Electrolytes are electrically charged ions that dissolve in water and conduct electricity. The major electrolytes are sodium, potassium, calcium, magnesium, phosphate, and chloride. Disturbances in electrolyte levels can cause various signs and symptoms, especially relating to muscle function, nerve impulses, and cardiac rhythm. Treatment aims to correct underlying causes and restore normal electrolyte balance.

1. Electrolyte Disturbances Na+ Ca++ Cl- Mg+ K+ PO 4 NH 3 Cu HCO 3 - NaCl

2. Electrolytes Electrolytes are electrically charged ions Electrolytes dissolve in water and form ions Electrolytes have can conduct electricity

3. Sodium (Na+) Dominant extracellur electrolyte Chief determinant of osmolality Normal serum level:135-145 mEq/L NaCl

4. Hyponatremia Signs & Symptoms Deficiency of sodium in the blood Hypotension Tachycardia Muscle weakness

5. Hypernatremia Signs & Symptoms Excess sodium in the blood Hypertension Muscle twitching Mental confusion Coma

6. Potassium (K+) Dominant intracellular electrolyte Primary buffer in the cell Normal serum level: 3.5-5.5 mEq/L K+

7. Potassium (K+) Has a role in: Muscle contraction Nerve impulses Cell membrane function Attracting water into the ICF Imbalances interfere with neuromuscular function and may cause cardiac rhythm disturbances

8. Hypokalemia Serum level below 3.5 mEq/L Causes Reduced dietary intake Poor absorption by the body Vomiting and/or diarrhea Renal disease Medications (typically diuretics)

9. Hypokalemia Signs and Symptoms Malaise Skeletal muscle weakness Decreased reflexes Hypotension Vomiting Excessive thirst Cardiac arrhythmias and cardiac arrest Flattened T wave U wave

10. Hyperkalemia Serum level above 5 mEq/L Causes: Chronic or acute renal failure Burns Crush injuries Excessive use of Potassium salts

11. Hyperkalemia Signs & Symptoms Excess potassium in the blood Cardiac arrhythmias and cardiac arrest Elevated T wave Muscle weakness ECG Changes

12. Hyperkalemia ECG Changes Peaked T wave Wide QRS complex Flat P wave Lead into sine wave appearance

13. Potassium Disturbances

14. Hyperkalemia Peaked T Waves  Sine Waves 

15. Hyperkalemia Signs and Symptoms Irritability Nausea Diarrhea Oliguria (100 – 400 ml urine output/24 hours) Weakness and paralysis Treatment IV administration of glucose and insulin helps lower serum Potassium levels. Sodium Bicarbonate also causes potassium to shift into the cells.

16. Magnesium (Mg+) Activates many enzymes 50% is insoluble in bone 45% is intracellular 5% is extracellular Mg+

17. Hypomagnesemia Signs & Symptoms Flat T wave ST interval depression Prolonged QT interval – may lead to Torsade de Pointes

18. Hypomagnesemia Low magnesium levels Caused by: Alcoholism Malabsorption Starvation Diarrhea Diuresis

19. Hypomagnesemia Signs and Symptoms Tremors Diarrhea Hyperactive deep reflexes Confusion/Hallucinations Seizures Dysrhythmias

20. Hypermagnesemia Excess of Magnesium Not common Occurs with chronic renal insufficiency Treatment is hemodialysis

21. Hypermagnesemia Signs & Symptoms Peaked T wave Bradycardia CNS Depression Areflexia Sedation Respiratory paralysis

22. Calcium (Ca++) Essential for Neuromuscular transmission Growth and ossification of bones Muscle contraction Excreted through urine, feces, and perspiration Ca++

23. Calcium (Ca++) Most is in bones and teeth Involved in Blood clotting Nerve impulse Muscle contraction Ca++

24. Hypocalcemia Deficiency of calcium in the blood Causes Renal insufficiency Decreased intake or malabsorption of Calcium Deficiency in or inability to activate Vitamin D

25. Hypocalcemia Signs & Symptoms Tetany (cramps/convulsions in wrists and ankles) Weak heart muscle Increased clotting time Prolonged QT interval – may lead to Torsade de Pointes Abnormal behavior Chvostek's sign (facial twitching) Paresthesia

26. Hypercalcemia Excess calcium in the blood Causes Neoplasms (tumors) Excessive administration of Vitamin D

27. Hypercalcemia Signs & symptoms Kidney stones Bone pain Cardiac arrhythmias Shortened QT interval

28. Hypercalcemia Signs and Symptoms Hypotonicity of muscles (decreased muscle tone) Renal stones Altered mental status Treatment Usually aimed at underlying disease and hydration Severe hypercalcemia may be treated with forced diuresis

29. Phosphorus (P,PO 4 ) A major player in: energy metabolism genetic coding cell function bone formation Normal serum level: 2.5-4.5 mg/dL PO 4

30. Hypophosphatemia Causes Alcoholism Hyperalimentation without phosphate Chronic ingestion of antacids Post stomach surgery If you are lacking in Vitamin-D (which is needed to absorb phosphate)

31. Hypophosphatemia Signs & Symptoms Respiratory difficulty Confusion Irritability Coma.

32. Hyperphosphatemia Causes Severe infections Kidney failure Thyroid failure Parathyroid Failure Often associated with hypocalcemia or hypomagnesemia or too much Vitamin D Cell destruction - from chemotherapy, when the tumor cells die at a fast rate. This can cause tumor lysis syndrome.

33. Hyperphosphatemia Signs & Symptoms Elevated blood phosphate level There are no symptoms of hyperphosphatemia.

34. Hyperphosphatemia Treatment Calcium Carbonate tablets Aluminum hydroxide (can cause aluminum toxicity.

35. Na+ Ca++ Cl- Mg+ K+ PO 4 NH 3 Cu HCO 3 - NaCl THE END

36. References Schmidt, Tracy, RN, “Assessing a Sodium and Fluid Imbalance”, Nursing 2000, Volume 30 Number 1, p18 (C) 2004 Lippincott Williams & Wilkins, Inc.