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1. Disturbances of fluid and electrolytes
balance
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Luckmann and Sorensen's
medical - surgical nursing

2. 2

3. Electrolyte Values
 Na : 135-145 meq/L
 K : 3.5-5 meq/L
 Cl : 98-107 meq/L
 Ca : 9–11 mg/dL
 P : 2.5-4.5 mg/dL
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4. Hyponatremia
 Definition : Na < 135 mmol/L
 Etilogy :
 Diuretic therapy
 Hydratation
 ↑ADH secretion (Syndrome of inappropriate
ADH,SIADH)
 diaphoreses
 Addison's disease ( aldosterone)
 Diabetes mellitus (hyperglycemia)
 Diabetic ketoacidosis (DKA)
 Metabolic acidosis
 Renal disease (Nephrotic syndrome, Renal tubular acidosis
, RTA)
 Pseudo-hyponatremia (hyperlipidaemia)
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5. Signs and Symptoms
 Nausea
 Emesis
 Malaise
 Confusion
 Agitation
 Lethargy
 Headache
 Seizures
 Coma
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6. Hypernatremia
 Definition : Na > 145 mmol/L
 Etilogy :
 Excessive intake (bicarb, hypertonic saline, seawater)
 Disdipsia (inadequate intake of water)
 Diabetes insipidus (decreased ADH secretion )
 Severe diarrhea and vomiting
 Excessive Sweating
 Insulin therapy
 Hyperaldostronism
 Chronic kidney disease, Acute tubular nephropathy (ATN)
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7. Signs and Symptoms
 Neuromuscular Irritability
 Muscle twitching
 Lethargy
 Weakness
 Confusion
 Convulsions
 “Doughy” feel to skin
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8. Hypokalemia
 Definition : K < 3.5 mmol/l
 Etilogy :
 GI losses (Vomiting, Diarrhea)
 Renal losses (Chronic Kidney disease)
 Primary hyperaldostronism (Conn’s syndrome)
 Diuretics use (Thiazide, Loop diuretics)
 Alkalosis (Shift of K from ECF to ICF)
 Shifts of K into cells (Insulin, β2-adrenergic agonists)
 Magnesium deficiency
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9. Signs and Symptoms
 Usually asymptomatic
 Skeletal muscle : weakness, cramps, respiratory failure,
Flaccid paralysis
 Smooth muscle: Decreased peristalsis or ileus
(constipation), urinary retention
 Ventricular fibrillation can happen
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10. Hyperkalemia
 Definition : K > 5 mmol/L
 Etilogy :
 Massive intake of K (eating large amounts KCl)
 Insulin deficiency
 Addison's Disease (hypoaldosteronism)
 Renal tubular acidosis (RTA)
 K sparing diuretic, β-adrenergic antagonists, ACE
inhibitors
 Acidosis (Shift of K from ICF to ECF)
 Tumor lysis syndrome, Rhabdomyolysis, Tissue necrosis
 Adrenal insufficiency, Congenital adrenal hyperplasia
(CAH)
 Malignant hyperthermia 10

11. Signs and Symptoms
 Cardiac effects : Ventricular fibrillation, Asystole
 Neuromuscular effects : Paresthesias, Skeletal muscle
weakness, Flaccid paralysis
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12. Flame photometry
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13. Chloride disorders
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14. Cystic fibrosis and Sweat test
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15.  Chloride Concentration for Infants (birth to 6 months)
Result :
 0 - 29 mmol/L Cystic fibrosis is unlikely
 30 - 59 mmol/L Intermediaet
 ≥ 60 mmol/L Indicative of cystic fibrosis
 Chloride Concentration for Infants (older than 6 months)
children and adults
Result :
 0 - 39 mmol/L Cystic fibrosis is unlikely
 40 - 59 mmol/L Intermediate
 ≥ 60 mmol/L Indicative of cystic fibrosis
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16. Coulometric titration of chloride
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17. Calcium
 Roles :
 Coagulation
 Cellular signals
 Muscle contraction
 Neuromuscular transmission
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18. Hypocalcemia
 Definition : Ca < 8.0 mg/dL
 Etiology :
 Hypoparathyroidism
 Vitamin D deficiency
 Chronic renal failure
 Alkalosis
 Hypoalbominemia
 Magnesium deficiency
 Massive transfusion
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19. Signs and Symptoms
 neuromuscular effects : neuromuscular excitability,
Weakness, Muscle cramps, Tetany, Convulsions,
Paresthesia
 Cardiac effects : arrhythmias
 Positive Trousseau’s or Chvostek’s sign
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Positive Trousseau’s Sign Positive Chvostek’s Sign

20. Hypercalcemia
 Definition : Ca > 11 mg/dL
 Etiology :
 Hyperparathyroidism (two thirds of cases)
 Malignancy (Parathyroid tumor, Multiple myeloma)
 Excess vitamin D
 Chlorthiazide diuretics
 Lithium
 Renal failure
 Hyperalbominemia
 Acidosis
 Granulomatous disorders (eg Sarcoidosis and TB)
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21. Signs and Symptoms
 Hypotonia
 Lethargy
 Fatigue
 Muscle weakness
 Arrhythmias
 Cardiac arrest
 Confusion
 Pancreatitis
 Nausea
 Vomiting
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22. Atomic absorption spectrometry
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23. Hypophosphatemia
 Definition : P < 2.5 mg/L
 Etiology :
 Intracellular shift (Glucose, Insulin)
 Hyperparathyroidism
 Vitamin D deficiency
 Decreased absorption (Vomiting, Diarrhea, Phosphate
binding anti acids)
 Respiratory alkalosis
 Renal tubular defects
 X-linked hypophosphatemia (Vitamin D resistant rickets )
 Fanconi syndrome
 Alcohol abuse
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24. Signs and Symptoms
 Cardiomyopathy (decreased myocardial output)
 Muscle dysfunction and weakness
 Respiratory depression
 Rickets/Osteomalacia
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25. Hyperphosphatemia
 Definition : P > 4.5 mg/L
 Etiology :
 Hypoparathyroidism
 Excess vitamin D
 Chronic renal failure
 Respiratory acidosis
 Lactic acidosis
 Chemotherapy
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26. Signs and Symptoms
 Calcified deposition (joints, arteries, skin, kidney, cornea)
 Neuromuscular irritability
 tetany
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