chaboy electrolytes

8/3/2019 Chaboy Electrolytes

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Electrolytes

Imbalances

Prepared By: Mr. Charlie C. Falguera, RN


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Sodium ImbalancesHyponatremia

- A plasma sodium level below 135 mEq/L.

Types:

1. Hypovolemic hyponatremia

- When sodium loss is greater than water loss.

2. Euvolemic hyponatremia

- When the total body water is moderately increased and the total body

sodium remains at a normal level.

3. Hypervolemic hyponatremia

- When a greater increase occurs in TBW than in total body sodium.

4. Redistributive hyponatremia

- No change occur in TBW or total body sodium; water merely shifts

between the intracellular & extracellular compartments relative to

the sodium concentration.


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Etiology:

1. Hypovolemia hyponatremia

- Renal loss of sodium from diuretic use, diabetic glycosuria,

aldosterone deficiency, intrinsic renal disease

- Extrarenal loss of sodium from vomiting, diarrhea, increased

sweating, burns, high-volume ileostomy.

2. Euvolemic hyponatremia

- Sodium deficit resulting from SIADH or the continuous

secretion of ADH due to pain, emotion, medications,

cancers, CNS disorders


- Edematous disorder resulting in sodium deficit, CHF, livercirrhosis, nephrotic syndrome, acute & chronic renal

failure

4. Redistributive hyponatremia

- Pseudohyponatremia, hyperglycemia, hyperlipidemia


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Pathophysiology:

1. Decreased excitability of the membranes.

2. ECF becomes hypo-osmolar.

Clinical Manifestations:

1. Headache 11. Tachypnea, dyspnea

2. Apprehension 12. Cheyne-stokes respi,3. Confusion neurogenic hyperventilation

4. Hallucinations apneustic breathing

5. Behavioral changes ataxic breathing

6. Seizures 13. Nausea & vomiting

7. Hypotension 14. Hyperactive bowel sounds

8. Weak thready pulse 15. Abdominal cramping

9. Tachycardia 16. Diarrhea

10. Crackles 17. Dryness of skin & mucous


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Diagnostic Findings;

1. Plasma sodium level below 135 mEq/L

2. Plasma chloride level below 98 mEq/L.

3. Plasma osmolality less than 275 mOsm/kg.

Management:

1. Treat the underlying cause.

2. Restrict fluid intake.3. Dietary supplementation.

4. IV infusionPNSS or LR solution, 3% NaCl

5. Meds: Diuretics, Demeclocycline

6. Safety precautions.

Complications:

1. Brain herniation, coma, death


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Hypernatremia

- A plasma sodium level above 145 mEq/L.

Types:

1. Hypovolemic hypernatremia

- When TBW is greatly decreased relative to sodium.

2. Euvolemic hypernatremia

- When the total body water is decreased relative to the normal total

body sodium.

3. Hypervolemic hypernatremia

- When TBW is increased but the sodium gain exceeds the water gain.


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Etiology:

1. Hypovolemia hypernatremia

- Renal loss of, osmotic diuresis, diuretics, severe

hyperglycemia

- Extrarenal loss: profuse diaphoresis, decreased thirst,

diarrhea occuring with inadequate volume replacement or

fluid replacement with hyperosmolar solutions, burns.

2. Euvolemic hypernatremia

- Excess fluid loss from the skin & lungs, hypodipsia in

the elderly & infants, DI


- Administration of concentrated saline solutions,hypertonic feedings, excess mineralocorticoids, accidental

or intentional salt ingestion, commercially preapred soups

& canned vegetables.


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Pathophysiology:

1. Water shift from ICF to ECF.

2. Na competes with Ca in the Ca channels for cardiac musclecontraction..


1. Polyuria, oliguria 13. Weight gain

2. Anorexia, N & V, weakness 14. Edema

3. Restlessness, agitation, irritability 15. Dysrhythmia4. Dry, flushed skin 16. Crackles

5. Dry, sticky mucous mem 17. Dyspnea

6. Tongue furrows 18. Pleural effusion

7. Increase thirst

8. Fever

9. Orthostatic hypotension/HPN

10. Tachycardia

11. Jugular vein distention

12. S3 gallop


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1. Plasma sodium level above 145 mEq/L

2. Plasma chloride level above 106 mEq/L.

3. Plasma osmolality more than 295 mOsm/kg.

Management:


2. Increase fluid intake.

3. Restrict sodium.4. IV infusion0.3%, 0.45% NaCl, or D5W

5. Meds: Diuretics, Desmopressin acetate


Complications:

1. Coma, irreversible brain damage, death


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Potassium Imbalances

Hypokalemia

- A plasma potassium level below 3.5 mEq/L. Etiology & Risk Factors:

1. Inadequate K-intake.

- Debilitated, confused, restrained, or lack access to dietary

intake.- Malnourished, anorexic, bulimic, K-restricted diets, K-free IV

solutions, older adults

2. Excessive K-loss.

- Vomiting & diarrhea, nasogastric suctioning, intestinal fistulae,

ileostomy.

- Osmotic diuresis, post-op clients, alcoholism,

- Meds: K-wasting diuretics, cathartics, steroids,

aminoglycosides, amphotericin B, digitalis preparations, beta-

adrenergic drugs, cisplatin, bicarbonate, natural licorice


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Etiology & Risk Factors:

1. Redistribution of potassium

- Increased levels of insulin, alkalosis, burns, sever tissue injury2. Others

- Cushings syndrome, diuretic phase of renal failure,

hyperaldosteronism, liver disease, cancer, wounds, Bartters

syndrome

Pathophysiology:

1. Decreased gradient between ICF & plasma.

2. Increase excitability.


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1. Anorexia 16. Apnea

2. Abdominal distention 17. Dysphasia

3. Constipation 18. Areflexia4. Muscle weakness 19. Confusion

5. Flabbiness 20. Vomiting

6. Leg cramps 21. Ileus

7. Fatigue 22. Polyuria8. Paresthesias 23. Nocturia

9. Hyporeflexia

10. Irritability

11. Dysrhythmias

12. Hypotension

13. Slow, weakened pulse

14. Shallo respirations

15. SOB

Di ti Fi di


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Diagnostic Findings:

1. ECG results:- Depressed & prolonged ST segment

- Depressed & inverted T wave

- Prominent U wave2. Lab test:- Plasma potassium level below 3.5 mEq/L

Management:


2. Foods high in K.

3. K-supplementation.

(eg. K-chloride, K-gluconateIV or PO)



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Hyperkalemia

- A plasma potassium level above 5.0 mEq/L.


1. Retention of K by body because of decreased or inadequate

urine output.

2. Excessive release of potassium from the cells during the first

24-72 hours after traumatic injury or burns, or from cell lysis

or acidosis

3. Excessive infusion of IV solutions that contain K or

excessive oral intake, especially in a person who has renal

disaese.


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Pathophysiology:

1. Increase cell membranes excitation threshold.


1. Paresthesia

2. Tachycardia

3. Intestinal colic

4. Diarrhea

5. Hypotension

6. Convulsions

7. Impaired cardiac conduction8. Muscle weakness

9. Paralysis

10. Flaccid muscles


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1. Plasma potassium level above 5 mEq/L

2. Plasma BUN above 20 mg/dL.

3. Plasma creatinine more than 2.5 mg/dL.

4. ECG reveals: Peak T-wave

Management:


2. Dietary restriction of foods high in K.3. Infusion of IV Calcium gluconate.

4. Infusion of insulin & glucose.

5. IV Beta-agonist albuterol.

6. Na-polystyrene sulfonate (Kayexalate)PO or rectal

7. Allopurinol & diuretics

8. Safety precautions

Complications:

1. Cardiac arrest, respiratory muscle paralysis


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Calcium Imbalances

Hypocalcemia-A plasma calcium level below 4.5 mEq/L or

8.5 mg/dL.


1. Inadequate intake

- Older adult, decreased Vit. D, lactose intolerance, GI disease, liverdisease, alcoholism, anorexia, bulimia, prolong NPO, prolong

intsitutionalization

2. Hypoparathyroidism, inadvertent removal of PT gland,

Pancreatitis, open wounds, Cushings disease, alkalosis,

multiple BT.3. Meds: Mg So4, colchicine, neomycin, aspirin,

anticonvulsants, estrogen, phosphate preps, steroids, loop

diuretics, antacids & laxatives


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Pathophysiology:

1. Decrease in threshold potential.


1. Numbness & tingling sensations 17. Fractures

2. Emotional lability 18. Diarrhea

3. Cardiac insufficiency

4. Hypotension

5. Dysrhythmias

6. Trousseaus sign

7. Chvosteks sign

8. Prolonged bleeding time

9. Seizures

10. Catarcts

11. Dry, sparse hair

12. Rough skin

13. Laryngeal stridor

14. Tetany

15. Hemorrhage

16. Cardiac collapse


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Hypercalcemia

- A plasma calcium level over 5.5 mEq/L or 11 mg/dL.


1. Metastatic malignancy

2. Hyperparathyroidism.3. Thiazide diuretic therapy

4. Excessive intake of Ca & vit D supplements.

5. Calcium-containing anatcids

6. Prolonged immobilization7. Metabolic acidosis

8. Hypophosphatemia


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Pathophysiology:

1. Increase in threshold potential.


1. Anorexia

2. Nausea & vomiting

3. Polyuria

4. Muscle weakness

5. Fatigue

6. Lethargy

7. Dehydration

8. Constipation

9. Colicky pain

10. Bone pain

Diagnostic Findings:

1. Plasma calcium levelabove 5.5 mEq/L or 11.5 mg/dL

2. ECG: widened T wave, shortened QT interval.


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Management:

1. Assess V/S, & ECG.

2. Assess bowel sounds & renal function.


4. Sodium intake is increased.

5. Consumption of high fiber foods.


7. Meds:

- IV normal saline

- Cortocosteroids

- IV phosphate

- Calcitonin

- Etidronate disodium (Didronel)

- Gallum nitrate

Complications:

1. Renal stones, renal failure, coma

h h b l


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Phosphate Imbalances Hypophosphatemia

A plasma phosphorous level less than 1.2 mEq/L.


1. Loss or long-term lack of intake

2. Increased growth or tissue repair3. Recovery from malnourished state.

4. Prolonged & excessive intake of antacids

5. Admin of high levels of glucose via tube feedings or IV line

6. Cushings syndrome7. Hyperparathyroidism

8. Respiratory/Metabolic Alkalosis

9. Lead poisoning

10. Burns


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Pathophysiology:

1. Impairs the conversion of glucose & other substances to ATP.

Clinical Manifestations:1. Decreased cardiac or respiratory functions

2. Muscle weakness

3. Fatigue

4. Brittle bones

5. Bone pain6. Confusion

7. Seizures


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Management:

1. Diet & dietary supplementation.

2. TPN


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Hyperphosphatemia

A plasma phosphorous level greater than 3

mEq/L.


1. Excessive intake of high-phosphate foods

2. Excess vitamin D3. Impaired colonic motility

4. Hypoparathyroidism

5. Addisons disease


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1. Tachycardia

2. Palpitations3. Restlessness

4. Anorexia

5. Nausea & vomiting

6. Hyperreflexia

7. Tetany


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Manifestations:

1. Anorexia

2. Nausea

3. Abdominal distention

4. Depression

5. Psychosis

6. Confusion

7. Chvosteks sign

8. Trousseaus sign

9. Tetany

10. Convulsion

11. Vasospasm

Diagnostic Tests:


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Diagnostic Tests:

1. ECGProlonged QT intervals, widened QRS complex,

broadening T waves

Management:

1. Increase intake of Mg rich foods.

2. Safety & seizure precautions.

3. Assess DTR.

4. Supplementation:

1. Oral magnesium replacement

2. Parenteral Mg So4


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Hypermagnesemia

A plasma megnesium level above 2.5 mEq/L.


1. Renal insufficiency

2. Excessive use of Mg-containing antacids or laxatives3. Potassium-sparing diuretics

4. Dehydration from ketoacidosis

5. Overuse of IV MgSO4


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Manifestations:

1. Peripheral vasodilation

2. Hypotension

3. Severe muscle weakness

4. Lethargy

5. Drowsiness

6. Loss of DTR

7. Respiratory paralysis

8. PVC

Diagnostic Test:

ECGProlonged PR, QT intervals


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Management:

1. Assess V/S, respiratory function, ECG recordings, urine

output.

2. Safety & seizure precaution.3. Drugs:

1. IV calcium salts

2. Albuterol

4. Avoid constant use of laxatives & antacids containing Mg.

5. Diet: High fiber.



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Thank

You!!!

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