Electrolyte Imbalances Electrolyte Sodium 135-145 Hypo or Hyper Hyponatremia Hypernatremia Potassium 3.5-5 Hypokalemia Hyperkalemia Calcium 9-10.5 Hypocalcemia Hypercalcemia Magnesium 1.5-2.5 Phosphorus 2.5-4.5 Symptoms/Signs Causes Treatment Weakness, lethargy, seizures, headache, muscle cramps, twitching, hypotension Same symptoms as dehydration (dry mucus membranes, neuro symptoms….), seizures Muscle cramps, muscle weakness, paresthesia, flattened T waves, decreased bowel motility, cardiac arrhythmias Paralysis, muscle weakness, cardiac arrhythmias, peaked T waves, increased bowel motility GI loss, SIADH, NPO, water intoxication, medication Restrict fluids, give sodium, seizure precautions Dehydration, burn, DI Restrict sodium, give fluids, daily weights, I&O’s, seizure precautions Potassium chloride, cardiac monitoring, Potassium sparing diuretics, renal failure, acidosis IV dextrose with insulin. If there is EKG changes (like peaked T waves) give calcium gluconate, kayexalate, dialysis, cardiac monitoring positive trousseau’s (carpal spasm) and Chvostek’s (facial twitching), tetany (tingling in hands/feet/mouth), seizures, cardiac dysfunction *** Hyporeflexia, lethargy, cardiac dysrhythmias, bone pain, renal stone Thyroidectomy, parathyroidectomy, vit D deficiency, GI loss Calcium Gluconate, seizure precautions, cardiac monitoring Hyperparathyroidism, dehydration, vitamin D excess, dehydration, immobilization Alcohol abuse, inadequate nutritional intake, increased loss via GI/renal Renal failure, adrenal insufficiency, laxative overdose Renal excretion, alcohol abuse, DKA, hypomagnesemia, antacids, TPN, burns Renal failure, chemo, excessive use of laxatives, acidosis Cardiac monitoring, fluids, dialysis, medications (diureitcs) Hypomagnesemia Same as hypocalcemia, cardiac abnormalities Hypermagnesemia Decreased DTR, flushed/warm skin, cardiac abnormalities muscle weakness, seizures, chest pain, bone pain Hypophosphatemia Hyperphosphatemia Same as hypocalcemia Diuretics, diarrhea, prolonged NGT suctioning. Magnesium sulfate, seizure precautions, Mechanical ventilation, medications (diuretics), fluids Oral phosphate, increase intake, seizure precaution Aluminum hydroxide, hydration, dialysis, seizure precaution