Electrolyte Imbalances
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By purchasing this material, you agree to the following terms and conditions: you agree that this material and all other media produced by
NurseInTheMaking LLC are simply guides and should not be used over and above your course material and teacher instruction in nursing school.
When details contained within these guides and other media differ, you will defer to your nursing school’s faculty/staff instruction. Hospitals and
universities may differ on lab values; you will defer to your hospital or nursing school’s faculty/staff instruction. These guides and other media
created by NurseInTheMaking LLC are not intended to be used as medical advice or clinical practice; they are for educational use only. You also agree
to not distribute or share these materials under any circumstances; they are for personal use only.
© 2023 NurseInTheMaking LLC. All content is property of NurseInTheMaking LLC and www.anurseinthemaking.com. Replication and distribution of
this material is prohibited by law. All digital products (PDF files, ebooks, resources, and all online content) are subject to copyright protection. Each
product sold is licensed to an individual user and customers are not allowed to distribute, copy, share, or transfer the products to
any other individual or entity, they are for personal use only. Fines of up to $10,000 may apply and individuals will be reported to
the BRN and their school of nursing.
Sodium (Na+) Imbalance
Nurse in the making
< 135 mEq/L =
> 145 mEq/L =
HYPERNATREMIA
SIGNS & SYMPTOMS
“fried salt”
F
R
flushed skin
I
increased BP
& fluid retention
E
D
S
A
L
T
Restless, anxious,
confused, irritable
RISK FACTORS
“salt loss”
Sodium
imbalances
can lead
to neuro
changes
S
A
decreased urine output
Skin is dry
agitation
Low-grade fever
Stupor/coma
anorexia
(nausea/vomiting)
L
Lethargy
(weakness/fatigue)
T
Edema (pitting)
tachycardia
(thready pulse)
Where Sodium goes,
Water flows!
seizures/headache
stomach cramping
(hyperactive bowels)
TWO TYPES OF HYPONATREMIA:
Nª+
Sodium intake
• Oral ingestion
Nª+
• Adm. of
IV fluids w/ sodium
(hypertonic IV fluids)
HYPOVOLEMIC
HYPONATREMIA:
HYPERVOLEMIC
HYPONATREMIA:
From ↓ levels of fluid
& sodium
From ↑ levels of water in the
body which DILUTES sodium
↓ water = ↑ salt
(Hemoconcentration)
Nª+
Nª+
• LOSS OF SODIUM from:
• Diaphoresis
• Diarrhea & vomiting
5 D S • Drains (NGT suction)
• Diuretics
• SiaDh (dilution)
•
in water
• Heart failure
• Adm. IV fluids
(hypertonic solution)
• Restrict sodium intake
• Adm. IV fluids if due to fluid loss:
(isotonic or hypotonic solutions)
© 2023 NurseInTheMaking LLC
O
S
S
Limp muscles
(muscle weakness)
Orthostatic hypotension
Sodium
imbalances
can lead
to neuro
changes
(dry mucous membranes)
• LOSS OF FLUIDS from:
• Fever
• Burns
• Diabetes insipidus (DI)
L
If there is a lot of sodium in
the vessels, there will also be
a lot of water in the vessels;
this is why these symptoms
are seen
thirst
•
TREATMENT
HYPONATREMIA
↑ water = ↓ salt
(All the water dilutes the sodium - hemodilution)
Hypertonic
solutions
contain HIG
H
amounts of
salt
TREAT
UNDERLYIN
G
CAUSE!
• Place patient on seizure precaution
• Place the patient on fluid restriction if due to SIADH
(they are in fluid volume overload)
• Place patient on airway protection (NPO)
• Never give food or water to a patient who
is lethargic, confused, or in a comatose state
Risk for
aspiration
Potassium (K+) Imbalance
Nurse in the making
< 3.5 mEq/L =
> 5 mEq/L =
HYPERKALEMIA
HYPOKALEMIA
Muscles contract for TOO long
=
Tight & contracted
Generalized weakness in the muscles
(Example: smooth muscle in bronchi, GI system)
• Weak muscles & LESS contraction
SIGNS & SYMPTOMS
“murder”
M
urine abnormalities
E
eKG changes
• Slowing of GI system (constipation)
•
Respiratory distress
Hyperkalemia
think High (peaked)
Blood pressure
(especially with position change)
• Nausea, vomiting, bloating
decreased cardiac contractility
(↓ HR, ↓ BP)
Reflexes (↓ DTR )
Reflexes
• Shallow breathing
muscle cramps & weakness
U
R
D
R
•
• EKG changes
Low levels
of potassium
can cause:
Flattened T-wave or
inversion of the
T-wave
High levels
of potassium
can cause:
Hypokalemia think low
(flattened or inversion)
Tall, peaked
T-waves
RISK FACTORS
• Intake of too much potassium
(IV fluids with K+)
• Low potassium intake (not eating, NPO diet)
• Adrenal gland issues (insufficiency)
• Vomiting & diarrhea
• High levels of acid in blood (acidosis)
• Gastric suction
• Non-steroidal anti-inflammatory drugs (NSAIDs)
(ibuprofen, naproxen)
• Alkalosis
• Potassium-wasting diuretics (loop or thiazide)
• Potassium-sparing diuretics (spironolactone)
TREATMENT
REPLACE the potassium
• Stop potassium intake (IV or PO)
• Adm. medications
• IV sodium bicarbonate
• IV calcium gluconate
© 2023 NurseInTheMaking LLC
EKG monitoring
for both:
potassium imbalances
can cause cardiac
dysrhythmias that
can be lifethreatening!
Oral potassium
supplement
IV potassium
• ALWAYS dilute in fluid
• Potassium can
burn the vein, therefore
infuse SLOWLY!
• Never administer
potassium via IV push
Calcium (Ca+) Imbalance
Nurse in the making
< 9 mg/dL =
> 11 mg/dL =
HYPERCALCEMIA
HYPOCALCEMIA
“cats go numb”
C
SIGNS & SYMPTOMS
“Backme”
B
A
A
T
S
bone pain
Arrhythmias
C
K
M
E
Convulsions/seizures
Arrhythmias
Tetany
spasms & stridor
GO NUMB
cardiac arrest (bounding pulses)
kidney stones
Also called
renal calculi
muscle weakness
Numbness in fingers, face, limbs
POSITIVE TROUSSEAU’S:
Carpal spasm caused by
inflating a blood pressure cuff
Excessive urination
CHVOSTEK’S SIGNS:
Contraction of facial muscles w/
a light tap over the facial nerve
TREATMENT
RISK FACTORS
Think “C” for
Cheesy smile
•
Calcium absorption
•
Calcium excretion
• Kidney disease
The kidney
s
are unable
to
excrete exce
ss
calcium ou
t of
the body
• Issues absorbing calcium from the GI tract
• Too much calcium leaving the body from excretion
• Kidney disease
• Use of thiazide diuretics
(
• HYPERparathyroidism & HYPERthyroidism
• Diuretics
• Diarrhea
• Drainage from wounds
• Bone breakdown from metastatic cancer
• Highly concentrated blood
(hemoconcentration)
• Stop calcium intake (IV or PO)
• Adm. medications to
calcium levels
• Phosphorus
• Calcitonin
© 2023 NurseInTheMaking LLC
Calcitonin helps
tone down calcium
levels in the blood
phosphorus and low vit D = hypocalcemia)
Can be from
dehydratio
n!
A patient with a
calcium imbalance
is at risk for a
pathological
fracture
Move the patient
carefully and
slowly
•
calcium intake in diet
• Calcium supplements
• Vitamin D
• Calcium gluconate
• Initiate seizure precautions
• High risk for seizures
Magnesium (Mg) Imbalance
Nurse in the making
< 1.5 mg/dL =
> 2.5 mg/dL =
HYPERMAGNESEMIA
Low
everything – sedated
DTRs (deep tendon reflex)
high
everything – not sedated
DTRs (deep tendon reflex)
“Hyperreflexia”
Energy (drowsiness/coma)
SIGNS & SYMPTOMS
HYPOMAGNESEMIA
Magnesium
acts like a
SEDATIVE!
HR (tachycardia)
HR (bradycardia)
BP (hypertension)
BP (hypotension)
• Shallow respirations
RR (bradypnea)
• Twitches, paresthesias
• Tetany & seizures
Respirations (shallow)
• Irritability & confusion
Bowel sounds
POSITIVE TROUSSEAU’S:
Also seen in
hypocalcemia.
Ca & Mg rise
and fall
together!
Carpal spasm caused by
inflating a blood pressure cuff
CHVOSTEK’S SIGNS:
Contraction of facial muscles w/
light tap over the facial nerve
RISK FACTORS
Think “C”for
Cheesy smile
• Increased magnesium intake
• Magnesium-containing antacids (TUMS)
& laxatives
• Excessive adm. of magnesium IV
• Renal insufficiency
•
renal excretion of Mg =
Mg in the blood
• Diabetic ketoacidosis (DKA)
• Insufficient magnesium intake
• Malnutrition/vomiting/diarrhea
• Malabsorption syndrome
• Celiac & Crohn’s disease
• Increased magnesium excretion
• Diuretics or chronic alcoholism
• Intracellular movement of magnesium
• Hyperglycemia & insulin adm.
• Sepsis
TREATMENT
• Adm. loop diuretics
• IV administration of calcium chloride
or calcium gluconate
• Restrict dietary intake
of magnesium-containing foods
• Avoid the use of laxatives &
antacids containing magnesium
• Use of hemodialysis in severe cases
© 2023 NurseInTheMaking LLC
• Adm. magnesium sulfate IV or PO
• Place patient on seizure precautions
• Instruct patient to
intake of
magnesium-containing foods
Nuts & seeds
Legumes
Whole grains
Milk
Phosphorus (P) Imbalance
Nurse in the making
< 2.5 mg/dL =
> 4.5 mg/dL =
HYPOPHOSPHATEMIA
SIGNS & SYMPTOMS
HYPERPHOSPHATEMIA
Directly leads to LOW levels of calcium
(hypocalcemia)
• Muscle spasms & tetany
• Cardiac arrhythmias
• Seizures
• Dry & brittle skin/nails
RISK FACTORS
• Kidney dysfunction
• Consistent use of
enemas and/or laxatives
• Rhabdomyolysis
• Vitamin D toxicity
An injured
kidney is unab
le
to filter the ex
cess
phosphate, ca
using
levels to rise
in the
blood
• Delayed growth & development
in children
• Poor bone density
& frequent fractures
• Loss of appetite
• Cardiac arrhythmias
• Chronic vomiting or diarrhea
• Example: eating disorders
that involve vomiting
• Overconsumption of diuretics
• Patients with significant
burn injuries
• Malnutrition & starvation
• Hypoparathyroidism
• ETOH (alcohol) dependency
• Acromegaly
TREATMENT
• Fatigue & weakness
• Refeeding syndrome
Foods that
are high in
Diet Modifications:
phosphorus
•
Dietary phosphorus
Red meat, beans,
dairy products,
• Use dialysis for patients with
end-stage renal disease (ESRD) nuts, & lentils
• Control hypertension to maintain
kidney function
Anything that
causes loss
of FLUIDS
↑ vomiting,
urination,
defecation, or
fluid loss from
burns all cause
phosphate to
leave the body
=
Lower serum
level of
phosphate
Diet Modifications:
•
Dietary phosphorus
• Adm. oral or IV phosphate
• Reintroduce nutrients slowly in
patients with history of starvation
to prevent refeeding syndrome
• Reduce diuretic dosing/use
• Provide proper care & recovery of burns
P =
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Cª+ → INVERSE RELATIONSHIP
Chloride (Cl) Imbalance
Nurse in the making
< 95 mEq/L =
> 105 mEq/L =
HYPOCHLOREMIA
SIGNS & SYMPTOMS
HYPERCHLOREMIA
• HYPOtension & tachycardia
• HYPERtension
• Fluid retention
• Mental status changes
• Muscle weakness
• Generalized swelling
• Fatigue
• Peripheral edema
• Cardiac arrhythmias
• Hypernatremia (
Similar
ptoms
signs & sym
tremia
of HYPOna
levels)
(low sodium
• Dehydration related to large
fluid volume loss through:
sodium)
TREATMENT
RISK FACTORS
• Overuse of IV sodium chloride
• Vomiting & diarrhea
• Metabolic acidosis
• Renal damage
• The kidneys are not able to filter & excrete
excess chloride = ↑ chloride in the body
• Dehydration
• Decrease water = increased concentration
of chloride in the body
• Syndrome of inappropriate
antidiuretic hormone secretion
(SIADH)
• Overuse of diuretics
• Addison’s Disease
• Metabolic alkalosis
• Uncontrolled glucose levels
• Excessive suctioning of gastric contents
• Diabetes insipidus (DI)
• Potassium imbalance
Diet Modifications:
•
Dietary salt intake
with meals
Diet Modifications:
• Sodium restriction
•
Fluids to flush salt
• Oral or IV fluids
• Adm. IV potassium
• Start blood glucose management or insulin
• Use dialysis in patients with renal disease
Cll =
Cll =
© 2023 NurseInTheMaking LLC
• Adm. IV sodium chloride
• Rehydration
• Limit or reduce diuretic use
Nª+
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Dear future nurse,
You may be stressed, you may feel tired,
and you may want to give up. Nursing school is
hard, there's no doubt about it. Everyone cries,
everyone has meltdowns, and there will be
moments you don't feel qualified for the task at
hand. But take heart, the challenge only makes
you stronger. Put in the work, show up on time,
and find an amazing study group. You got this!
– Kristine Tuttle, BSN, RN
By purchasing and/or downloading this material, you agree to the following terms and conditions: you agree that this ebook and all other
media produced by NurseInTheMaking LLC are simply guides and should not be used over and above your course material and teacher
instruction in nursing school. When details contained within these guides and other media differ, you will defer to your nursing school’s faculty/
staff instruction. Hospitals and universities may differ on lab values; you will defer to your hospital or nursing school’s faculty/staff instruction.
These guides and other media created by NurseInTheMaking LLC are not intended to be used as medical advice or clinical practice; they are for
educational use only. You also agree to not distribute or share these materials under any circumstances; they are for personal use only.
© 2023 NurseInTheMaking LLC. All content is property of NurseInTheMaking LLC and www.anurseinthemaking.com. Replication and
distribution of this material is prohibited by law. All digital products (PDF files, ebooks, resources, and all online content) are subject to
copyright protection. Each product sold is licensed to an individual user and customers are not allowed to distribute, copy, share, or
transfer the products to any other individual or entity, they are for personal use only. Fines of up to $10,000 may apply and individuals
will be reported to the BRN and their school of nursing.
www.anurseinthemaking.com