Electrolyte Imbalances Deficits Hypokalemia Anxiety, Irritability, Fatigue, Weakness, N/V, *Cardiac Conduction Abnormalities Excesses Potassium (K+) 3.5-5.0 mmol/L Hyperkalemia Cardiac Arrest, Abdominal Cramping, Rhythm Abnormalities, Death, leg cramps, weakness/paralysis Vital for skeletal, cardiac & smooth muscles, neuro/cardiac conduction, acid-base balance Hypomagnesemia Confusion, Tremors, Seizures, Muscle Cramps, ↑ DTRs, BP & Pulse Cardiac Dysrhythmias Magnesium (Mg2+) 1.8-2.6 mEq/L ↑DTRs=Hypo Hypermagnesemia Lethargy & Drowsiness, N/V, Shallow Resps, Warm-flushed skin, Muscle Weakness, ↓ DTRs, BP & Pulse ↓DTRs=Hyper Regulates neuro, cardiac function, protein and carb metabolism, contracting muscles Hyponatremia Confusion, Coma, Irritability, VS Changes, ↑ ICP Sodium (Na+) 136-145 mEq/L Controls H2O balance, ECF volume, nerve impulses & contracting Hypocalcemia Numbness, Tingling, laryngeal spasms (stridor) ,↑ DTRs, EKG changes Chvostek’s & Trousseaus Calcium (Ca2+) (total) 9-10.5 mg/dL ↑DTRs=Hypo ↓DTRs=Hyper Hypernatremia Restlessness, Agitation, Twitching, Seizures, Coma, Intense Thirst, Dry Swollen Tongue Hypercalcemia ↓ DTRs, Memory Loss, Confusion, Nephrolithiasis (Kidney Stones) EKG Changes Vital for neuro function, muscle contraction & relaxation, Cardiac Function Hypophosphatemia CNS Depression Confusion Muscle Weakness Phosphate (PO4) 2.4-4.4 mg/dLchemical INVERSE relationship w/ Ca (they hate each other) Hyperphosphatemia Asymptomatic Associated w/ Hypocalcemia Caused by kidney disease! Phos helps reactions of cells essential for Fx of muscles, nerves & RBCs ↓Na = ↓Cl Chloride (CL) 96-106 mmol/L Chloride follows Sodium They’re BFFs ↑Na = ↑Cl Causes and Treatments of Deficits Fasting, NPO, Vomiting, Diarrhea, NG suctioning, ↑ Sweating, ↑ Steroid use, Loop Diuretics, Acidosis? water intoxication, DKA Tx: Check Renal Function, give K+ supp (but NEVER IM, IVP or Subq) Kidneys must be Fx to get K Chronic Alcoholism, Long Term Diuretics, Poor Nutrition, Pancreatitis, Burns, Prolonged TPN, Rx: IV (must be diluted) or PO MG supp (Slo-Mag) large rapid Water Intake, Diuretics, Vomiting, Diarrhea, GI suctioning, Improper use of Hypotonic IV Rx: Stop IV soln if pt has one. Removed Parathyroid (↓PTH), Pancreatitis, Multiple Blood transfusions, calcium loss Rx: ↑ Ca intake, ↑Vitamin D, Give pt. Tums -aka Calcium Carbonate Malnourishment, Alcohol Withdraw, Phos-binding Antacids, TPN Potassium 3.5-5.0 mmol/L Found in: Bananas, supplements (cador, florocin, IV diluted), salt substitutes. Causes and Treatments of Excesses ↓ K+ excretion, Renal Failure, ↓ Aldosterone (Addison’s), other Diuretics, Alkalosis? Crush Injury, Burns, Sepsis, ↑ K+ Administration, Saltsubstitutes , Meds that cause ↑ K: (K sparring diuretics, ACE inhibitors) Tx: K+ binding Diuretic (Lasix), Kayexalate, Dialysis Magnesium 1.8-2.6 mEq/L Found in: Green beans, nuts, bananas, chocolate, Peanut butter Sodium 136-145 mEq/L Found in: everything Calcium Total 9-10.5 mg/dl Phosphate 2.4-4.4 mg/dL ↑ Mg+ Intake, Renal Disease, Adrenal Insufficiency, Mg Salts, Milk of Magnesia Rx: pt. teaching, stop the cause, diuretics, CaCl binder, Dialysis Excessive water or sodium loss, hypertonic IV, too much salt intake, common in elderly w/ infections Rx: replace via IV fluids HYPO to dilute slowly ↑ PTH, Cancers, malignant esp. BONE prolonged immobility Rx: ↑ fluid intake, loop-diuretic, isotonic saline, medications: bisphosphonates or calcitonin Renal Failure, Chemo, Excessive intake (baby bottle) Rx: Phos. Binding medication (Phoslow s/e constipation), dialysis, ↓ Phos intake Rx: Give Phos supplement PO or IV potassium phosphate Chloride 96-106 mmol/L