This document discusses electrolyte imbalances, including causes, signs and symptoms, and treatment approaches. It covers the major electrolytes: sodium, potassium, calcium, magnesium, and their roles in the body. Key points include how electrolytes are involved in neuromuscular function, acid-base balance, and fluid distribution. Electrolyte imbalances like hyponatremia, hyperkalemia, hypocalcemia and hypomagnesemia are described in terms of their definitions, causes, and clinical manifestations that clinicians should look for as well as treatment goals.
7. What do Electrolytes - Do?
• Promotes neuromuscular impulses.
• Maintain body fluid volume & Osmolarity.
• Distribute body water between fluid
compartments.
• Regulate acid base balance.
11. What Do You See ?
• Sunken eyes, Dry coated
tongue, poor skin turgor
• Headache, N/V, muscle
twitching, altered mental
status
• Irritability, neurological
symptoms, convulsions ,
coma
12. What Do We Do?
• MILD / CHRONIC
CASE
– Na < 115 mEq/ L
– Restrict fluid intake for
hyper/isovolemic
hyponatremia
– IV fluids and/or
increased Na+ intake
for hypovolemic
hyponatremia
• SEVERE / ACUTE
CASE
– Na < 100 mEq/L
– Infuse hypertonic
NaCl solution (3% or
5% NaCl)
– Frusemide to remove
excess fluid
– Monitor client in ICU
13. Hypernatremia
• Excess Na+ relative to body water
• Occurs less often than hyponatremia
• Na > 150 mEq / L
• When hypernatremia occurs, fluid shifts
outside the cells
• May be caused by water deficit or over-
ingestion of Na+ - Renal dysfuction
• Also may result from diabetes insipidus,
Cardiac failure, Drug – NSAID / Steroids
14. What Do You See ?
• Think S-A-L-T
Skin flushed
Agitation
Low grade fever
Thirst
• Neurological symptoms
• Signs of hypovolemia
Firm,
15. What Do We Do?
• Correct underlying
disorder
• Restrict saline &
sodium
• Gradual / Slow fluid
replacement
• Monitor for s/s of
cerebral edema
• Monitor serum Na+
level
• Seizure precautions
16. Potassium
• Major intracellular cation
• Untreated changes in K+ levels can lead to
serious neuromuscular and cardiac
problems
• Normal K+ levels = 3.5 - 5 mEq/L
17. Balancing Potassium
• Most K+ ingested is excreted by the kidneys
• Three other influential factors in K+ balance :
– Na+/K+ pump
– Renal regulation
– pH level
21. What Do We Do?
• Increase dietary K+
• Oral KCl supplements
• IV K+ replacement
• Change to K+-sparing diuretic
• Monitor ECG changes
22. IV K+ Replacement
• Mix well when
adding to an IV
solution bag
• Concentrations
should not exceed
40-60 mEq/L
• Rates usually 10-
20 mEq/hr
NEVER GIVE IVNEVER GIVE IV
PUSHPUSH
POTASSIUMPOTASSIUM
23. Hyperkalemia
• Serum K+ > 6 mEq/L
• Less common than
hypokalemia
• Caused by altered
kidney function,
increased intake (salt
substitutes), blood
transfusions, meds
(K+-sparing diuretics),
cell death (trauma)
24. What Do You See?
• Irritability
• Paresthesia
• Muscle weakness (especially legs)
• ECG changes (tented / peak T wave)
• Irregular pulse
• Hypotension
• Nausea, abdominal cramps, diarrohea
25.
26. What Do We Do?
• Mild
– Loop diuretics (Lasix)
– Dietary restriction
• Moderate
– Cation-exchange resin
such as Kayexalate (act by
exchanging the cations in
the resin for the potassium
in the intestine) potassium
is then excreted in the stool
• Emergency
– 10% calcium
gluconate for cardiac
effects
– Sodium bicarbonate
for acidosis
27. Calcium
• 99% in bones, 1% in serum and soft tissue
(measured by serum Ca++)
• Works with phosphorus to form bones and
teeth
• Role in cell membrane permeability
• Affects cardiac muscle contraction
• Participates in blood clotting
• Normal value 8.5 – 10.5 mg/dl
34. What Do You See?
• Fatigue, confusion, lethargy, coma
• Muscle weakness, hyporeflexia
• Bradycardia ⇒ cardiac arrest
• Anorexia, nausea/vomiting, decreased bowel
sounds, constipation
• Polyuria, renal calculi, renal failure
35. CLINICAL MANIFESTATIONS OF HYPERCALCEMIACLINICAL MANIFESTATIONS OF HYPERCALCEMIA
Decreased GIDecreased GI
MotilityMotility
Cardiac DysrhythmiasCardiac Dysrhythmias
ConstipationConstipation
NauseaNausea
Mental status changes:Mental status changes:
lethargy, confusion,lethargy, confusion,
memory lossmemory loss
36. CLINICAL MANIFESTATIONS OF HYPERCALCEMIACLINICAL MANIFESTATIONS OF HYPERCALCEMIA
ImmobilizationImmobilization BoneBone
DemineralizationDemineralization
CalciumCalcium
accumulates inaccumulates in
the ECF andthe ECF and
passes throughpasses through
the kidneysthe kidneys
Ca PrecipitationCa PrecipitationCalcium StonesCalcium Stones
37. What Do We Do?
• If asymptomatic, treat underlying cause
• Hydrate the patient to encourage diuresis
• Loop diuretics
• Corticosteroids
38. Magnesium
• Cofactor for many enzymes – ATP
utilisation in muscle fiber
• Role in protein synthesis &
carbohydrate metabolism
• Helps cardiovascular system function
(vasodilation)
• Regulates muscle contractions
40. What Do You See?
• CNS
–Altered LOC
–Confusion
–Hallucinations
• Neuromuscular
– Muscle weakness
– Leg/foot cramps
– Hyper DTRs
– Tetany
41. CLINICAL MANIFESTATIONS OF HYPOMAGNESEMIACLINICAL MANIFESTATIONS OF HYPOMAGNESEMIA
CONFUSIONCONFUSION
DEPRESSIONDEPRESSION
CRAMPSCRAMPS
TETANYTETANY CONVULSIONSCONVULSIONS
42. What Do You See?
• Cardiovascular
–Tachycardia
–Hypertension
–ECG changes
• Gastrointestinal
–Dysphagia
–Anorexia
–Nausea/vomiting
43. What Do We Do?
• Mild
– Dietary replacement
• Severe
– IV or IM magnesium sulfate
• Monitor
– Neuro status
– Cardiac status
– Safety
44. Mag Sulfate Infusion
• Use infusion pump - no faster than 150
mg/min
• Monitor vital signs for hypotension and
respiratory distress
• Monitor serum Mg++ level q6h
• Cardiac monitoring
• Calcium gluconate as an antidote for
overdosage
45. Hypermagnesemia
• Serum Mg++ level > 2.5 mEq/L
• Not common
• Renal dysfunction is most common
cause
– Renal failure
– Addison’s disease
– Adrenocortical insufficiency
– Untreated DKA
46. What Do You See?
• Decreased neuromuscular activity
• Hypoactive DTRs
• Generalized weakness
• Occasionally nausea/vomiting
47. What Do We Do?
• Increased fluids if renal function normal
• Loop diuretic if no response to fluids
• Calcium gluconate for toxicity
• Mechanical ventilation for respiratory
depression
• Hemodialysis (Mg++-free dialysate)
Editor's Notes
Deficit: abnormal losses through skin, anorexia third spacing, nausea,
Excessive sweating, inability to access fluids, polyuria, impaired swallowing,
Fever, confusion, NG suction, depression, bleeding, prolonged rapid respiration,
Vomiting, diarrhea
symptomatology: decreased BP, pulse, urine output &lt;30 ml/ hour, decreased skin turgor, dry mucus membranes, sunken eyeballs, hemoconcentration, elevated temperature, concentrated urine weakness, confusion.
Excess:,
It can occur because of A. Excessive intake Na Cl B. rapid administration of sodium rich infusions, C. disease that impair regulatory mechanisms, like renal failure, congestive heart failure
Symptomatology: weight gain &gt; 2lbs in 24 hours, elevated BP, full bounding pulses, moist, labored respirations, large volume of pale urine, pitting edema, crackles, Auscultate in lungs, dyspnea, distended jugular veins