Electrolyte imbalances

1. Electrolyte imbalances
Ms Shiwani sah

2. Water distribution
60% : Total body weight
40%: Intracellular fluid 15%: interstitial
20%: Extracellular 5% intravascular
Major electrolytes:
ECF (Extracellular fluid)
ICF(Intracellular fliuid)

6. ICF COMPONENTS ECF COMPONENTS
Potassium
Magnesium
phosphate
Sodium
Chloride
Bicarbonate ions

7. electrolytes
• Electrolytes are positively charged and negatively
charged ions which are in solution in all body fluids.
• Normal cellular functions and survival requires
elctrolytes which are maintained within narrow limits.

8. Cations (+vely charged) Anions (-vely charged)
Na, Cl,
K, Hco3,
Ca, Po4, So4,
Mg Organic acids
Protein

9. Normal values:

10. Electrolye Normal values
Na 135 to 145 mEq/lt
K 3.5 to 5.0 mMol
Ca 8.6 to 10.2 mg/dl
PO4 2.5 to 4.5 mg/dl
Mg 1.7 to2.2 mg/dl
Cl 97 to 107 mEq/l

12. Sodium imbalances
Hyponatremia:
Low sodium level in the blood
Either deficit of sodium
Excess of water.

13. Causes of hyponatremia

14. Causes contd,,
• Severe vomiting or diarrhea
• Retention of water
• Excessive exercise and sweating
• Burns
• Infections or high fever

15. Clinical manifestation
• Depends on cause
• Usually don’t appear until serum sodium falls below
125 mEq/lt
• Headache
• Confusion
• Neausea and vomiting
• Diarrhea
• Abdominal cramps
• Muscle tremors, weakness

16. Management
Medical management
• Determine cause and correct it
• If it is due to fluid volume excess, intake of fluids will be restricted fo
regaining balance.
• If falls below 125 mEq/lt Na relacement is indicated.
• Pharmacological management
• For moderate hyponatremia, 0.9%Nacl or Rl may be ordered
• When 115 mEq/lt Or less a concentrated saline dolution such as 3%Na
indicated

17. Nursing intervention
• Monitor cardiovascular, respiratory, neuromuscular,
cerebral, renal and gi status of the client.
• Administration of NS iv infusion as per prescription to
restore sodium content and fluid volume.
• If accompanied by fluid volume excess, administer osmotic
diuretics to promote the excretion of H2O rather than
sodium.

18. • Instruct the client to increase oral Na intake and
inform about the foods which are rich in Na.
• Oral salt can be given to patient which is in the form
of 1 or 2 gm.
• If patient is taking lithium (Lithobid), monitor the
level of lithium as it may lead to toxicity.

19. Hypernatremia
• Usually due to water deficit.
Etiology
• Excess water loss: heat exposure, diabetes
insipidus
• Impaired thirst: primary hypodyspsia,
comatose
• Excessive Na retention

20. Clinical features
• Excessive thirst, polyuria, nausea
• Muscular weakness
• Neuromuscular irritability
• Altered mental status
• Neurological deficit
• Occassionally coma or seizures.

21. Management
• Correct water deficit
• Rate of hypernatremia:
• Acute hypernatremia:
1 mEq/lt/hour
• Chronic hypernatremia:
10 mEq/l over 24 hour

22. Dietary management
•Consume food which is less in salt
diet
•Example pickle, pappad, chips and
salty products.

24. Hypokalemia
• Serum potassium level of less than 3.5
mEq/l

25. Causes:
• Overall depletion of K or excessive uptake
by muscle from surrounding fluids.
• Drug induced: diuretics
• Gl losses
• Alcoholism
• Renal disorders
• Cushing’s syndrome

26. Clinical manifestations
• Alkosis
• Confusion, discomfort
• Weakness, disorentation
• Anorexia, nause, nausea, vomiting
• Muscke cramps, lethargy
• ECG pattern changes

28. Medical management
• Determining and correcting the cause of
the imbalance.
• Extreme hypokalemia requires
• Cardiac monitoring

29. Pharmacological management
• Oral replacement therapy
• K binding sachet (15 g) , k is extremely irritating to
gastric mucosa therefore the drug must be takrn with
glass of water or juice or during meals.
• Can be administeref iv for moderate or severe
hypokalemia and must be diluted in Iv fluids.

30. • Administration of potassium by IV push may result
Cardiac arrest.
• KCl: 10 to 20 mEq/hr diluted in IV fluid if client is on
heart monitor.
• High concentration of potassium is irritating to heart
muscle Thus correcting a potassium deficit may take
several days.

31. Dietary management
• The administration of foods that are
high in potassium.
• Banana, avocado, potatoes, spinach,
beans, citrus juice, fish

32. hyperkalamia
• Elevated level over 5.0 mEq/l.
Causes:
• Retension of potassium:renal insuffiency,renal
failure,decreased urine output, potassium sparing
diuretics.
• Excessive Iv infusions or oral administration of K
• Excessive release of cellular
K:burns,infections,metabolic acidosis.

33. Clinical features
• Muscle cramps
• Urine abnormalities
• ECG changes

35. MEDICAL MANAGEMENT
• When serum 5.0 to 5.5 mEq/l, restrict potassium intake.
• If potassium excess is due to metabolic acidosis, correcting
the acidosis with sodium bicarbonate promotes potassioum
uptake into cells .
• Potassium less dietary intake
Green beans, corn, apples, grapes, pineapple.

36. Nursing implications
• Prepare to administer potassium excreating diuretics if renal
function is not impaires.
• Initiate a potassium strict diet.
• Cardiac monitoring.
• Discontinue iv potassium and hold oral potassium supplements.
• Administer sodium polysterene sulfonate .
• Prepare the client for dialysis if potassium level is critically
high.
• Hypertonic glucose with regulau insulin to move potassium into
cells.
• Teach to avoid high K rich food and salt susbstitutes or other K

37. hypocalcemia
• Serum level below 4.5 or 8.5 mg/dl.
Causes:
Malabsorption of fat in intestine
Metabolic alkalosis
Renal failure with hyperphosphotemia.
Acute pancreatitis
Burns
Medications MgSo4

38. •Clinical features

39. Medical mangement
• Corrected by oral Ca gluconate ,calcium lactates or Ca Cl-
• Administer Ca supplements 30 minutes before meals for better absorption
and with glass of milk as vit d is necessary for absorption.
• Iv CaCl- or Ca gluconate(10 %) given slowly to avoid hypertension,
bradycardia or other arrhythmias.
• Chronic or mild can be treated by high diet Ca foods
• Red beans, milk, spinach, mushroom, Broccoli, beans curd.

40. Nursing implications
• Cardiac monitoring.
• When administering Ca Iv, warm the injection
solution to body temperature before administrating
and administer slowly.
• Monitor for hyper calcemia.
• Administer vitD and the medications that aborp Ca
from intestines.

41. • Seizure precautions
• keep 10 % Ca gluconate for treatment of acute Ca
deficit.
• Encourage for high Ca diet.

42. hypercalcemia
• Above 5.5m Eq/l.
Etiology:
Metastatic malignancies.
Hyper parathyroidism
Thiazide diuretic hormones.
Prolong immobilization.
Excessive Ca and vita D supplements.

43. Clinical features
• Anorexia
• Vomiiting
• Constipation
• Weakness
• Extreme lethargy
• Dysrhythmias

44. •ECG: shortened St segment
•Lengthened QT interval
•ABG: ph< 7.45 serum Ca >5,5 mEq/l

45. MANAGEMENT
• ACCORDING TO CAUSE
• NS 0.9 % rapidly with furosemide to prevent fluid overload.
• Corticosteriods to decreses Ca levels by competing with VitD
• Reduce Ca rich foods.
• Drug Etidorate di-sodium
• Reduces serum Ca by reducing abnormal bone reabsorption
and secondarily bone formation.

46. hypomagnesemia
• Plasma Mg < 1.8 mg /dl
Etiology:
Diarrhea,Vomiting
Chronic alcoholism
Prolonged malnutrition
Hyperaldosteronism
Impaired gi absortion, Ng suctioning, Poorly controlled
DM

47. Clinical manifestations
• Anorexia
• Nausea
• Abdominal distention
• Severe causes: Chvostek”s and
Troussean”s, tetany, convulsion, stroke
• Myocardial irritability
• ECG: shortened QT, broad T

48. management
• Oral Mgso4 replacement (antacids)
• Parenteral MgSo4
• Increase dietary intake og Mg
Chilli, tofu, wheat gram
Initate safety and seizure precautions, Mg levels,
electrolytes.

49. hypermagnesemia
• Mg> 3mg/dl
Causes:
Renal insuffiency
Excessive anta-acid use
Adrenal insufficiency

50. Clinical manifestations
• Related to blocked release of acetylcholine from
myoneromal junction which affects muscle cell activity
• Hypotension.
• Muscle weakness
• Prolonged QT, PR interval.
• Lethargy, drowsiness
• Respiratory paralysis , LOC

51. MANAGEMENT
• LOW Mg diet
• Chicken , ggs, green peas, white bread, burger
• Decrease MgS04 use
• In severe cases, saline infusion with diuretics to promote
excreation.
• IV Ca (antagonist action)
• Albuterol drug
• If renal failure then dialysis can be done for severe cases.

52. THANK YOU