Hyponatremia
- Sodium, <135 mEq/L
ECF Cation (+), Sodium is most abundant
electrolyte in ECF.
Cause: Decreased ADH causes loss +H20. Assess
for lithium toxicity. Can be too much water or loss of
sodium. Kidney retains sodium to compensate for
fluid loss, deficiency of aldosterone (adrenal
insufficiency). Lost in sweat.
S/S: poor skin turgor, dry mucosa, headache, low
saliva production, orthrostatic drop in BP, nausea,
vomiting, abdominal cramping, neurological
changes, status epilepticus, coma (cerebral edema),
muscle cramps, anorexia, fatigue, lethargy, muscle
twitching, seizures & death.
Treatment: lactated ringer or 0.9% NACL, IV
Sodium. Water restriction.
Hypokalemia
- Potassium, <3.5 mEq/L
Cation (+), Intracellular (98%)
Cause: Lost in sweat, most diuretics, except those
that work at last distal tubule (thiazide, loop
diuretics), kidneys affect potassium levels.
Medications: corticosteroids, sodium penicillin,
amphotericin B, GI loss, common cause:
vomiting/GI suctioning. Seen in patients w/persistent
insulin hypersecretion, alcoholism, anorexia.
S/S: Severe: Death by cardiac/respiratory arrest,
fatigue, N/V, muscle weakness, leg cramps, often
asst/ w/metabolic alkalosis.
Treatment: Diet, cautious IV
Hypocakcemia
- Calcium, <8.6 mg/dL
Cation (+), Calcium plays major role in transmitting
nerve impulses and helps regulate muscle
contraction/relaxation, including cardiac muscles
Cause: Third space shift occurs in these patients.
Regulated by parathyroid (PTH). Primary
hypoparathyroidism.
S/S: Tetany (common), increases neural excitability,
tingling sensation, painful spasms, “Trousseau's sign”
seizures, depression, delirium, ventricular tachycardia.
dyspnea (SOB), laryngospasm. Hyperactive bowel signs,
dry/brittle nails. Hyperphosphatremia
Treatment: Diet, cautious IV (life threatening),
avoid too rapid = cardiac arrest preceded by
bradycardia)
Hypernatremia
+ Sodium, >145 mEq/L
ECF Cation (+), Sodium is most abundant
electrolyte in ECF.
Cause: Gain of sodium/loss of water. Common: fluid
deprivation in unconscious patients. Very old or very
young. Administration of hypertonic enteral feeding
without adequate water supplements, diarrhea,
hyperventilations, burns. Less common: heat stroke, near
drowning in salt water, IV hypertonic saline.
S/S: Neurological, water moves to ECF w/all
dehydration. Thirst, dry mouth, postural hypotention,
increased muscle and deep tendon reflexes.
Treatment: Assess for overload in cardiac patients.
Avoid too fast water because dangerous cerebral
edema happens. IV hypotonic electrolyte solution.
Diuretics prevent. push fluids.
Hyperkalemia
+ Potassium, >5.0 mEq/L
Cation (+), Intracellular (98%)
Cause: Less common than hypokalemia.
Aldosterone is released, diuretics that work at last
distal tubule (thiazide, loop diuretics), kidneys affect
potassium levels.
S/S: Severe: Ventricular dysrhythimics, and cardiac
arrest, muscle weakness, paralysis, r/t depolarization
block in muscle. Effects primarily on peripheral
nervous system. Nausea, diarrhea, intestinal colic.
Treatment: IV Calcium gluconate, beta2 antagonist,
DX: ECG
Hypercakcemia
+ Calcium, <10.2 mg/dL
Cation (+), Calcium plays major role in transmitting
nerve impulses and helps regulate muscle
contraction/relaxation, including cardiac muscles
Cause: Malignancies, hyperparathyroidism,
severe/multiple fractures, spinal cord injury, thiazide
diuretics.
S/S: Life-threatening, 50% die if not treated
promptly. Reduces neuromuscular excitability.
Muscle weakness, in-coordination, constipation,
N/V, confusion, impaired memory, slurred speech,
lethargy, coma. Sever: Cardiac arrest.
Treatment: Flurosemide, IV phosphate, 0.9%
NACL, Calcitonin, increase mobility & push fluids
 Hypomagnesemia
- Magnesium, >1.3 mg/dL
Cation (+), ICF
Cause: Loop & thiazide diuretics. NG suctioning,
diarrhea/fistulas. Common in acutely & critical
patients, often withdrawal from alcohol &
administration of ET feedings. Aminioglycosides,
digitalis, amphotericin. Occurs in diabetic
ketoacidosis, pregnancy, lactation, sepsis, burns,
hypothermia and dysphagia.
S/S: Increases irritability of muscle & contraction.
Neuromuscular junction excitability, Chrostek's &
Trousseau's sign tetany.
Treatment: Diet, oxide or gluconate form IV
magnesium sulfate.
Hypophosphatemia
- Phosphorus, <2.5 mg/dL
Anion (-), Intracellular
Cause: Regulated by parathyroid (PTH). During
administration of calories to patients with severe
protein-calorie malnutrition. Alcoholism. Heat-
stroke, hyperventilation, diabetic ketoaidosis,
respiratory alkalosis, major thermal burns, osmotic
diuresis, malignancies. Phosphorus crical component
of body's tissues, muscle & RBCs.
S/S: Most result from deficiency of ATP, irritability,
fatigue, apprehension, weakness, numbness,
dysphagia, confusion, seizure, coma, muscle damage
may occur as ATP level drops. Rickets.
Treatment: Prevention! IV phosphorus only for
severe cases. Diet increase phosphorus
Hypochloremia
- Chloride, <97 mEq/L
Anion (-), ECF
Cause: Lost in sweat. Found in interstitial and
lymph fluid (more than blood) gastric, pancreatic
juices, bile & saliva. Assist in determining osmotic
pressure. Lost in feces. GI tube drainage, GI suction,
N/V, low sodium intake, metabolic alkalosis,
massive blood transfusion, diuretics, burns & fever.
Hyperkalemia.
S/S: Hyperexcitability of muscle, tetany, hypoactive
DTRs, weakness, twitching, muscle cramps, avoid look,
osmotic or thiazide diuretics.
Treatment: Treat cause of hypochloremia, normal
saline & 0.45% replace chloride. Ammonium
chloride, sometimes used (not for renal failure) diet.
Hypermagnesemia
+ Magnesium, >2.3 mg/dL
Cation (+), ICF
Cause: Renal failure (most common), untreated diabetic
ketoacidosis, Addison's disease, hypothermia,
adrenocortical insufficiency, excessive antacids/laxatives,
medications that decrease GI motility (opioids and
antichlinergics) excessive injury, necrosis (trauma, shock,
sepsis, cardiac arrest and severe burns.
S/S: Diminishes excitability of muscle cells.
Decrease BP, N/V, facial flushing, lethargy, difficulty
speaking, drowsiness, coma, cardiac arrest.
Treatment: Ventilatory support, IV Calcium
gluconate
Hyperphosphatemia
+ Phosphorus, >4.5 mg/dL
Anion (-), Intracellular
Cause: Regulated by parathyroid (PTH). Renal
failure (most common), excessive vitamin D,
chemotherapy, hyperparathyroidism, acidosis,
muscle necrosis.
S/S: Few. Tetany (most important), anorexia,
tingling, N/V, bone & joint pain, muscle weakness,
tachycardia, hyperreflexia, soft tissue calcification.
Treatment: Treat underlying disorder. Surgery for
removal of large calcium & phosphorus deposits.
Hyperchloremia
+ Chloride, >107 mEq/L
Anion (-), ECF
Cause: Found in interstitial and lymph fluid (more
than blood) gastric, pancreatic juices, bile & saliva.
Assist in determining osmotic pressure. Almost
always because of introgenically induced
hyperchloremic metabolic acidosis from excessive
9.9% NACL, head trauma, increased perspiration,
excessive adrenocortical hormone production,
decreased glomerular filtration.
S/S: Tachypnea, weakness, lethargy, deep rapid
respirations, diminished cognitive ability, hypertension.
Treatment: Correct underlying cause, Lactated
ringers, diuretics, IV sodium bicarbonate.
 Metabolic Acidosis
(Base Bicarbonate -)
- pH, <7.35
Cause: Gain of hydrogen or loss of bicarbonate.
Diarrhea, early renal insufficiency, excessive
administration of chloride, lactate.
S/S: Headache, confusion, drowsiness, increased
respirations, rate/depth, N/V
Treatment: Correct imbalance.
Respiratory Acidosis
(Carbonic Acid +)
- pH, <7.35, PACO2 >42mmHg
Cause: Inadequate excretion of Co2 w/inadequate
ventilation. Pulmonary edema, aspiration of foreign
objects, atelectasis, pneumothorax, overdose of
sedatives, sleep apnea, o2 give to pt w/hypercapnia,
severe pneumonia, acute respiratory distress
syndrome, emphysema, bronchitis.
S/S: Sudden hypercapnia, increased pulse, increased
respiratory rate, increased blood pressure, mental
cloudiness, ventricular fibrillation, hypercalemia.
Treatment: Improve ventilation, broncodilators,
antibiotics, thrombolytics, anticoagulants. Increased
fluids, Oxygen given, semi-fowler's position.
Metabolic Alkalosis
(Base Bicarbonate +)
- pH, >7.45
Cause: Gain of bicarbonate or loss of hydrogen.
Vomiting, GI suction, diuretic therapy that potassium
wasting (thiazide, furosemide), excessive
adrenocorticoid hormone.
S/S: r/t calcium ionization, tingling finger/toes,
dizziness, hypertonic muscles, decreased
respirations, tachycardia.
Treatment: Correct underlying cause. Give sodium
chloride fluids, potassium given
Respiratory Alkalosis
(Carbonic Acid -)
- pH, >7.45, PACO2 <38mmHg
Cause: Hyperventilation, extreme anxiety,
hypoxemia, salicylate, intoxication, gram – bacteria,
inappropriate ventilator. .
S/S: lightheadness, decreased blood flow, inability to
concentrate, numbness, tingling from decreased
calcium ionization, tinnitus, loss of consciousness,
tachycardia, ventricular & atrial dyshrythmias,
Treatment: Correct underlying cause. Breath
slower/Breath into bag