Identify the assessment findings that you could expect to see for the identified electrolyte
imbalance. Select all that apply.
Sodium level of 150 mEq/dL
Normal range of serum sodium is 135-145 mEq/dL, so this value represents hypernatremia. Lithium
therapy can lead to hypernatremia. Limited fluid intake (with flu-like symptoms) or excessive loss (from
hiking in the desert, polyuria, or burns) can lead to water depletion and increased sodium retention.
Nutritional canned products have a high concentration without added water, which leads to a high
sodium level. Diuretic therapy with a loop diuretic, such as furosemide, would lead to hyponatremia due
to renal loss of sodium. Hemoglobin A1c level of 5.0% is within normal range and as such would not
affect sodium levels. The nurse needs to be especially aware of neurological changes in the client with
sodium imbalance since it can lead to cerebral edema and seizures.
Potassium level of 6.5 mEq/L
This serum sodium level represents moderate hyperkalemia. A normal potassium level would be
between 3.5 and 5.0 mEq/L. Moderate hyperkalemia is often the result of renal dysfunction, which is
supported by the GFR of 20 mL/min and a creatinine of 3.2 mg/dL. Normal renal function is indicated by
a GFR of 60 or higher and a creatinine between 0.5 and 1.2 mg/dL. A client with adrenal cortex
insufficiency (Addison’s disease) has a lack of aldosterone, causing a secondary hyperkalemia.
Spironolactone is a potassium sparing diuretic, causing a client to retain potassium. The use of NSAIDS
such as naproxen could also impact renal function and lead to increased potassium levels when taken in
excess. Two doses will not cause a problem. Diarrhea is associated with hypokalemia. A sulfa allergy
does not predispose a client to hyperkalemia. The nurse needs to be especially aware of cardiac changes
in the client with potassium imbalance since it can lead to dysrhythmias and sudden cardiac arrest.
Magnesium level of 0.8 mEq/L
A normal magnesium level is between 1.6 and 2.2 mEq/L. A value below this range indicates decreased
magnesium or hypomagnesemia. The presence of Chvostek sign indicates hypocalcemia, which is
consistent with decreased magnesium levels. When a client is an alcoholic, abusing laxatives or
malnourished he or she is at a higher risk of developing hypomagnesemia from excess loss or limited
ingestion of magnesium. A potassium level of 4.0 mEq/L is within normal range. Both milk of magnesia
and lithium toxicity cause hypermagnesemia, not hypomagnesemia. The treatment for
hypomagnesemia includes the replace of magnesium by oral or intravenous routes.
Total calcium level of 12.9 mg/dL
This total calcium value is consistent with hypercalcemia. A normal total calcium level is between 8.2
and 10.2 mg/dL. Malignant conditions, such as lymphoma and bone metastasis are commonly
associated with an increased incidence of hypercalcemia. Use of theophylline also indicates a risk for
increased calcium levels. Vitamin D deficiency, limited dairy intake, the presence of Trousseau sign,
pregnancy, and chronic alcohol use are associated with hypocalcemia.
Phosphorus level of 1.0 mg/dL
Normal phosphorus level is between 2.5 and 4.5 mg/dL. Phosphorus levels should be evaluated in
comparison to calcium because of their inverse relationship. Refeeding syndrome leads to a decreased
intestinal absorption of phosphorus. Respiratory alkalosis causes phosphate to shift into the cell. In
extensive burns, the mechanism of development is unclear but likely due to salt and water diuresis.
Acute kidney injury in the critically ill client causes increased phosphorus uptake due to catecholamine
release. Rhabdomyolysis, decreased calcium levels, and hyperthyroidism all lead to hyperphosphatemia.
Chloride level of 94 mEq/L
A normal chloride level is between 97 and 107 mEq/L. A chloride level of 94 mEq/L demonstrates
hypochloremia and is a result of chloride loss. Common reasons include chronic respiratory acidosis,
from the kidneys retaining bicarbonate and excreting chloride to re-establish acid-base balance. In
metabolic alkalosis from severe vomiting, nasogastric suctioning, and adrenal cortex insufficiency,
hypochloremia occurs as a result of increased bicarbonate concentration from hydrogen loss in the GI
tract. The client receiving certain IV solutions with metabolic acidosis or hypernatremia will experience
hyperchloremia. Daily vitamins will not impact chloride levels.