Imbalance
Lab Value
Range
Serum Na+
below 136
mEq/L
Serum
Osmalality
below 285 m
mL/kg
Risks
Expected Findings
Pt Care Considerations
Low ECF volume,
excessive GI
gasses, renal
losses, edema,
hyperglycemia,
skin losses,
ascites
Monitor I and O, daily
weight, vitals and LDC,
change position slowly,
encourage foods/fluids
high in sodium, oral/IV
fluids
Hypernatremia
Blood sodium
levels,
greater than
145 mEq/L
NPD, heat
stroke, excessive
sodium intake or
retention, fluid
loss
+/-/= ECF volume, O.
H., rapid pulse,
hypothermia,
headache, confusion,
DTRs, seizures,
anorexia, N/V,
hyperactive bowel
sounds
Hyperthermia,
tachycardia, O. H.,
restlessness, fatigue,
muscle weakness,
confusion, ECG
disturbances, N/V,
constipation, anxiety
Hypokalemia
Blood
potassium
level greater
than 5.0
mEq/dL
Hypercalcemia
Total blood
calcium level
less than 1.3
mEq/dL
Hypomagnesimia
Blood
magnesium
level less that
1.3 mEq/L
Hypermangesemia
Blood
magnesium
level greater
than 2.1
mEq/L
Increased
potassium, ECF
shift, hypertonic
states,
decreased
potassium
excretion, age
Thiazide diuretic,
long term
glucocorticoid,
use, Paget’s
Disease,
hyperthyroidism,
boner hyperparathyroidism,
cancer
Increased
magnesium
output shifts into
inactive form,
inadequate
intake or
absorption
Kidney or
adrenal
impairment,
increased intake
of medications
containing
magnesium
Hyponatremia
Slow, irregular pulse,
hypotension,
irritability, confusion,
paresthesia, diarrhea,
hyperactive bowel
sounds
Decreased reflexes,
bone pain,
dysrhythmia, blood
clots, N/V, weakness,
lethargy, confusion,
personality changes
Monitor LDC and ensure
safety, provide oral
hygiene, monitor intake
and output, low sodium
diet, IV fluids,
encourage fluids.
Diuretics if kidney is
impaired.
Continuous ECG
monitoring; decrease
potassium intake,
administer IV fluids,
monitor cardiac rhythm,
prepare for dialysis if
necessary
Restrict calcium intake,
increase fluid intake,
monitor patient for
pathological fractures
Increased nerve
transmission,
hyperactive bowels,
dysrhythmias,
tachycardia,
hypertension, PVC’s
Discontinue Magnesium
losing meds, oral or IV
magnesium
replacement, diet
changes
Diminished DTR’s,
paralysis, decreased
respirations, cardiac
changes, lethargy
Frequent focused
assessment, loop
diuretics, calcium
gluconate for severe
cardiac changes
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