Electrolyte Imbalance Study Notes: Na, K, Ca, Mg

Normal Na+ level135mEq/L-145mEq/L How are Na levels regulated thru RAAS  RAAS functions byKidneys secrete Renin when they sense a drop in blood volume and blood pressure Reninin converts Angiotensinogen to Angiotensin 1 ACE (angiotensin converting enzyme) in the lungs converts Angiotensin 1 to Angiotenisn 2.  Angiotensin 2 stimulates release of Aldosterone in the Kidneys, which causes water and sodium retention Hypothalamus is stimulated to thirst and ADH is secreted to inc water retention Reduced sensitivity in baroreceptors causes BP to inc Overal: BP increases (baroreceptors) and BV increase (intake/save water and Na) HypernatremiaHigh-sodium (sodium lvls greater than 145 mEq/L) Causes hyperosmolality leading to Cellular Dehydration (low water, remaining water has high sodium conc) Hypertonic saline solutions can cause:Hypernatremia Hypernatremia affects the CNS byLethargy Agitation Seizures Coma (thirst,edema,weakness) HyponatremiaLow-sodium sodium levels less than 135mEq/L Results from loss of sodium, inadequate sodium intake, or from excess water Cues of HyponatremiaDec urine output CNS: confusion/alt mental status Cerebral Edema SIADHSymptoms of Inapropriate Diuretic Hormone Excess ADH dillutes conc of Na in body Norm Potassium lvls3.5mEq/L-5.0mEq/L Potassium FunctionMajor ICF Cation Used for transmission and conduction of nerve and muscle impulses Cellular Growth Maintenance of Cardiac Rhythms Acid-Base Balance HyperkalemiaHigh-Potassium High serum potassium  Blood lvls higher than 5mEq/L Caused by:  large intake of potassium impaired kidney function massive cellular destruction ACE inhibitors (lisonopril, enalapril) Aldactone Low sodium/ salt substitues can cause Hyperkalemia becausethey contain large levels of Potassium How do Ace Inhibitors cause HyperkalemiaAce inhibitors cause a decrese in Glomerular Filtration, which decreases renal function, and decreases the excretion of potassium. Thus excess potassium stays in system.  How does Aldactone cause Hyperkalemia Aldactone causes decreased glomerular filtration, which decreases renal function, and decreases the ammount of potassium leaving thru urine, causing a build up.  Cues of HyperkalemiaLeg Cramp/Pain Weak or Paralyzed skeletal muscle  Ventricular Fibrilation or cardiac standstill Peaked T waves, widened QRS Abdominal Cramping or Diarrhea "<img src=""Screenshot 2023-09-07 at 8.36.51 PM.png""> Is This Hypokalemia or Hyperkalemia Describe it shape difference to that of a regular EKG"Hypokalemia  T wave inversion ST Depression Prominant U wave "<img src=""Screenshot 2023-09-07 at 8.38.51 PM.png""> Is this Hypokalemia or Hyperkalaemia Describe it shape difference to that of a regular EKG"Hyperkalaemia Peaked T Waves P wave flattening Wide QRS complex To treat Hyperkalemia :Eliminate Oral and Paranteral K intake  Increase elimination of K  ---Loop diuretics (lasix) --Dialysis --Kayexalate How do Loop Diuretics aid in Elimination of PotassiumLoop diuretics work by blocking off Na+K+2Cl cotransporters in the loop of henle and creating a buildup of sodium in the collecting duct, creating a more negative charge, causing the K-Na pump to pump more potassium into the collecting duct where it is excreted How do thiazide diuretics increase elimination of PotassiumCause a buildup of Sodium in the collecting duct, which pulls more potassium in thru the K-Na pump, allowing for more K to be secreted kayexalte function in elemination of potassiumBinds to K and eliminates excess thru fecees why is Calcium Gluconate administered during Hyperkalemia To stabalize membrane potential Why is insulin administered during HyperkalemiaPromotes the sodium potassium pump and remove excess potassium from the ECF Hypokalemialow-potassium less than 3.5mEq/L low seru potassium caused by : -abnormal loss of K+ ---kidneys or GI tract Magnesium Deficiency (w/o magnesium, potassium cannot be transported) Metabolic alkalosis Most common: Thiazide and Loop Diuretics How does hypokalemia cause Metabolic Alkalosis caused bc excess sodium absorption will cause a neg charged lumen causing elevation in serum bicarbonate and elevated pH Cues for Hypokalemniaweakness of resp muscles cardiac irregularities  weak skeletal muscles (legs) dec GI motility  impaired reg of arteriolar blood flow Treatments for Hypokalemia"KCl supplements (orally or IV) ---shouldnt exceed 10-20mEq/L to prevent Hyperkalemia and cardiac arrest ---IV K should be given slowly bc it's potentially fatal (cardiac arrest)" <div>Function of Spironolactone in relation to Potassium</div>its a diuretic which that spares potassium and keeps them from reaching low levels, would not be given if a patient is Hyperkalemic  Calcium has an inverse relationship withPhosphorus Magnesium is used to move Potassium Phosphorus used to moveCalcium Calcium Lvls (total and ionized)Total: 8.8-10.5 mg/dl Ionized: 4.5-5.6 mg/dl 30% of calcium from foods is absorbed in the:GI tract Calcium is stored in ____. Stabalizes ____ ______. bones, cell membranes  Ionized form of calcium is biologically active Calcium is present in the serum in three forms: Free or ionized Bound to protein (primarily albumin) Complexed with phosphate, citrate, or carbonate Functions of Calcium (5)Nerve imnpulse transmission Myocardial contractions Blood Pressure (inc vasoconstriction) Formation of teeth and Bone Muscle contractions Calcium Balance controlled by (3)Parathyroid Hormone (inc calcium lvls in blood) Calcitonin (red blood calcium) Vitamin D (aid in calcium absorption) HypercalcemiaHigh Calcium 10.5mg/dl + Causes of Hypercalcium (5)"Hyperparathyroidism (2/3 of the time)  Malignancy and Tumors (caused by inc PTH made) Vit D overdose (inc calc absorption) Prolonged Immobilization Addison's Disease ( dec cortisol = no vit D inhibition and high vit D levels)" Hyper calcemia ManifestationsMuscle weakness Loss of muscle tone bone pain/ osteoporosis  Arrhythmias Lethargy Kidney Stones (hard water has limestone = inc calc ) Constipation  Potential Complication for Hypercalcemia?Dysrhythmias (abnormal beating of heart) In hypercalcemia, patient must drink ____ to _____ mL of fluid daily to promote the renal excretion of calcium and to dec the possibility of kidney stone formation.3,000 to 4,000 Picamycin (mithracin) is a cytotoxic antibiotic that inhibits:bone break down, thus loweing serum calcium levels Pamidronate (aredia) is used when ________ is caused by__________.hypercalcemia, malignancy  some cancers can cause high blood calcium, and  in this case, Pamidronate (aredia) would be used to increase phosphorus levesl as a means of decreasing calcium. Hypocalcemia cause (6)Decreased productvity of PTH (possibly caused by a thyroidectomy) Hypomagnesium (inhibits PTH so calc levels drop) Pancreatitis (fat necrosis and precipitation of calcium soaps) Alkalosis (inc Ph dec ionized calc) Renal Failure (kidney secrete active form of Vit D which increases calcium reabsorption) Multipil Blood Transfusions Cues/Manifestations of Hypocalcemia"Inc muscle tone Possitive Troussaeu's or Chvostek Sign Laryngeal Stridor Dysphagia Arrhythmias Tingling around mouth or extremities Seizures " Chvosteks TestTests for Hypocalcemia Tap facial nerve on anterior side of face near ear If lip twitch or muscle spasm then + for hypocalcemia "Trousseau's Test"Tests for Hypocalcemia Inflant BP cuff above SBP and if hand cramps up then + for Hypocalcimia (think the italian hand sign) during Hypocalcemia theres a risk of _______ imbalance, risk for ______, and ______ as a potential complication.Electrolyte Injury Fracture  Pracaution when administering IV Calcium?Administer slowly, too rapid can cause hypercalcemia  How can Calcium be adminstered to a Hypocalcimic Patient? What meathod of administration isnt recomended?Oral or IV Intramuscular can cause a local reaction. Norm Magnesium Lvls1.3-2.1mEqL 50-60% of ______ is contained in boneMagnesium _______ is a coenzyme of metabolism of protein and carbohydrates.Magnesium Factors that regulate calcium balance also influence ?Magnesium Balance Magnesium aids in absorption of calcium into bones  Magnesium directily acts on ____ _____ (smooth). Myonerual Junction **important for normal cardiac function.  Hypermagnesemia what is it and what causes ithigh-magnesium 2.1mEqL+ High serum magnesium Caused by inc intake or ingestion of products contacting magnesium.  Also caused by renal insufficiency/ failure Cues of Hypermagnesemia (6)Decrease in DTR Lethargy or Drowsiness (Somnolence) Nausea/ Vomitting Muscle weakness Resp and Cardiac Arrest How to treat hypermagnesemia (3)Emergency Treatment *IV CaClor calcium gluconate  Fliuds to promote urinary excretion Dialysis in presence of renal failure  Hypomagnesemia Causes and levelLow Magnesium Low serum magnesium  Less than 1.3 mEqL Causes: Prolonged Fasting/Starvation Chronic Alcoholism: Alc dec mineral absorption in intestine and alc is a diuretic that causes and intracellular shift Fluid loss from GI Tract Prolonged Parenteral (IV) nutrition w/o supplementation Diuretics Hyperglycemia (insulin resistance reduces Mg reabsorption during urination) Cues of HypomagnesiumConfusion Increased DTR Tremors Seizures Cardiac Dysrhtmias Treat HypomagnesemiaOral supplements Inc diatery intake Parenteral IV or IM of magnesium when severe Foods high in magnesium:Green vegetables Nuts (almonds have most) Banannas Oranges Peanut Butter Chocolate Phosphate Normal lvsl and FunctionPO4: 2.5mEq/L-5.0mEq/L Function: involved in acid base buffering system, ATP production, and cellular uptake of glucose Phosphate maitenance is related to ______ levels.Calcium  Hyperphosphatemia lvl and causehigh phosphate serum cause:  *kidney failure *chemotherapy Excessive Ingestion of Phosphate ----Alendronate (fosamax) ----Ibandronate (Boniva) ----Bisphosphonates What medication casue Excessive Ingestion of Phosphate----Alendronate (fosamax) ----Ibandronate (Boniva) ----Bisphosphonates Hyperphosphatemia CuesCalcified deposits in soft tissue such as joints, arteries, skin, kidneys, and corneas Neuromuscular irritability and Tetany (muscle lock up) Cues of Hyperphosphatemia are similar to Hypocalcemia Foods with Phosphorus: 6Dairy Beans Meat Nuts Seeds Grains To manage Hyperphosphatemia you can: 3restrict food and fluids containing phophorus adequte hydration and correction of Phosphate and Calcium conditions avoid food high in phosphate (dairy, nuts, meats, seeds, grains, beans) Hypophosphatemia lvl an cause (4)Low serum Phosphate (less than 2.5mEqL) Causes: *Malnourishment/Malabsorption *alcohol Abuse/withdrawl *Use of phosphate binding antacids  *During parenteral nutrition w/ inadequate replacement Cues of HypophosphatemiaCNS depression Confusion Muscle Weakness and Pain Dysrhythmias Cardiomyopathy Hypophosphatemia Management (3)Oral supplements: Neutra-phos  Ingestion of foods high in phosphorus  IV administration of sodium or potassium phosphate

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