Kelly Culver Electrolytes Normandale

Normal Lab value for Sodium?

3.5 - 5.5 mEq / L

96 - 106 mEq / L

1.8 - 2.5 mEq / L

8.5 - 10.5 mg / dl
or
4.5 - 5.1 mg/dl Free (ionized)

2.5 - 4.5 mg / dl

• Most abundant cation in ECF
• Contributes to serum osmolality
• Controls & regulates water balance
• When reabsored, Cl- and water follow

• Major cation in ICF
• Maintains ICF water balance
• Vital electrolyte for skeletal, cardiac, and smooth muscle activity
•Maintains acid-base balance
• Contributes to intracellular enzyme reactions

• Major anion of ECF
• Regulates serum osmolality and blood volume
• Major component of gastic juic (HCl)
•Regulates acid-base balance

• Levels linked to albumin levels
• Regulated levels thru dietary intake, GI absorption & excretion, and kidneys thru reabsorption or excretion
• most abundant ICF cation, after K+
• Promotes enzyme reactions
• Helps produce ATP for energy
• Protien synthesis
• Influences vasodilatioin
• Helps Na and K ions cross cell membrane
• Regulates muscle contractions, influences Ca levles
•

• Majority in skeletal system / bones.
• Cation found in both ECF & ICF
• Formation of bnes & teeth
• Participates in blood clotting
• Maintain cell st ructure & function & role in cell membrane permeability
• impulse transmission
• contraction of muscles

• Primary anion of ICF
• Also found in ECF: bone, muscle, and nerve tissue
• involved in chemical actions of the cell
• essential for functioning of muscle's nerves and RBC
• metabolism of protein, fat, & carbohydrates
• absorbed in intestines
• normally inversed relationship with Ca levels (if one is high, the other is low)
• meat / fish / chx / milk / chz / eggs / legumes

• < 135
• deficiency of Na+ in relation to body water = body fluids are diluted
• loss of sodium or excess gain of water

• Head trauma
• Stroke
• Cancer of the lung
• HF
• Hyperglycemia
• Excess intake of plain water
• Tap water enemas

inadequate sodium intake, excessive sodium loss, or water gain.
non-renal or renal
• loss of GI fluid (vomit / diarrhea/ gastric suction)
• use of diuretic
• too much D5W
• too much water
• *primary polydipsia* (pt drank too much water)

primary neurological signs
• abdominal cramps
• nausea
• headache
• altered consciousness (lethargy / confusion)
• muscle twitching, tremors, weakness
• hypovolemia with depletion
(orthostatic hypotension, poor skin turgor, dry mucous membranes, tachycardia)
• hypovolemia with diliutional:
(hypertension, weight gain, rapid – bounding pulse)

• restrict fluid intake
• possibly administer piggyback Na+ (3% or 5% NaCL

• Primary problem is water retention
– Safer to restrict water than to administer sodium

• Serum sodium level above normal
• >145 mEq/L
• Water loss exceeds sodium loss
• Increased sodium retention

• People unable to perceive or respond to THIRST
• Heatstroke
• Sea water near drowning
• Diabetes insipidus

water loss, inadequate water intake, or sodium gain
• watery diarrhea
• Diabetes insepidus
• *Osmotic diuresis* (increased urination)
• Kayexalat (med containing high sodium content)

• Thirst
• Elevated temperature
• Dry, red, swollen tongue
• Sticky mucous membranes
• Disoriented, irritable and hyperactive
• Dyspnea

• Hypervolemia (hypertension, bounding pulse, and syspnea)
• Hypovolemia (dry mucous membranes, orthostatic hypertension)

What does the acronym SALT stand for in relation to S&S of hypernatremia?

• Oral or IV fluid replacement
• Restrict Na+ intake
• Thiazide diuretic (decrease FREE water loss from kidneys)

Sodium is a cation or anion? of the ICF or ECF?

2 g. Should be less than 2400 mg

Increased serum sodium causes thrist and release of?

Sodium potassium pump works to?

name 3 factors that affect K levels:

• < 3.5
• insufficient intake of K+
• loss of K+ from body
• shift of K+ from extracellular to intracellular fluid

These 2 issues are major concerns:
arrhythmias (lead to cardiac arrest)
or
respiratory muscle weakness (lead to resp arrest)

of which electrolyte imbalance?

• Bulimics, anorexics / starvation, • Alkalosis • Alcoholics
Taking K+ wasting diuretics (thiazide)

• muscle weakness
• paresthesia (abnormal sensation of the skin, such as numbness, tingling)
• cramps
• weak, irregular pulse
• orthostatic hypertension
• ECG changes
• decreased bowel sounds, constipation
• polyuria

• diuretics
• Diarrhea / Vomiting / Gastric suction
• Steroids
• Osmotic diuresis (increased urine)
• * Metabolic Alkalosis

• High K+ diet
• K+ supplements
• piggyback IV replacements
• K+ sparing diuretics
• MONITOR HEART RATE and resp rate

• Paralytic ileus (paralysis of intestine) • Muscle paralysis
• Digitalis toxicity • Arrhythmias • Cardiac arrest • Respiratory arrest

Veggies: Avocados / carrot / potato / tomato
Fruits: raisin / banana / apricot / orange
Meat: beef / pork / veal / cod

weak, irregular, rapid pulse

Another 2 types of treatment for hyperkalemia:

What happens when Aldosterone is secreted

Tall tented T wave

• < 1.8
• overstimulates neuromuscular system
• Any condition that impairs either of the Mg regulators: GI / Urinary systems can lead to Mg shortage: • poor dietary intake
• Poor Mg absorption by GI tract
• Excessive Mg loss from GI tract • Excessive Mg loss from urinary tract

• Chrones , Chronic alcoholics, Renal

Causes:
• Alcohol withdrawal
• NG suction / Diarrhea
• Chronic alcoholism

The acronym STARVED stands for what symptoms of hypomagnesemia?

Treatments:
Mg replacements – Oral or Piggyback,
Safety precautions, and AIRWAY assessment

S• seizures
T• tetany
A• annorexia / arrhythmias
R• rapid heart rate
V• Vomiting
E• emotional changes
D• deep tendon reflexes increased

• > 2.5
• Depresses neuromuscular system (muscle relaxation)

Causes:
• Impaired Mg excretion (renal dysfunction)
• Excessive intake
• Mg antacids
• Milk of Magnesium – in renal patient

Clients at risk:
• elderly
• Renal diseases
• Pregnant women in preterm labor

what does the acronym RENAL stand for for S&S of hypermagnesemia?

• Decrease BP
• Facial flushing
• Sensations of warmth and thirst
• Lethargy
• Dysarthria
• Weakness to paralysis
• Irregular apnea
• Coma

Treatments:
• Give fluids – oral or IV to raise urine output
• Calcium gluconate IV in emergency
• Patient should use Mg-free laxatives if renal failure
• monitor EKG / reflexes / flushed appearance

plenty of seafood, as well as chocolate, dry beans and peas, green leafy veg, meats, nuts, and whole grains.

• < 8.9 or <4.5 ionized
• doesn’t take in enough Ca, body doesn’t absorb properly, or excessive amts of Ca are lost from body

Clients at risk:
• alcoholics
• Renal
• inactive
• doesn’t receive enough sunlight (vit D)
• newborns

Causes:
• Parathyroidectomy
• Vit D deficiency
• Alkalosis

• Tetany
• Confusion
• Tingling fingertips, mouth, & feet
• Muscle spasms
• ECG changes
• Pain
• Bleeding
• Seizures
• Diplopia (double vision)
• Trousseaus’s sign
• Chvostek’s sign

Treatment:
• IV calcium admin
• Vit D therapy
• Monitor airway, respiratory and cardiac status

• >10.5 or >5.1 ionized
• The rate of Ca entry into ECF exceed the rate of CA excretion by the kidneys

Clients at risk:
• patients on thiazide diuretic • severe fractions
• prolonged peptic ulcer treatment • prolonged immobilization
• overuse of supplements • Acidosis

Causes:
• Cancer & hyperparathyroidism
• Neoplastics disease
• Prolonged immobilization
• Paget’s disease

• anorexia / nausea / vomiting
• hypertension
• behavioral changes, including confusion
• lethargy
• bone pain • ECG changes
• constipation, abdominal pain
• polyuria, extreme thirst
• muscle weakness, decreased deep tendon reflex
• slurred speech • bradycardia

Arrythmias such as bradycardia paralytic ileus
stupor
coma
Cardiac Arrest

Treatment:
• Increase mobility
• Encourage Sodium containing fluids
• Safety precautions
• Assess for s&s of digitalis toxicity
• monitor pulse

Albumin binds with what electrolyte to make it ineffective?

A Chvostek’s sign, along with Trousseau’s sign, is associated with

• >4.5

Causes:
• Renal failure
• Fleet’s enema
• Over ingestion of phosphorus
• chemo
• large amt of Vit D

Clients at Risk:
• Renal diseases
• Infants fed cow’s milk
• Rhabdomyolysis (rapid breakdown of skeletal muscles)
• Hyperthyroidism

Clients at Risk:
• Renal diseases
• Infants fed cow’s milk
• Rhabdomyolysis (rapid breakdown of skeletal muscles)
• Hyperthyroidism

• Numbness, tingling around mouth and in
the fingertips
• Muscle spasms
• Tetany
• Soft tissue calcification (kidney)
• Increase RBC levels

Relationship between phosphorus and calcium?

The binding of phosphorus and calcium in a patient with hyperphosphatemia can lead to?

can lead to Resp muscle weakness and impaired contractility of the diaphragm, which compromises the patient’s ability to breathe spontaneously.

• < 96
• GI issues

Causes:
• GI losses
• Kidney losses
• Diet very low in salt
• long term diuretic use

Clients at Risk:
• Excessive sweating
• Using diuretics
• Adrenal insufficiency
• N & V
• NG suctioning

• Muscle weakness
• Twitching
• Tetany
• Slow shallow respirations (rare)
• Respiratory arrest

• hyponatremia
• hypokalemia
• hypochloremia
• alkolosis

Treatment:
• Limit fluid intake and replace lost electrolytes
• IV piggy backs with “sodium chloride”, KCL, etc

• > 106
• Associated with hypernatremia
• increased Cl intake or absorption, from acidosis, or from Cl retention from kidneys

Causes:
• Conditions causing sodium retention
• Excess replacement of sodium chloride or potassium chloride

Clients at Risk
• Unconscious
• increased insensible water loss
• excessive parental admin of Cl

• Same S&S of hypernatremia
• S&S metabolic acidosis
• Lethargy
• Weakness
• Confusion
• Deep rapid breathing

Treatments;
• Bicarbonate • Hydrate
• Diuretics • Monitor fluid losses and gains
• If receiving TPN, balance is tricky – test each electrolyte daily!

Chloride is largely produced by the:

If the level of bicarbonate ions increases, the level of chloride ions:

For a patient who has a low serum chloride level, you would expect the patient to have the acid-base imbalance:

suspect metabolic acidosis, a condition associated with hyperchloremia. With these breathing symptoms?

These 3 imbalances also reflect acidosis:

These 2 imbalances reflect Alkalosis

Osmotic diuresis (increased urination) is a cause of 2 types of imbalances:

This MED:
Contains high sodium content --- cause hypernatremia
Treats – hyperkalemia (enema)

Decrease free water LOSS from kidney--- treat hypernatremia

- at risk for hypercalcemia

Treats – Hyperkalcemia
Hypermagnesemia

At risk for:
- Hyperkalemia
- Hypocalcemia
- Hypomagnesemia
- Hypermagnesemia
- Hyperphosphatemia

• Fluid loss exceeds intake
• Fluids lot in isotonic situation

-Decreased circulating blood volume

Abnormal losses
Decrease fluid intake
Bleeding
Mvmt of fluid into 3rd spacing

Increase heart rate
hypotension
restlessness
cool, pale, skin - arms & legs
high sodium labs
THIRST

Excess of isotonic fluid (water and Na) in the extracellular compartment. Prolonged or severe may develop pulmonary edema or heart failure

-Excess Na or fluid intake
-Na retention
-shift from interstitial to intravascular space
-renal failure with little urine output
-IV replacement
-blood replacement
-heart failure

Edema
Weight gain
Tachypnea
Hypertension
Dyspnea
Crackles in lung sounds
Rapid Bounding pulse
distended neck veins

loss of ONLY water. Hyperosmolality

Fluid moves out of intravascular space - but NOT into intracellular space. Moves into space where fluid is not usually found. Occurs as result of increased peremeability of capillary membrane or decrease in plasma colloid osmotic pressure.
• Edema •

Hypothalamus and posterior pituitary produce and secrete this hormone. Antidiuretic, causes body to retain water.
• Decrease solute concentration
• water retention
• Restore blood volume by reducing diuresis

• Maintain balance of sodium and water
• maintain blood volume and BP

Maintain BP and fluid balance
- secreted by adrenal cortex
** regulates reabsorption of Na & water within nephron. Causes kidneys to retain sodium and water

Cardiac hormone that maintains Na and water balance.
• decrease blood pressure
• decrease blood volume
• opposes ADH, Renin-angiotention, & aldosterone

Pressure exerted by proteins

ATP required transport

Flow of water from LOW solute concentration to HIGH concentration

FORCE exerted by a fluid

PASSIVE mvmt of molecules from HIGH concentration to LOW concentration

Force determined by osmolarity of a fluid

Alcohol withdrawal

Metabolic alkalosis causes:

Parathyroidectomy causes:

Diabetes insepsidus causes:

Fleet's enema can cause:

Primary polydypsia (excessive thirst) can cause:

Milk of magnesia use in a renal failure patient can cause:

Burns can cause:

Chronic alcoholism can cause:

Vit D deficiency can cause:

Osmotic diuresis can cause:

prolonged immobilization can cause: