Fluid and Electrolytes, Balance and Disturbances

1. Fluid and Electrolytes,
Balance and Disturbances
Mr. v. chandiran, MSN,
K.M.C.H. CON

2. Fluid and Electrolytes
• 60% of body consists of fluid
• Intracellular space [2/3]
• Extracellular space [1/3]
• Electrolytes are active ions:
positively and negatively charged

3. Regulation of Body Fluid
Compartments
• Osmosis is the diffusion of water
caused by fluid gradient

4. Regulation of Body Fluid
Compartments 2
• Tonicity is the ability of solutes to cause
osmotic driving forces
• Determines the cell size and hydration

5. Regulation of Body Fluid
Compartments 3
• Diffusion is the movement of a substance
from area of higher concentration to one
of lower
concentration
• “Downhill
Movement”

6. Regulation of Body Fluid
Compartments 4
• Filtration is the movement of water
and solutes from an area of high
hydrostatic pressure to an area of
low hydrostatic pressure

7. Regulation of Body Fluid
Compartments 5
• Osmolality reflects the
concentration of fluid that affects
the movement of water between
fluid compartments by osmosis

8. Regulation of Body Fluid
Compartments 6
• Osmotic pressure is the amount of
hydrostatic pressure needed to
stop the flow of
water by osmosis

9. Sodium-Potassium Pump
• Sodium concentration is higher in
ECF than ICF
• Sodium enters cell by diffusion
• Potassium exits cell into ECF

10. Gains and Losses
• Water and electrolytes move in a
variety of ways
–Kidneys. 1ml/kg
–Skin. perspiration
–Lungs. 300ml/day
–GI tract. 100-200 ml/day

11. Regulation of body water
The default is get rid of it
The control processes include:
Release of ADH (antidiuretic hormone)
Thirst

12. Regulation of body water
Any of the following:
• Decreased amount of water in body
• Increased amount of Na+ in the body
• Increased blood osmolality
• Decreased circulating blood volume
Results in:
• Stimulation of osmoreceptors in hypothalamus
• Release of ADH from the posterior pituitary
• Increased thirst
And thus: water consumption and conservation

13. Fluid Volume Disturbances
• Fluid Volume deficit.

14. Fluid Volume Deficit
• Mild – 2% of body weight loss
• Moderate – 5% of body weight loss
• Severe – 8% or more of body
weight loss

15. Fluid Volume Deficit
• Pathophysiology – results from loss of
body fluids and occurs more rapidly when
coupled with decreased fluid intake

16. Fluid Volume Deficit 4
• Risk factors:
– Diabetus insipidus. Excessive thirst .
Excretion of large amounts of severly diluted
urine
– Adrenal insufficiency. aldosterone
– Hemorrhage
– Third space fluid shift. Edema in burns and
ascites with liver dysfunction.

17. Fluid Volume Deficit 2
• Clinical manifestations
?

18. Fluid Volume Deficit 3
- Acute weight loss
- Decreased skin turgor
- Oliguria
- Concentrated urine
- Postural hypotension
- Weak, rapid, heart rate
- Flattened neck veins
- Increased temperature
- Decreased central venous pressure

19. Fluid Volume Deficit 5
• Assessment:
– BUN ELEVATED 7-30 mg/dl
– BUN : CREATININE(0.7-1.2 mg/dl) > 20:1
– Hypokalemia due to GI or renal loss
– Hyperkalemia occurs with adrenal insufficiency
– Hyponatremia with thirst and ADH release
– Hypernatremia results from insensible loss and DI.
– Urine osmalality > 450 mOsm/kg
– Urine sp. Gravity 1.001-1.035

20. Difference between and
HYPOVOLEMIA
• Extracellular fluid volume
is reduced, results in
decreased tissue
perfusion.
• It can be produced by salt
and water loss (e.g., with
vomiting, diarrhea,
diuretics or third spacing)
• salt and water loss comes
from Extracellular fluid
• TREATMENT: salt-based
so- called “crystalloid”
infusion.
DEHYDRATION
• Water loss alone is
termed as
DEHYDRATION.
• Pure water loss comes
from total body water,
only about 1/3 is of ECF.
• ALWAYS
HYPERNATREMIC.
• TREATMENT: free water
administration.

21. Fluid Volume Deficit 6
• Management:
– Isotonic solution (RL/ 0.9% NACL)-
Hypotensive & FVD
– HYPOTONIC SOLUTION (0.45% NACL) –
normotensive + FVD

22. • 0.9% NaCl
• Na+ 154 mEq/L
• Cl− 154 mEq/L
• (308 mOsm/L)
• expands the extracellular fluid
volume, used in hypovolemic
states, resuscitative efforts,
shock, metabolic alkalosis,
hypercalcemia, mild Na+
deficit.
• Supplies an excess of Na+
and Cl−; can cause fluid
volume excess and
hyperchloremic acidosis if
used in excessive volumes,
particularly in patients with
compromised renal function,
heart failure, or edema
• Not desirable as a routine
maintenance solution, as it
provides only Na+ and Cl−
(and these are provided in
excessive amounts)

23. • Lactated Ringer’s
solution
• (Hartmann’s solution)
• Na+ 130 mEq/L
• K+ 4 mEq/L
• Ca++ 3 mEq/L
• Cl− 109 mEq/L
• Lactate (metabolized
to bicarbonate)
• 28 mEq/L (274
mOsm/L)
• Contains multiple
electrolytes in roughly the
same concentration as
found in plasma (note
that solution is lacking in
Mg++): provides 9
calories/L
• Used in the treatment of
hypovolemia, burns, fluid
lost as bile or diarrhea,
and for acute blood loss
Replacement
• Should not be used in
renal failure because it
contains potassium and
can cause hyperkalemia
• Similar to plasma

24. • Hypotonic Solutions
• 0.45% NaCl (half-
strength saline)
• Na+ 77 mEq/L
• Cl− 77 mEq/L
• (154 mOsm/L)
• Provides Na+, Cl−, and free
water
• Free water is desirable to
aid the kidneys in
elimination of solute.
• Used to treat hypertonic
dehydration, Na+ and Cl−
depletion, and gastric fluid
loss
• Not indicated for third-space
fluid shifts or increased
intracranial pressure
• Administer cautiously, as it
can cause fluid shifts from
vascular system into cells,
resulting in cardiovascular
collapse and increased
intracranial pressure.

25. Nursing Diagnosis
• Fluid volume Deficit r/t
Insufficient intake, vomiting, diarrhea, hemorrage
m/b dry mucous membranes, low BP, HR 112-122,
BUN 28, Na 152, urine dark amber; Intake
200mL/Output 450mL over 24 hours
Goal: Client will have adequate fluid volume within
24 hours AEB:
Moist tongue, mucous membranes, HR WNL, BUN
between 8-20, Na 135-145, Urine clear yellow,
balanced I/O

26. Fluid Volume Deficit 5
• Nursing management
- Restore fluids by oral or IV
- Treat underlying cause
- Monitor I & O at least every 8 hours
- Daily weight 0.5kg= 500ml loss
- Vital signs
- Skin turgor
- Urine concentration

27. Fluid Volume Disturbances 2
• Fluid Volume Excess
(Hypervolemia)

28. Fluid Volume Excess
• Pathophysiology – may be related to
fluid overload or diminished function of the
homeostatic mechinisms responsible for
regulating fluid balance
• Contributing factors – CHF, renal failure,
cirrhosis

29. Fluid Volume Excess 2
• Clinical manifestations – edema,
distended neck veins, crackles,
tachycardia, increased blood pressure,
increased weight

30. Fluid Volume Excess 3
• DIAGNOSTIC FINDINGS:
– Hb & Hematocrit
– serum & urine osmolarity
– urine sodium and sp. Gravity
– CXR- pulmonary congestion

31. Fluid Volume Excess 4
• Diuretics:
– thiazide (hydrochlorothiazide)
• mild to moderate hypervolemia (block Na
reabsorption in the distal tubule- where 5-10%
filtered Na is reabsorbed)
– Loop (frusemide)
• severe (blocks in asending limb of henle’s loop –
where 20-30% filtered Na is reabsorbed)
• Renal replacement therapy- To remove nitrogenous
waste and control potassium and acid base balance.
• Nutritional therapy

32. Nursing Diagnosis and Goal
• Fluid volume excess r/t CHF, excess sodium
intake, renal failure AEB:
Weight gain of 6 lb. in 24 hours; lungs with
crackles in bases bilaterally; 2+ edema in ankles
bilaterally
Goal: Client will have normal fluid volume within 48
hours AEB:
Decreased weight of 1 lb. per day, lung sounds
clear in all fields, ankles without edema

33. Fluid Volume Excess
• Nursing management
– I/O chart, weight daily, gain – 1 kg =1 lit,
breath sounds, edema
• Preventing FVE
– Fluid restriction, sodium restricted diet
• Controlling FVE
– Semi fowlers position, rest (diuresis),
medicines.
• Teaching patients about edema

34. Electrolyte Imbalances
Sodium!
Normal range – 135 to 145 mEq/L
- Primary regulator of ECF volume (a loss
or gain of sodium is usually accompanied
by a loss or gain of water)

35. Hyponatremia
• Sodium level less than 135 mEq/L
• May be caused by vomiting, diarrhea,
sweating, diuretics, etc.

36. Hyponatremia 2
• Clinical manifestations
- Poor skin turgor
- Dry mucosa
- Decreased saliva production
- Orthostatic hypotension
- Nausea/abdominal cramping
- Altered mental status

37. Differential Diagnosis for
Hyponatremia
• In almost all cases, results from the intake
(either oral or intravenous) and subsequent
retention of water
• In almost all cases, occurs because there is an
impairment in renal water excretion, due most
often to an inability to suppress ADH release
• Elevated
– Syndrome of Inappropriate ADH secretion
– Hormonal changes
Adrenal insufficiency, pregnancy.

38. Evaluation of Patients with
Hyponatremia
• Serum sodium level.
• Assess volume status of patient
– Hypovolemia: orthostatic, dry mucous membranes
– Hypervolemia: peripheral edema, pulmonary edema,
JVD, ascites
• For Euvolemic pt:
– Check urine osmolality for SIADH (inappropriately
concentrated urine- should be dilute in this setting)

39. Hyponatremia 3
• Medical management
– Sodium Replacement
• mild- isotonic solution IV.
• Moderate – 2-4 lit over 6-12 hrs.
• Severe – 2-3 lit in first 2-3 hrs, followed by 2-5 lit
within 24-48 hrs.
– Formula: ?
- Water Restriction

40. Hyponatremia 4
• Nursing Management
- Detecting and controlling hyponatremia
- Returning sodium level to normal

41. Critical Thinking Exercise: Nursing
Management of the Client with
Hyponatremia
• Situation: An 87 year old man was
admitted to the acute care facility for
gastroenteritis, 2 day duration. He is
vomiting, has severe, watery diarrhea and
is c/o abd cramping. His serum
electrolytes are consistent with
hyponatremia r/t excessive sodium loss.

42. Critical Thinking Exercise: Nursing
Management of the Client with
Hyponatremia 2
• 1. What is the relationship between
vomiting, diarrhea, and hyponatremia?
– Hypovolemic hyponatremia.
• 2. What s/s should the client be monitored
for that indicate the presence of sodium
deficit?
• 3. In addition to examining the client’s
serum electrolyte findings, how will the
nurse know when the client’s sodium level
has returned to normal?

43. Hypernatremia
• Sodium level is greater than 145 mEq/L
- Can be caused by a gain of sodium in
excess of water or by a loss of water in
excess of sodium

44. Hypernatremia 2
• Etiopathogenesis:
- Fluid deprivation in patients who cannot
perceive, respond to, or communicate their thirst
- Most often affects very old, very young, and
cognitively impaired patients
- Insensible loss
- parenteral administration of hypertonic solution
(3-5% nacl, 7.5% of sodium bicarbonate)
- salt consumption
- With water excess – edema.

45. Hypernatremia 3
• Clinical manifestations
- Thirst
- Dry, swollen tongue
- Sticky mucous membranes
- Flushed skin
- Postural hypotension

46. Hypernatremia 4
• Medical Management
• Isotonic non saline solution dextrose 5% in
water. (An isotonic solution that supplies 170 calories/L and
free water to aid in renal excretion of solutes. Used in treatment
of hypernatremia, fluid loss, and dehydration)
• Formula: ?
– Desmopressin acetate, synthetic ADH-
diabetes insipidus
• Nursing Management
• - Preventing Hypernatremia
• - Correcting Hypernatremia

48. Critical Thinking Exercise: Nursing
Management of the Client with
Hypernatremia
• Situation: A 47 year old woman was taken to the
ER after she developed a rapid heart rate and
agitation. Physical assessment revealed dry
oral mucous membranes, poor skin turgor, and
fever of 101.3 orally. The client’s daughter
stated her mother had been very hungry recently
and drinking more fluids than usual. Suspecting
DM, the practitioner obtained serum electrolytes
and glucose levels, which revealed serum
sodium of 163 mEq/L and serum glucose of 360
mg/dL.

49. Critical Thinking Exercise: Nursing
Management of the Client with
Hypernatremia 2
• 1. Interpret the client’s lab data.
• 2. Why are clients with DM prone to the
development of hypernatremia?
• 3. What precautions should the nurse take when
caring for the client with hypernatremia?
• 4. List 4 food items this client should avoid and
why.

50. All About Potassium
• Major Intracellular electrolyte
• 98% of the body’s potassium is inside the
cells
• Influences both skeletal and cardiac
muscle activity
• Normal serum potassium
concentration –
3.5 to 5.5 mEq/L.

51. Hypokalemia
• Serum Potassium below 3.5 mEq/L
Causes:
Diarrhea, diuretics, poor K intake, stress,
steroid administration

52. Hypokalemia 2
• Clinical manifestations:
– Muscle weakness, cardiac arrythmias, increased
sensitivity to digitalis toxicity, fatigue,
– ECG changes
• ST depression, inverted T waves, prolonged PR interval,
large U waves.
– Respiratory hyperventilation.
– Skeletal muscle weakness
– Irregular, weak pulse
– Orthostatic hypotension
– Numbness (paresthesia)

53. Management
• 40-80 mEq/day of K is adequate.
• IV is manditory for severe hypokalemia.
• Diet – 50-100mEq/ day.
• KCL is used often.
• Food rich in K – banana, melon,
vegetables.

54. Hypokalemia 3
• Nursing interventions:
– Assess sign & symptoms.
– Encourage high K foods
– Monitor ECG results
– Dilute KCl! – can cause
cardiac arrest if given IVP

55. Hypokalemia 4
• Administering IV Potassium
- Should be administered only after adequate
urine flow has been established
- Decrease in urine volume to less than 20
mL/h for 2 hours is an indication to stop the
potassium infusion
- IV K+ should not be given faster than 20
mEq/h

56. Critical Thinking Exercise: Nursing
Management of the Client with
Hypokalemia
Situation:
A 69 year old man has a history of
CHF controlled by Digoxin and Lasix. Two
weeks ago he developed diarrhea, which
has persisted in spite of his taking OTC
antidiarrheal meds. His partner transported
him to the ER when she found him lethargic
and confused. Initial assessment of the
client reveals heart rate at 86 bpm,
respiratory rate 10, and blood pressure
102/56 mmHg.

57. Critical Thinking Exercise: Nursing
Management of the Client with
Hypokalemia 2
• 1. An electrolyte panel shows the client’s serum
potassium is 2.9 mEq/L. Does the nurse have
cause to be concerned about the client’s serum
potassium? Why or why not?
• 2. What data supports the presence of
hypokalemia in this client?
• 3. What, if anything, should the nurse do?
• 4. What foods should the client be advised to eat
that are high in potassium?

58. Hyperkalemia
Serum Potassium greater than
5.5 mEq/L
-More dangerous than hypokalemia
because cardiac arrest is frequently
associated with high serum K+ levels

59. Hyperkalemia 2
• Etiopathogenis:
– Decreased renal potassium excretion as seen
with renal failure and oliguria
- High potassium intake
- Hypoaldosteronism
- Shift of potassium out
of the cell as seen in
acidosis.
ECF K- Severe infection, major trauma,
crush injuries

60. Hyperkalemia 3
• Clinical manifestations:
- Skeletal muscle weakness/paralysis
- ECG changes – such as peaked T waves,
widened QRS complexes, absent P wave,
ST depression.

61. Hyperkalemia 4
Management:
-Monitor ECG changes.
-Administer Calcium solutions to neutralize the potassium
-Monitor muscle tone
- Sodium bicarbonate- in severe metabolic acidosis, shift K
in to cells.
-Regular insulin and hypertonic dextrose D50W
- shift K inside.
-Loop diuretic- excrete H2O, inhibit reabsorption of Na, K,
Cl in ascending loop of Henle
-Give Kayexelate –k removing resin. Draws k in large
intestine and eliminates.

62. Calcium
• More than 99% of the body’s calcium is
located in the skeletal system
• Normal serum calcium level is 8.5 to
10mg/dL
• Needed for transmission of
nerve impulses
• Intracellular calcium is needed
for contraction of muscles

63. Calcium 2
• Extracellular needed for blood clotting
• Needed for tooth and bone formation
• Needed for maintaining a normal heart
rhythm

64. Hypocalcemia
• Serum Calcium level less than 8.5 mEq/L

65. Hypocalcemia 2
• Causes
- Vitamin D/Calcium consumption
- Primary/surgical hypoparathyroidism
- Radial neck dissection
- Pancreatitis
- Renal failure
- Massive adm. Of citrated blood- transient hypocalcemia.
- Medications- antacid, cisplatin, isoniazid, loop diuretics.

66. Hypocalcemia 3
• Clinical Manifestations
- Tetany and cramps in muscles of
extremities
Definition – A nervous affection
characterized by intermitten tonic spasms
that are usually paroxysmal and involve
the extremities

67. Hypocalcemia 4
• Seizures (irritability of CNS), mental
changes
• Trousseau’s sign – carpal spasms

68. Hypocalcemia 5
- EKG shows
prolonged
QT intervals
• Chvostek’s sign
– cheek twitching

69. Hypocalcemia 6
• Impaired clotting time
• Decreased prothrombin time
• Decreased blood pressure
• Diarrhea

70. Hypocalcemia 7
• Diagnostic findings:
– Serum calcium levels
– Calculate corrected serum calcium levels
= measured total serum Ca level (mg/dl)
+ 0.8
* [ 4.0- measured albumin level (g/dl) ]

71. Hypocalcemia 8
• Medical management
- IV/PO Calcium Carbonate or Calcium Gluconate
- Encourage increased dietary intake of Calcium
- Monitor neurlogical status
- Establish seizure precautions
- Vit. D therapy.
- Diet- Ca intake 1000-1500 mg/day

72. IV Treatment of Low Calcium
per UofM CVC ICU Protocol Guidelines
Serum calcium
concentration
Preferred
calcium salt*
Calcium dose
Recheck serum
calcium
concentration
Ionized calcium = 1.05
– 1.11 mmol/L
(or corrected calcium ~ 8
– 8.4 mg/dL)
Gluconate
1 g calcium gluconate over 30 – 60
minutes
With next AM lab draw
Ionized calcium = 0.99 –
1.04 mmol/L
(or corrected calcium ~
7.5 – 7.9 mg/dL)
Gluconate 2 g calcium gluconate over 60 minutes
4 – 6 hours after
completing dose
Ionized calcium = 0.93 –
0.98 mmol/L
(or corrected calcium ~ 7
– 7.4 mg/dL)
Gluconate 3 g calcium gluconate over 60 minutes
4 – 6 hours after
completing dose
Ionized calcium < 0.93
mmol/L (or corrected
calcium < 7 mg/dL)
Gluconate
4 g calcium gluconate over 60 minutes
and notify MD
4 – 6 hours after
completing dose
72

73. Nursing consideration
• Check for digitalis medicine intake – as Ca
exerts same effect and can cause digitalis
toxicity.
• IV site – infiltration and extravasation.
• 0.9% sodium chloride should not be used with
calcium- increases renal calcium loss.
• Solution containing phosphates or bicarbonates
should not be used with calcium- precipitation.
• Seizure precautions.

74. Hypercalcemia
• Serum Calcium level greater than 10.5
mEq/L (2.6 mmol/L)

75. Hypercalcemia 2
• Causes:
- Hyperparathyroidism & malignancies.
- Excess PTH – increased release of calcium
from bones.
- Prolonged immobilization- bone mineral
lost
- Thiazide diuretics
- Large doses of Vitamin A and D

76. Hypercalcemia 3
• Clinical manifestations:
- Muscle weakness, nausea and vomiting
- Lethargy and confusion
- Constipation
- Cardiac Arrest (in hypercalcemic crisis, level
17mg/dL or higher) severe thirst, polyuria,
polydypsia, hypo active Deep tendon reflexes.
- ECG- short QT intervals.

77. Hypercalcemia 4 (>10.5mg/dL)
• Assessment findings:
– Neuro – Disorientation, lethargy, coma, profound
muscle weakness
– Resp. – Ineffective resp. movement
– CV - Inc. HR, Inc. BP. , Bounding peripheral pulses,
Positive Homan’s sign.
Late Phase – Bradycardia, Cardiac arrest
– GI – Dec. motility. Dec. BS. Constipation
– GU – Inc. urine output. Formation of renal calculi
• Diagnostic findings
– Serum calcium level
– ECG
– PTH level increased
– X ray – bone changes
– Renal calculi,

78. Hypercalcemia 5
• Medical Management
- Eliminate Calcium from diet
- Monitor neurological status
- Increase fluids (IV or PO)
- IV phosphate
- Calcitonin
- Cancer- surgery/chemotherapy

79. Calcitonin
• - used to lower serum calcium level
- useful for pts with heart disease or renal
failure
- reduces bone resorption
- increases deposit of calcium and
phosphorus in the bones
- increases urinary excretion of calcium
and phosphorus

80. • Parathyroid pulls, calcitonin keeps
Parathyroid hormone pulls calcium out of
the bone.
Calcitonin keeps it there.

81. Magnesium
- Normal serum magnesium level is 1.5 to 2.5
mg/dL
- Helps maintain normal muscle and nerve activity
- Exerts effects on the cardiovascular system,
acting peripherally to produce vasodilation
- Thought to have a direct effect
on peripheral arteries and
arterioles

82. Hypomagnesemia
• Serum Magnesium level less than 1.5
mEq/L

83. Hypomagnesemia
• Causes
- Chronic Alcoholism
- Diarrhea, or any disruption in small bowel
function
- TPN
- Diabetic ketoacidosis
- Malabsorption
- Digitalis, diuretics, cyclosporin, cisplatin,
amphotericin, rapid adm. Of citrated blood.

84. Hypomagnesemia 3
• Clinical manifestations
- Neuromuscular irritability
- Positive Chvostek’s and Trousseau’s sign
- ECG changes with prolonged QRS,
depressed ST segment, and cardiac
dysrhythmias
- May occur with hypocalcemia and
hypokalemia

85. STARVED
• Starved – possible cause of hypomagnesemia
• Seizures
• Tetany
• Anorexia and arrhythmias
• Rapid heart rate
• Vomiting
• Emotional lability
• Deep tendon reflexes increased

86. Hypomagnesemia 5
• Medical / Nursing management
- IV/PO Magnesium replacement, including
Magnesium Sulfate
- Give Calcium Gluconate if accompanied by
hypocalcemia
- Monitor for dysphagia, give soft foods
- Measure vital signs closely
- Ca gluconate- to treat hypocalcemic tetany

87. IV Treatment of Low
Magnesium
per UofM CVC ICU Protocol Guidelines
Serum magnesium
concentration
Intravenous
magnesium
sulfate dose†
Recheck serum magnesium
concentration
1.9 – 2 mg/dL
1 g magnesium
sulfate
With next AM lab draw
1.7 – 1.8 mg/dL
2 g magnesium
sulfate
With next AM lab draw
1.6 – 1.7 mg/dL
3 g magnesium
sulfate otherwise use
sodium phosphate (1
mmol potassium
phosphate = 1).
4 – 6 hours after completion of dose if
symptomatic, otherwise with next AM lab
draw
< 1.5 mg/dL Notify MD
Rate of intravenous infusion
of magnesium
Recommend infusing 1 g magnesium sulfate/hour (~8 mEq
magnesium/hour), up to maximum of 2 g magnesium sulfate/hour
87

88. Hypermagesemia
• Serum Magnesium level greater than 2.5
mEq/L

89. Hypermagnesemia 2
• Causes
- Renal failure
- Untreated diabetic ketoacidosis
- Excessive use of antacids and laxatives
- Treatment of hypertension in pregnancy
- Lithium intoxication
- Extensive soft tissue injury

90. Hypermagnesemia 3
• Clinical manifestations
- Flushed face and skin warmth
- Mild hypotension
- Heart block and cardiac arrest
- Muscle weakness and even paralysis
- Platelet clumping

91. • Reflexes decreased (plus weakness and
paralysis)
• ECG changes (bradycardia and
hypotension, prolonged PR interval,
peaked T waves)
• Nausea and vomiting
• Appearance flushed
• Lethargy (plus drowsiness and
coma)

92. Hypermagnesemia 5
• Medical/Nursing management
- Monitor Mg levels
- Monitor respiratory rate
- Monitor cardiac rhythm
- Increase fluids
- IV calcium for
emergencies

93. Thanks