Electrolyte Disturbances

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Electrolyte Disturbances

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  • Electrolyte Disturbances

    1. 1. Electrolyte Disturbances Na+ Ca++ Cl- Mg+ K+ PO 4 NH 3 Cu HCO 3 - NaCl
    2. 2. Electrolytes <ul><li>Electrolytes are electrically charged ions </li></ul><ul><li>Electrolytes dissolve in water and form ions </li></ul><ul><li>Electrolytes have can conduct electricity </li></ul>
    3. 3. Sodium (Na+) <ul><li>Dominant extracellur electrolyte </li></ul><ul><li>Chief determinant of osmolality </li></ul><ul><li>Normal serum level:135-145 mEq/L </li></ul>NaCl
    4. 4. Hyponatremia <ul><li>Signs & Symptoms </li></ul><ul><ul><li>Deficiency of sodium in the blood </li></ul></ul><ul><ul><li>Hypotension </li></ul></ul><ul><ul><li>Tachycardia </li></ul></ul><ul><ul><li>Muscle weakness </li></ul></ul>
    5. 5. Hypernatremia <ul><li>Signs & Symptoms </li></ul><ul><ul><li>Excess sodium in the blood </li></ul></ul><ul><ul><li>Hypertension </li></ul></ul><ul><ul><li>Muscle twitching </li></ul></ul><ul><ul><li>Mental confusion </li></ul></ul><ul><ul><li>Coma </li></ul></ul>
    6. 6. Potassium (K+) <ul><li>Dominant intracellular electrolyte </li></ul><ul><li>Primary buffer in the cell </li></ul><ul><li>Normal serum level: 3.5-5.5 mEq/L </li></ul>K+
    7. 7. Potassium (K+) <ul><li>Has a role in: </li></ul><ul><ul><li>Muscle contraction </li></ul></ul><ul><ul><li>Nerve impulses </li></ul></ul><ul><ul><li>Cell membrane function </li></ul></ul><ul><ul><li>Attracting water into the ICF </li></ul></ul><ul><ul><li>Imbalances interfere with neuromuscular function and may cause cardiac rhythm disturbances </li></ul></ul>
    8. 8. Hypokalemia <ul><li>Serum level below 3.5 mEq/L </li></ul><ul><li>Causes </li></ul><ul><ul><li>Reduced dietary intake </li></ul></ul><ul><ul><li>Poor absorption by the body </li></ul></ul><ul><ul><li>Vomiting and/or diarrhea </li></ul></ul><ul><ul><li>Renal disease </li></ul></ul><ul><ul><li>Medications (typically diuretics) </li></ul></ul>
    9. 9. Hypokalemia <ul><li>Signs and Symptoms </li></ul><ul><ul><li>Malaise </li></ul></ul><ul><ul><li>Skeletal muscle weakness </li></ul></ul><ul><ul><li>Decreased reflexes </li></ul></ul><ul><ul><li>Hypotension </li></ul></ul><ul><ul><li>Vomiting </li></ul></ul><ul><ul><li>Excessive thirst </li></ul></ul><ul><ul><li>Cardiac arrhythmias and cardiac arrest </li></ul></ul><ul><ul><li>Flattened T wave </li></ul></ul><ul><ul><li>U wave </li></ul></ul>
    10. 10. Hyperkalemia <ul><li>Serum level above 5 mEq/L </li></ul><ul><li>Causes: </li></ul><ul><ul><li>Chronic or acute renal failure </li></ul></ul><ul><ul><li>Burns </li></ul></ul><ul><ul><li>Crush injuries </li></ul></ul><ul><ul><li>Excessive use of Potassium salts </li></ul></ul>
    11. 11. Hyperkalemia <ul><li>Signs & Symptoms </li></ul><ul><ul><li>Excess potassium in the blood </li></ul></ul><ul><ul><li>Cardiac arrhythmias and cardiac arrest </li></ul></ul><ul><ul><li>Elevated T wave </li></ul></ul><ul><ul><li>Muscle weakness </li></ul></ul><ul><ul><li>ECG Changes </li></ul></ul>
    12. 12. Hyperkalemia <ul><li>ECG Changes </li></ul><ul><ul><li>Peaked T wave </li></ul></ul><ul><ul><li>Wide QRS complex </li></ul></ul><ul><ul><li>Flat P wave </li></ul></ul><ul><ul><li>Lead into sine wave appearance </li></ul></ul>
    13. 13. Potassium Disturbances
    14. 14. Hyperkalemia Peaked T Waves  Sine Waves 
    15. 15. Hyperkalemia <ul><li>Signs and Symptoms </li></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Nausea </li></ul></ul><ul><ul><li>Diarrhea </li></ul></ul><ul><ul><li>Oliguria (100 – 400 ml urine output/24 hours) </li></ul></ul><ul><ul><li>Weakness and paralysis </li></ul></ul><ul><li>Treatment </li></ul><ul><ul><li>IV administration of glucose and insulin helps lower serum Potassium levels. </li></ul></ul><ul><ul><li>Sodium Bicarbonate also causes potassium to shift into the cells. </li></ul></ul>
    16. 16. Magnesium (Mg+) <ul><li>Activates many enzymes </li></ul><ul><li>50% is insoluble in bone </li></ul><ul><li>45% is intracellular </li></ul><ul><li>5% is extracellular </li></ul>Mg+
    17. 17. Hypomagnesemia <ul><li>Signs & Symptoms </li></ul><ul><ul><li>Flat T wave </li></ul></ul><ul><ul><li>ST interval depression </li></ul></ul><ul><ul><li>Prolonged QT interval – may lead to Torsade de Pointes </li></ul></ul>
    18. 18. Hypomagnesemia <ul><li>Low magnesium levels </li></ul><ul><li>Caused by: </li></ul><ul><ul><li>Alcoholism </li></ul></ul><ul><ul><li>Malabsorption </li></ul></ul><ul><ul><li>Starvation </li></ul></ul><ul><ul><li>Diarrhea </li></ul></ul><ul><ul><li>Diuresis </li></ul></ul>
    19. 19. Hypomagnesemia <ul><li>Signs and Symptoms </li></ul><ul><ul><li>Tremors </li></ul></ul><ul><ul><li>Diarrhea </li></ul></ul><ul><ul><li>Hyperactive deep reflexes Confusion/Hallucinations </li></ul></ul><ul><ul><li>Seizures </li></ul></ul><ul><ul><li>Dysrhythmias </li></ul></ul>
    20. 20. Hypermagnesemia <ul><li>Excess of Magnesium </li></ul><ul><ul><li>Not common </li></ul></ul><ul><ul><li>Occurs with chronic renal insufficiency </li></ul></ul><ul><ul><li>Treatment is hemodialysis </li></ul></ul>
    21. 21. Hypermagnesemia <ul><li>Signs & Symptoms </li></ul><ul><ul><li>Peaked T wave </li></ul></ul><ul><ul><li>Bradycardia </li></ul></ul><ul><ul><li>CNS Depression </li></ul></ul><ul><ul><li>Areflexia </li></ul></ul><ul><ul><li>Sedation </li></ul></ul><ul><ul><li>Respiratory paralysis </li></ul></ul>
    22. 22. Calcium (Ca++) <ul><li>Essential for </li></ul><ul><ul><li>Neuromuscular transmission </li></ul></ul><ul><ul><li>Growth and ossification of bones </li></ul></ul><ul><ul><li>Muscle contraction </li></ul></ul><ul><ul><li>Excreted through urine, feces, and perspiration </li></ul></ul>Ca++
    23. 23. Calcium (Ca++) <ul><li>Most is in bones and teeth </li></ul><ul><li>Involved in </li></ul><ul><ul><li>Blood clotting </li></ul></ul><ul><ul><li>Nerve impulse </li></ul></ul><ul><ul><li>Muscle contraction </li></ul></ul>Ca++
    24. 24. Hypocalcemia <ul><li>Deficiency of calcium in the blood </li></ul><ul><li>Causes </li></ul><ul><ul><li>Renal insufficiency </li></ul></ul><ul><ul><li>Decreased intake or malabsorption of Calcium </li></ul></ul><ul><ul><li>Deficiency in or inability to activate Vitamin D </li></ul></ul>
    25. 25. Hypocalcemia <ul><li>Signs & Symptoms </li></ul><ul><ul><li>Tetany (cramps/convulsions in wrists and ankles) </li></ul></ul><ul><ul><li>Weak heart muscle </li></ul></ul><ul><ul><li>Increased clotting time </li></ul></ul><ul><ul><li>Prolonged QT interval – may lead to Torsade de Pointes </li></ul></ul><ul><ul><li>Abnormal behavior </li></ul></ul><ul><ul><li>Chvostek's sign (facial twitching) </li></ul></ul><ul><ul><li>Paresthesia </li></ul></ul>
    26. 26. Hypercalcemia <ul><li>Excess calcium in the blood </li></ul><ul><li>Causes </li></ul><ul><ul><li>Neoplasms (tumors) </li></ul></ul><ul><ul><li>Excessive administration of Vitamin D </li></ul></ul>
    27. 27. Hypercalcemia <ul><li>Signs & symptoms </li></ul><ul><ul><li>Kidney stones </li></ul></ul><ul><ul><li>Bone pain </li></ul></ul><ul><ul><li>Cardiac arrhythmias </li></ul></ul><ul><ul><li>Shortened QT interval </li></ul></ul>
    28. 28. Hypercalcemia <ul><li>Signs and Symptoms </li></ul><ul><ul><li>Hypotonicity of muscles (decreased muscle tone) </li></ul></ul><ul><ul><li>Renal stones </li></ul></ul><ul><ul><li>Altered mental status </li></ul></ul><ul><li>Treatment </li></ul><ul><ul><li>Usually aimed at underlying disease and hydration </li></ul></ul><ul><ul><li>Severe hypercalcemia may be treated with forced diuresis </li></ul></ul>
    29. 29. Phosphorus (P,PO 4 ) <ul><li>A major player in: </li></ul><ul><ul><li>energy metabolism </li></ul></ul><ul><ul><li>genetic coding </li></ul></ul><ul><ul><li>cell function </li></ul></ul><ul><ul><li>bone formation </li></ul></ul><ul><li>Normal serum level: 2.5-4.5 mg/dL </li></ul>PO 4
    30. 30. Hypophosphatemia <ul><li>Causes </li></ul><ul><ul><li>Alcoholism </li></ul></ul><ul><ul><li>Hyperalimentation without phosphate </li></ul></ul><ul><ul><li>Chronic ingestion of antacids </li></ul></ul><ul><ul><li>Post stomach surgery </li></ul></ul><ul><ul><li>If you are lacking in Vitamin-D (which is needed to absorb phosphate) </li></ul></ul>
    31. 31. Hypophosphatemia <ul><li>Signs & Symptoms </li></ul><ul><ul><li>Respiratory difficulty </li></ul></ul><ul><ul><li>Confusion </li></ul></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Coma. </li></ul></ul>
    32. 32. Hyperphosphatemia <ul><li>Causes </li></ul><ul><ul><li>Severe infections </li></ul></ul><ul><ul><li>Kidney failure </li></ul></ul><ul><ul><li>Thyroid failure </li></ul></ul><ul><ul><li>Parathyroid Failure </li></ul></ul><ul><ul><li>Often associated with hypocalcemia or hypomagnesemia or too much Vitamin D </li></ul></ul><ul><ul><li>Cell destruction - from chemotherapy, when the tumor cells die at a fast rate. This can cause tumor lysis syndrome. </li></ul></ul>
    33. 33. Hyperphosphatemia <ul><li>Signs & Symptoms </li></ul><ul><ul><li>Elevated blood phosphate level </li></ul></ul><ul><ul><li>There are no symptoms of hyperphosphatemia. </li></ul></ul>
    34. 34. Hyperphosphatemia <ul><li>Treatment </li></ul><ul><ul><li>Calcium Carbonate tablets </li></ul></ul><ul><ul><li>Aluminum hydroxide (can cause aluminum toxicity. </li></ul></ul>
    35. 35. Na+ Ca++ Cl- Mg+ K+ PO 4 NH 3 Cu HCO 3 - NaCl THE END
    36. 36. References <ul><li>Schmidt, Tracy, RN, “Assessing a Sodium and Fluid Imbalance”, Nursing 2000, Volume 30 Number 1, p18 </li></ul><ul><li>(C) 2004 Lippincott Williams & Wilkins, Inc. </li></ul>

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