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