ELECTROLYTE
FUNCTION
HYPER (High)
HYPO (Low)
CONSIDERATIONS
• Na+ >155 or <120 are
Na+ = <135
Na+ = >145
BIG & BLOATED
Major electrolyte in ECF
Essential for:
• Active & passive
transport mechanism
• Irritability
• CONDUCTION of nervemuscle tissue
SODIUM
135 – 145
Swells the body to maintain:
• BP
• Blood volume
• pH balance
• Fluid balance
Regulated by Aldosterone &
RAAS
Manifestations:
• Flushed skin
• Agitation, confusion
• Edema
• Low-grade fever
• Polydipsia = ↑ thirst d/t
↑ Na+
• ↓ urine output
• Dry mouth
Late serious signs:
• Swollen dry tongue
• ↑ muscle tone
• N/V
Causes:
• Dehydration
• Excess saline IV
(hypertonic)
• Impaired renal function
• Primary aldosteronism
• Corticosteroid therapy
o ↓ Na+ excretion
• Medications, meals
• Diabetes insipidus
DEPRESSED & DEFLATED
WEAK & SHAKEY
Manifestations:
• Seizures & coma
• Tachycardia & weak
thready pulse
• Abdominal cramping
• Confusion/lethargy/troubl
e concentrating
• Loss of urine & appetite
• ↓ bowel sounds
• ↓ DTR
• ↓ BP
Late serious signs:
• Shallow respirations
• Respiratory arrest
Causes:
• Overhydration
• V/D
• GI suctioning
• Sweating
• Diuretic therapy
• DKA
• SIADH
• Addison’s disease
• Chronic renal
insufficiency
life-threatening
• Sodium + Potassium =
inverse
• Sodium + Chloride =
same
• Tx is based on cause
• Free H2O ↓ Na+
• Monitor daily wts
HYPERnatremia:
• Correction is SLOW to ↓
risk of cerebral edema
• Monitor for CNS
changes
• Diuretics
• Na+ intake restriction
• IV isotonic or hypotonic
Severe HYPOnatremia:
• SEIZURES
HYPOnatremia:
• Give IV hypertonic =
hard on veins
• Fluid restrictions
• Diuretics
POTASSIUM
3.5 – 5.0
K+ = >5.0
K+ = <3.5
TIGHT & CONTRACTED
LOW & SLOW
Manifestations:
• ST elevation
• Peaked T waves
• Widened QRS
• Flat P waves
• Prolonged PR intervals
• Hypotension
• Bradycardia
Function:
• Hyperactive BS =
• MANAGE heart + muscle
diarrhea
function
• Respiratory failure
• MAINTAIN fluid balance
• Confusion
+ BP
• ↑ DTR
• REGULATED by kidneys • Profound muscle
weakness
Important in cardiac cell
• Extremities paralysis
function
• Cramping, tingling,
numbness, burning
Severe Hyperkalemia:
• V-fib
• Cardiac ARREST
Causes:
• Renal failure
• ACE inhibitors
• ARB’s
• Medication (NSAIDS,
ACE, ARBs,
Manifestations:
• Inverted T waves
• ST depression
• Prominent U wave
• Irregular, thready pulse
• ↓ BP; orthostatic
• ↓ HR
• Shallow respirations
• ↓ DTR
• Muscle cramping
• Flaccid paralysis
• Hypoactive – absent BS
• ↓ motility
• Constipation
• Abdominal distention
• Confusion, anxiety,
lethargy, coma
• Paralytic ileus
Causes:
• Dehydration
• Deficient K+ intake
• V/D
• Drains (NGT)
• Diuretic therapy
• Large doses of
corticosteroids = H2O
retention
• Severe acid imbalance
• Life-threatening: <2.5
or >6.0
• BFFs w/ MAGNESIUM =
same direction
• Inverse of SODIUM =
opposite direction
• Alterations may lead to
arrhythmia, EKG
changes, & cardiac
arrest
• Monitor EKG changes
• Treatment w/
medications or dialysis
HYPERkalemia:
• Kayexalate
• Dialysis
• IV sodium bicarbonate
• IV calcium gluconate
• Albuterol
• IV regular insulin
• IV hypertonic dextrose
• Beta-2 agonists
• Lasix/HCTZ
•
•
•
•
•
Spironolactone, beta
blockers)
Too rapid K+ IV
Acidosis
Initial reaction to
massive tissue damage
Burns or trauma
Addison’s disease
• HYPERaldosteronism
• Insulin, albuterol = push
K+ into cell
HYPOkalemia:
• IV or PO K+
replacement
• ↓ K+ = ↑ DIGOXIN
TOXICITY risk
• Give IV K+ only when
adequate urine output
has been established
Major anion of ECF
CHLORIDE
97 – 107
• MAINTAIN BP + Blood
Volume
• MAINTAIN fluid balance
• MAINTAIN acid-base
balance
• Exert osmotic pressure
w/ Na+
• Produce hydrochloric
acid (HCl)
Cl- = >107
Cl- = <97
Manifestations:
• Nearly same as ↑ Na+
• N/V
• Swollen dry tongue
• Confusion
• Tachypnea
• Weakness
• Lethargy
• Deep, rapid RR
• HTN
• Fluid retention
Manifestations:
• Nearly same as ↓ Na+
• Excessive diarrhea
• Vomiting
• Sweating
• FEVER = only difference
w/ ↓ Na+
• Agitation, irritability
• Muscle cramps
• Hypertonicity
• Slow, shallow RR
Severe s/s:
• ↓ cardiac output
• Arrhythmias
• Coma
Severe s/s:
• Seizures
• Arrhythmias
• Coma
Causes:
• Metabolic acidosis
• Dehydration
• Excess saline IV
• Impaired renal function
• Primary aldosteronism
Causes:
• Metabolic alkalosis
• V/D
• GI suction
• Diuretic therapy
• Addison’s disease
• SODIUM’s side kick =
same direction
HYPERchloremia:
• Tx underlying cause
• IV hypotonic
• Give Lactated ringer’s
soln
• IV sodium bicarbonate
• Diuretics to flush chloride
• Na+ & fluid restriction
HYPOchloremia:
• IV 0.9% NaCl or 0.45%
NaCl given
• D/C diuretic (loop,
osmotic, thiazide)
• IV Ammonium chloride
for metabolic alkalosis
• Corticosteroid therapy
• Chronic renal failure
Ca+ = <9
• Calcium + Vitamin D =
same
CALCIUM
8.6 – 10.2 or
9 – 11
Keep 3 B’s strong:
• Bone
• Blood (clotting)
• Beats (heart)
STABILIZE neuron
excitability
AFFECTS clotting factors
Ca+ = >11
WILD & CRAZY
SWOLLEN & SLOW
Manifestations:
• Trousseau’s
• Chvostek’s
• TETANY
• Prolonged QT/ST
• Diarrhea
• Abdominal cramping
• Arrhythmias
• Circumoral tingling
• Weak bones
• Paresthesia
• Hyperactive DTR
• Seizures
• Dyspnea
• Laryngospasm
• Abnormal clotting
• Anxiety
Manifestations:
• Constipation
• Bone pain d/t excess
Ca+ taken from bone
• Short QT
• Wide T wave
• Stones (Kidney)
• ↓ DTR
• Fatigue
• N/V
• Abdominal pain
• ↑ thirst
• HYPERCALCEMIA
CRISIS
Severe s/s:
• Severe muscle
weakness
Causes:
• Hyperparathyroidism
• Multiple myeloma
• Multiple fractures
• Immobility
• Adrenal insufficiency
• Renal disease
• Vitamin D toxicity
• Calcium + Phosphate =
opposite
• ↑ risk for pathological
fractures
HYPERcalcemia:
• D/C IV or PO calcium
• D/C Thiazide diuretics
• Avoid foods ↑ in Ca+
• Give IV fluids, Loop
diuretics, phosphates,
calcitonin, NSAIDS,
bisphosphonates
• Encourage fluids
• ↑ fiber d/t constipation
• ↑ mobility
Severe s/s:
• Torsades de pointes
• V-Tach
• Dialysis → last resort
HYPOcalcemia:
Causes:
• Hypoparathyroidism
• Pancreatitis
• Renal failure
• Malabsorption
• Excessive laxative use
• Cushing’s syndrome
• Vitamin D deficiency
• IV calcium gluconate
• Seizure precautions
• PO calcium & Vitamin D
supplements
• Exercise = ↓ bone loss
• Calcium Acetate
• Magnesium hydroxide
• Seizure precautions
• Consume foods ↑ in Ca+
MAGNESIUM
1.5 – 2.5
• REGULATES BP
• REGULATES blood
sugar
• REGULATES muscle
contraction
• REGULATES nerve
function
• MAINTAIN immune
system
• MAINTAIN bones
• Sleep
• Necessary for ENERGY
PRODUCTION
Magnesium Mellows
(relaxes) the Muscles
Mg+ = >2.5
Mg+ = <1.5
TOO RELAXED
CALM & QUIET
MUSCLES GO WILD
BUCK WILD!
Manifestations:
• Prolonged PR interval
• Widened QRS
• ↓ BP
• ↓ HR
• ↓ RR
• Depressed, shallow
respirations
• Hyporeflexia = ↓ DTR
• ↓ Hypoactive BS
• ↓ energy (Drowsy,
Lethargic)
• Muscle weakness
Manifestations:
• Trousseau’s
• Chvostek’s
• ST depression
• T wave inversion
• Prolonged QT
• ↑ HR
• ↑ BP
• ↑ RR; shallow
respirations
• Tetany
• Dyspnea
• Diarrhea
• Confusion, irritability
• Insomnia
• Seizures
• Hyperreflexia = ↑ DTR
(clonus)
• Numbness, tingling
• Nystagmus
Severe s/s:
• Coma
• Heart block
• Cardiac arrest
Causes:
• Hypothyroidism
• Renal failure
• Addison’s disease
• DKA
• Excessive magnesium
• Hyperkalemia
• Extensive soft tissue
injury
Severe s/s:
• Torsades de pointes
• V-Tach
• V-Fib
• Magnesium, Calcium,
Potassium =
same/sister
• Magnesium &
Phosphate = opposite
• Evaluate w/ Ca+ and K+
• Evaluate cardiac
function → can
contribute to Torsades,
a type of V-tach
HYPERmagnesemia:
• IV calcium gluconate
→ ↓ muscle tension &
tightness
• Diuretics, NaCl, &
Lactated Ringer’s
• Dialysis
• Avoid medication w/
magnesium (antacids &
laxatives)
• Observe for DTR &
Causes:
• Hyperthyroidism
changes in LOC
•
•
•
•
•
•
•
Hyperparathyroidism
Hypoparathyroidism
Alcoholism
Malabsorption
Diarrhea
Acute pancreatitis
Antibiotics
(aminoglycosides)
• Fluid loss
• Rapid administration of
citrated blood
HYPOmagnesemia:
• Associated w/
hypokalemia &
hypocalcemia
• IV magnesium sulfate
via IV pump
o Give slowly
o Monitor VS & UO
• PO magnesium
• Monitor for dysphagia
• Seizure precautions
• Assess reflexes →
Clonus (↑ DTR) is BAD
PHOSPHORUS
• BUILD bones, teeth, &
muscles
• Helps REGULATE
calcium
2.5 – 4.5
STORED: mainly in bones
Regulated by KIDNEYS &
PARATHYROID
P = >4.5
P = <2.5
LOW CALCIUM
BRITTLE & WEAK
Manifestations:
• Trousseau’s
• Chvostek’s
• Diarrhea
• Tetany (muscle spasms)
• Hyperreflexia = ↑ DTR
• Laryngospasms
• Confusion
• Change in LOC
• Bone pain
• Weak B’s:
o Weak bones → risk
for fracture
o Weak blood clotting
→ risk for bleeding
Manifestations:
• Constipation
• ↓ DTR
• Severe muscle
weakness
• ↓ HR = ↓ CO
• ↓ RR
• ↑ BP
• Osteomalacia (fx risk)
• Immunosuppression
• ↓ platelet = ↑ bleeding
• Irritable
• Confusion
• Seizure
• Calcium + Phosphate =
inverse
• Magnesium +
Phosphate = inverse
• Associated w/ Ca+ & K+
HYPERphosphatemia:
•
Give PHOSLO
(Calcium Acetate) w/
food
o Phosphate binder
• Avoid phosphate enema
• Diet
• Dialysis → last resort
o Weak heart beats →
cardiac dysrhythmias
Causes:
• Hypoparathyroidism
• Healing fractures
• Renal failure
• DKA (initial)
• Bone tumors
• Vitamin D intoxication
•
Causes:
• Hyperparathyroidism
• Hypercalcemia
• Malnutrition
• Malabsorption
• Alcoholism
• DM; DKA
• Overuse of diuretics
• Burns
• Vitamin D deficiency
HYPOphosphatemia:
• Give PO phosphate,
Vitamin D
• IV phosphate
o Ensure kidney
function
o Watch Ca+ levels
o Monitor EKGs
• Seizure precaution
• Fall risk
• Diet