Electrolytes and Electrolyte imbalances

Fluid Electrolytes:
Electrolytes	Normal values
Sodium	135-145 mEq/L
Potassium	3.5-5 mEq/L
Calcium	4.5-5.5 mEq/L
Magnesium	1.5-2.5 mEq/L
Phosphorous	2.5-4.5 mEq/dL

Sodium 135-145 mEq/L Function: PULLS or Attracts WATER
Hyponatremia
Values:	<>
Causes:	· Excess sodium loss or weight gain
Signs and symptoms:	· Hypotension · Confusion · Headache · Lethargy · Seizures · Decreased muscle tone · Muscle twitching and tremors · Vomiting · Diarrhea · Cramps
Treatment:	Mild: Water restriction if water retention problem; Increase sodium if there is loss of Sodium Moderate: IV 0.9% NS, 0.45% NS, LR Severe: 3% NS – short term Therapy in ICU setting
Hypernatremia
Values:	Deprivation of water, hypertonic tube feedings without food supplements, watery diarrhea, greatly increases insensible water loss, renal failure, inadequate blood circulation to kidneys, use of large doses of adrenal corticoids, excess sodium intake
Causes:	Early: generalized muscle weakness, faintness, muscle fatigue, HA Moderate: Confusion, thirst Late: Edema, restlessness, thirst, hyperreflexia, muscle twitching, irritability, seizures, possible coma Severe: Permanent brain damage, HPN, tachycardia, N&V
Signs and symptoms:	· Free water to replace ECF volume · Gradual lowering with hypotonic saline (decreased by no more than 2 meq/L/hr) · Offer fluids at regular interval · Supplement tube feedings with free water · Teach about foods, medications high in Sodium · Treat underlying problem
Treatment:	Deprivation of water, hypertonic tube feedings without food supplements, watery diarrhea, greatly increases insensible water loss, renal failure, inadequate blood circulation to kidneys, use of large doses of adrenal corticoids, excess sodium intake

Potassium 3.5-5 mEq/L Function: major intracellular ion; influences muscle activity & pH regulation
Hypokalemia
Values:	<3.5,>
Causes:	· Loss of GI secretions · Excessive renal excretion of K · Movement of K in cells (DKA) · Diuretics
Signs and symptoms:	· Skeletal muscle weakness · ↓ smooth muscle function · ↓DTR’s · ↓ BP, EKG changes, possible cardiac arrest · N/V, paralytic ileus, diarrhea · Metabolic alkalosis · Mental depression and confusion
Treatment:	1. Potassium supplements: · Oral replacement through high K diet · IV supplementation No more than 10 mEq/hr; for child 2-4 mEq/kg/24hr No more than 4 mEq/hr 2. Hypertonic glucose solution 3. Monitor: · I&O · Bowel sounds · VS, cardiac rythm · Muscle strength · Digoxin level if necessary
Values:	<3.5,>
Hyperkalemia
Values:	>5.3
Causes:	· Excessive Potassium intake especially in patients with Renal failure · Tissue trauma · Acidosis · Catabolic state
Signs and symptoms:	· ECG Changes · Tall, tented T-waves · Cardiac arrhythmias · Muscle weakness · Paralysis, · Paresthesia of tongue, face, hands and feet · N&V · Cramping · Diarrhea · Metabolic acidosis
Treatment:	1. 10% Calcium gluconate 2. Sodium Bicaronate 3. 50% glucose solution 4. Kayexalate PO or PR 5. Stop K supplements and avoid K in foods, fluids, salt substitutes

Magnesium 1.5-2.5 mEq/L Function: Activates intracellular enzyme systems and plays role in CHO & protein metabolism
Hypomagnesemia
Values:	<1.5
Causes:	· ↓ intake or ↓absorption or excessive loss through urinary or bowel elimination · Acute pancreatitis, starvation, malabsorption syndrome, chronic alcoholism, burns, prolonged hyperalimentation without adequate Mg · Hypoparathyroidism with hypocalcemia · Diuretic therapy
Signs and symptoms:	· Tremors, tetany, ↑reflexes, paresthesias of feet and legs, convulsions · +babinski, Chvosteck and Trousseau signs · Personality changes with agitation, depression or confusion, hallucination · ECG changes (PVC’s, Ventricular tachycardia, Ventricular Fibrillation)
Treatment:	Mild: · Diet: best sources are unprocessed cereal grains, nuts, legumes, green leafy vegetables, dairy products, dried fruits, meat, fish · Magnesium salts More severe: · MgSO4 IM · MgSO4 IV slowly --- --- --- · Monitor Mg q 12 hrs · Monitor VS, knee reflexes · Precautions for seizures/confusions · Check swallow reflex
Hypermagnesemia
Values:	>2.5mEq/L
Causes:	Most common cause: Renal failure (esp. If taking large amounts of Mg-cntaining antacids or cathartics; DKA with severe water loss
Signs and symptoms:	· Hypotension · Drowsiness · Absent DTR’s · Respiratory depression · Coma · Cardiac arrest · ECG – Bradycardia, CHB, cardiac arrest, tall T-waves
Treatment:	· Withholding Mg-containing products · Calcium chloride or gluconate IV for acute symptoms · IV hydration and diuretics · Monitor VS, LOC · Check patellar reflexes

Calcium 4.5-5.5 mEq/L Function: nerve & muscle contraction, cardiac function, clotting.
Hypocalcemia
Values:	<4.5>
Causes:	· Most common: depressed function or surgical removal of parathyroid gland · Hypomagnesemia · Hyperphosphatemia · Administration of large quantities of stored blood (preserved with citrate) · Renal insufficiency · ↓absorption of Vit D from intestines
Signs and symptoms:	· Abdominal and/or extremity cramping · Tingling and numbness · +Chvostek or Trousseau signs · Tetany (hyperactive reflexes) · Irritability, reduced cognitive ability, seizures · Prolonged QT on ECG, hypotension, decreased myocardial contractility · Abnormal clotting
Treatment:	· High Calcium diet or oral calcium salt (check for calcium content) · IV calcium as 10% calcium chloride or 10% calcium gluconate (give with caution) · Close monitoring of serum Ca and digitalis levels · ↓Phosphorus levels and ↑Magnesium levels · Vitamin D therapy
Hypercalcemia
Values:	>5.5 mEq/L
Causes:	· Mobilization of Ca from bone · Malignancy · Hyperparathyroidism · Immobilization – cause of bone loss · Thiazide diuretics · Thyrotoxicosis · Excessive ingestion of Calcium or Vit. D
Signs and symptoms:	· Anorexia, constipation · Generalized muscle weakness, lethargy, loss of muscle tone, ataxia · Depression, fatigue, confusion, coma · Dysrythmias and heart block · Deep bone pain and demineralization · Polyuria & predisposes to renal calculi · Pathologic bone fractures *Hypercalcemic crisis: 8-9 mEq/L
Treatment:	· NS IV – match infusion rate t amount of UOP · I&O hourly · Loop diuretics · Corticosteroids and mithramycin in cancer patients · Phosphorous / calcitonin · Encourage fluids · Keep urine acid

Phosphorous 2.5-4.5 mEq/dL Functions: Essential to tissue oxygenation, normal CNS function and movement of glucose into cells, assists in regulation of Calcium and maintenance of acid base balance Influenced by parathyroid hormone and has inverse relationship to Calcium.
Hypophosphatemia
Values:	<2.5meq/dl
Causes:	· Malnutrition · Hyperparathyroidism · Certain renal tubular defects · Metabolic acidosis · Disorders causing hypercalcemia
Signs and symptoms:	· Impaired cardiac function · Poor tissue oxygenation · Muscle fatigue and weakness · N/V, anorexia · Disorientation, seizures, coma
Treatment:	· Closely monitor and correct imbalances: - adequate amount of Phos - recommended dietary allowance for formula-fed infants 300 mg Phos/day for 1st 6 mos and 500 mg for latter ½ of first year - 1:1 ratio Phos and Ca recommended dietary allowance. Exception: infans whose calcium req’ts is 400 mg/day for 1st 6 mos and 500 mg for the next 6 months. · Treatment of moderate to severe deficiency: · Oral or IV phosphate (do not exceed rate of 10mEq/h) · Identify clients at risk for disorder and monitor · Prevent infections · Monitor levels during treatment
Values:	<2.5meq/dl
	· Malnutrition · Hyperparathyroidism · Certain renal tubular defects · Metabolic acidosis · Disorders causing hypercalcemia
Hyperphosphatemia
Values:	>4.5mEq/dL
Causes:	· Chronic Renal failure (most common) · Hyperthyroidism · Hypoparathyroidism · Severe catabolic states · Conditions causing hypocalcemia
Signs and symptoms:	· Muscle cramping and weakness · ↑HR · Diarrhea · Abdominal cramping · nausea
Treatment:	· Goal: PREVENTION! · Restrict phosphate-containing food · Administer phosphate binding agents · Diuretics · Treat cause · Treatment may need to focus on correcting calcium levels