Intravenous calcium gluconate, loop diuretics, Intravenous NS of RL, hemodialysis
  29. Hypophosphatemia: serum phosphorus <2.5 mg/dl
    cause?
    • Alcoholism,
    • refeeding of patients after starvation,
    • pain,
    • heatstroke,
    • respiratory alkalosis,
    • hyperventilation,
    • diabetic ketoacidosis,
    • hepatic encephalopathy,
    • major burns,
    • hyperparathyroidism,
    • low magnesium,
    • low potassium,
    • diarrhea,
    • vitamin D deficiency,
    • use of diuretic and antacids
  30. Manifestations of Hypophosphatemia
    • Neurologic symptoms,
    • confusion,
    • muscle weakness,
    • tissue hypoxia,
    • muscle and bone pain,
    • increased susceptibility to infection.
    • Paresthesias,
    • chest pain,
    • confusion,
    • cardiomyopathy,
    • respiratory failure,
    • seizures,
    • nystagmus
  31. Medical Management of Hypophosphatemia:
    Oral or Intravenous phosphorus replacement
  32. Hyperphosphatemia: serum phosphorus >4.5 mg/dl
    cause?
    • Renal failure,
    • excess phosphorus,
    • excess vitamin D,
    • acidosis,
    • hypoparathyroidism,
    • chemotherapy 
    • respiratory and metabolic acidosis
    • volume depletion,
    • leukemia/lymphoma treated with cytotoxic agents,
    • increase tissue breakdown,
    • rhabdomyolysis
  33. Manifestations of Hyperphosphatemia:
    • Tetany,
    • tachycardia,
    • anorexia,
    • N/V.
    • muscle weakness,
    • s/s of hyocalcemia;
    • hyperactive reflexes,
    • soft tissue calcifications in the lungs,
    • heart, kidneys and cornea
  34. Medical Management of Hyperphosphatemia:
    • Treat underlying disorder,
    • vitamin-D preparations,
    • calcium-binding antacids,
    • phosphate-binding gels or antacids,
    • loop diuretics,
    • NS Intravenous,
    • dialysis
  35. Nursing Management of Hyperphosphatemia:
    Avoid high-phosphorus foods; patient teaching related to diet, phosphate-containing substances, signs of hypocalcemia.
  36. Hypochloremia:serum chloride < 96mEq/L
    cause?
    • Addison's disease,
    • reduced chloride intake,
    • GI loss,
    • diabetic ketoacidosis,
    • excessive sweating,
    • fever,
    • burns,
    • medications,
    • chronic respiratory acidosis,
    • gastric suction,
    • diarrhea,
    • sodium and potassium deficiency,
    • metabolic alkalosis,
    • loop, osmotic, or thiazide diuretic use,
    • overuse of bicarbonate,
    • rapid removal of sodium content,
    • IV fluid that lack chloride (dextrose and water) ,
    • draining fistula and ileostomies,
    • heart failure,
    • cystic fibrosis

    Loss of chloride occurs with loss of other electrolytes, potassium, sodium
  37. Manifestations of Hypochloremia:
    • Agitation,
    • irritability,
    • weakness,
    • hyperexcitability of muscles,
    • arhythmias,
    • seizures,
    • coma
    • tremors,
    • muscle cramps,
    • hypertonicity,
    • tetany,
    • slow shallow respiration
  38. Medical Management of Hypochloremia:
    Replace chloride-Intravenous NS or 0.45% NS
  39. Nursing Management of Hypochloremia:
    Avoid free water, encourage high-chloride foods, patient teaching related to high-chloride foods
  40. Hyperchloremia:serum chloride > 108 mEq/L
    cause?
    • Excess sodium chloride infusions with water loss,
    • head injury,
    • hypernatremia,
    • dehydration,
    • severe diarrhea,
    • respiratory alkalosis,
    • metabolic acidosis,
    • hyperparathyroidism,
    • medications
    •  renal failure,
    • corticosteroid use, dehydration,
    • severe diarrhea (loss of bicarb)
    • overuse of salicylates, Kayexalate, acetazolamide, phenylbutazone and ammonium chloride use,
    • hyperparathyroidism,
  41. Manifestations of Hyperchloremia:
    • Tachypnea,
    • lethargy,
    • weakness,
    • rapid,
    • deep respirations,
    • hypertension,
    • decline in cognitive status,
    • decrease cardiac output,
    • dyspnea,
    • tachycardia,
    • pitting edema,
    • dysrhythmia,
    • coma

    Normal serum anion gap
  42. Medical Management of Hyperchloremia:
    Restore electrolyte and fluid balance, LR, sodium bicarbonate, diuretics

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