1. Rachelle G. Peralta
ELECTROLYTE IMBALANCES
Imbalance Clinical manifestation Causes
1. Sodium Deficit -Anorexia, nausea and -use of diuretics,
(Hyponatremia) vomiting, headache, lethargy, excessive administration of
Serum sodium confusion, D5W and
<135 mEq/L muscle cramps and weakness, water supplements for patients
muscular twitching, receiving hypotonic
seizures, papilledema, dry tube feedings.
skin, ↑ pulse, ↓ BP Use of oxytocin
Labs indicate: ↓ serum and and certain tranquilizers
urine sodium, ↓ urine specific Hyperglycemia and
gravity and osmolality heart failure cause a loss of
sodium.
Sodium Excess -Thirst, elevated body Water deprivation in patients
(Hypernatremia) temperature, swollen dry unable to drink at will,
Serum sodium tongue and hypertonic tube feedings
>145 mEq/L sticky mucous membranes, without adequate water
hallucinations, lethargy, supplements,
restlessness, irritability, focal diabetes insipidus, heatstroke,
or grand mal seizures, hyperventilation,
pulmonary edema, and watery diarrhea. Excess
hyperreflexia, twitching, corticosteroid,
nausea, sodium bicarbonate, and
vomiting, anorexia, ↑ pulse, sodium chloride
and ↑ BP. administration,
Labs indicate. ↑ serum and salt water near-drowning
sodium, ↓ urine sodium, ↑ victims.
urine
specific gravity and osmolality
2. Potassium Deficit - Fatigue, anorexia, nausea Diarrhea, vomiting, gastric
(Hypokalemia) and vomiting, muscle suction, corticosteroid
Serum potassium weakness, administration,
<3.5 mEq/L polyuria, decreased bowel hyperaldosteronism,
motility, ventricular asystole carbenicillin,
or fibrillation, paresthesias, amphotericin B, bulimia,
leg camps, ↓ BP, ileus, osmotic diuresis, alkalosis,
abdominal distention, starvation, diuretics, and
hypoactive reflexes, digoxin toxicity.

2. ECG: flattened T waves,
prominent U waves, ST
depression, prolonged PR
interval
Potassium Excess - Vague muscular weakness, Pseudohyperkalemia, oliguric
(Hyperkalemia) tachycardia → bradycardia, renal failure, use of
Serum potassium dysrhythmias, flaccid potassium-conserving
>5.0 mEq/L paralysis, paresthesias, diuretics in patients with renal
intestinal insufficiency, metabolic
colic, cramps, irritability, acidosis, Addison’s disease,
anxiety. ECG: tall tented crush injury, burns, stored
T waves, prolonged PR bank blood transfusions,
interval and QRS duration, and rapid IV administration of
absent P waves, ST depression potassium.
3. Calcium Deficit - Numbness, tingling of Hypoparathyroidism (may
(Hypocalcemia) fingers, toes, and circumoral follow thyroid surgery or
Serum calcium region; radical neck dissection),
<8.5 mg/dL positive Trousseau’s sign and malabsorption, pancreatitis,
Chvostek’s sign; seizures, alkalosis, vitamin D
carpopedal spasms, deficiency, massive
hyperactive deep tendon subcutaneous
reflexes, irritability, infection, generalized
bronchospasm, anxiety, peritonitis, massive
impaired clotting time, transfusion
↓ prothrombin, ECG: of citrated blood, chronic
prolonged QT interval and diarrhea, decreased
lengthened ST. parathyroid
hormone, and diuretic phase
of renal failure.
Calcium Excess Muscular weakness, - Hyperparathyroidism,
(Hypercalcemia) constipation, anorexia, nausea malignant neoplastic disease,
Serum calcium and prolonged
>10.5 mg/dL vomiting, polyuria and immobilization, overuse of
polydipsia, hypoactive deep calcium supplements,
tendon vitamin D excess, oliguric
reflexes, lethargy, deep bone phase of renal failure,
pain, pathologic fractures, acidosis, corticosteroid
flank pain, and calcium stones. therapy, thiazide diuretic use,
ECG: shortened increased parathyroid
QT interval, bradycardia, heart hormone, and digoxin toxicity.
blocks

3. 4. Magnesium Deficit Neuromuscular irritability, Chronic alcoholism,
(Hypomagnesemia) positive Trousseau’s and hyperparathyroidism,
Serum magnesium Chvostek’s signs, insomnia, hyperaldo-
<1.8 mg/dL mood changes, anorexia, steronism, diuretic phase of
vomiting, increased tendon renal failure, malabsorptive
reflexes, and ↑ BP. disorders, diabetic
ECG: PVCs, flat or inverted T ketoacidosis, refeeding
waves, depressed after starvation, parenteral
ST segment. nutrition, chronic laxative
use, diarrhea, acute
myocardial infarction, heart
failure, decreased serum K+
and Ca++ and certain
pharmacologic agents (such as
gentamicin, cisplatin,
and cyclosporine.
Magnesium Excess Flushing, hypotension, Oliguric phase of renal failure
(Hypermagnesemia) drowsiness, hypoactive (particularly when
Serum magnesium reflexes, depressed magnesium-
>2.7 mg/dL respirations, cardiac arrest and containing medications are
coma, diaphoresis. administered),
ECG: tachycardia → adrenal insufficiency,
bradycardia, prolonged PR excessive IV magnesium
interval administration, and DKA.
and QRS.
5. Phosphorus Deficit - Paresthesias, muscle Refeeding after starvation,
(Hypophosphatemia) weakness, bone pain and alcohol withdrawal, diabetic
Serum phosphorus tenderness, ketoacidosis, respiratory
<2.5 mg/dL chest pain, confusion, alkalosis, ↓ magnesium,
cardiomyopathy, respiratory ↓ potassium,
failure, hyperparathyroidism,
seizures, tissue hypoxia, and vomiting, diarrhea,
increased susceptibility hyperventilation, vitamin D
to infection. deficiency associated
with malabsorptive disorders,
burns, acid–base
disorders, parenteral nutrition,
and diuretic use.
Phosphorus Excess - Tetany, tachycardia, Acute and chronic renal failure,
excessive intake of

4. (Hyperphosphatemia) anorexia, nausea and phosphorus, vitamin D excess,
Serum phosphorus vomiting, muscle respiratory acidosis,
>4.5 mg/dL weakness, signs and hypoparathyroidism, volume
symptoms of hypocalcemia. depletion, leukemia/
lymphoma treated with
cytotoxic agents, increased
tissue breakdown,
rhabdomyolysis.
6. Chloride Deficit -Agitation, irritability, Excessive sodium chloride
(Hypochloremia) tremors, muscle cramps, infusions with water loss,
Serum chloride hyperactive head injury (sodium
>108 mEq/L deep tendon reflexes, retention), hypernatremia,
hypertonicity, tetany, slow, renal
shallow failure, corticosteroid use,
respirations, seizures, dehydration, severe diarrhea
dysrhythmias, coma (loss of bicarbonate),
Labs indicate: ↓ serum respiratory alkalosis,
chloride, ↓ serum sodium, ↑ administration
pH, of diuretics, overdose of
↑ serum bicarbonate, ↑ total salicylates, Kayexalate,
carbon dioxide content, ↓ acetazolamide,
urine chloride level. phenylbutazone and
ammonium
chloride use,
hyperparathyroidism,
metabolic acidosis.
Chloride Excess Tachypnea, lethargy, Addison’s disease, reduced
(Hyperchloremia) weakness, deep rapid chloride intake or absorption,
Serum chloride respirations,decline in untreated diabetic
<96 mEq/ ketoacidosis, chronic
cognitive status, decreased
respiratory
cardiac output, dyspnea, acidosis, excessive sweating,
vomiting, gastric
tachycardia, pitting edema,
suction, diarrhea, sodium and
dysrhythmias, coma
potassium deficiency,
Labs indicate: increased
metabolic alkalosis, loop,
serum chloride, increased
osmotic, or thiazide diuretic
serum
use, overuse of bicarbonate,
sodium, decreased serum pH,
rapid removal of ascitic
decreased serum bicarbonate,
fluid with a high sodium
normal anion gap, increased
content, intravenous fluids
urinary chloride level
that lack chloride (dextrose
and water), draining
fistulas and ileostomies, heart

5. failure, cystic fibrosis