DNS, RL

1. ELECTROLYTE
PRESENTED BY- DR. SUJAY S. PATIL
PART 1 RESIDENT
DEPT. OF OMFS

2. CATIONSCATIONS ANIONSANIONS
Na- 135-145 m Eq/LNa- 135-145 m Eq/L
K- 3.5 – 5.0 m Eq/LK- 3.5 – 5.0 m Eq/L
Ca- 4.5-5.5 mEq/LCa- 4.5-5.5 mEq/L
Mg -1.5 – 2.5 mEq/LMg -1.5 – 2.5 mEq/L
HCO3- 22-26 mEq/LHCO3- 22-26 mEq/L
Cl- 96-106 mEq/LCl- 96-106 mEq/L
PO4 – 1.2 -3.0 mEq/LPO4 – 1.2 -3.0 mEq/L
Electrolytes –– These are chemical substances which when
dissolved, dissociate into ions and pass electrical potential..

3. SODIUM

4. HYPONATREMIA (<135MEQ/L)
Contributing Factors
Excessive diaphoresis
Wound Drainage
NPO
CHF
Low salt diet
Renal Disease
Diuretics

5. HYPONATREMIA (<135MEQ/L)
Assessment findings:
Neuro - Generalized skeletal muscle weakness. Headache /
personality changes.
Resp.- Shallow respirations
CV - Cardiac changes depend on fluid volume
GI – Increased GI motility, Nausea, Diarrhea (explosive)
GU - Increased urine output

6. HYPONATREMIA (<135MEQ/L)
Interventions/Treatment
Restore Na levels to normal and prevent further decreases in Na.
Drug Therapy –
(FVD) - IV therapy to restore both fluid and Na. If severe may
see 2-3% saline.
(FVE) – Administer osmotic diuretic (Mannitol) to excrete the
water rather than the sodium.
Increase oral sodium intake and restrict oral fluid intake.

7. HYPERNATREMIA (>145MEQ/L)
Contributing Factors
Hyperaldosteronism
Renal failure
Corticosteroids
Increase in oral Na intake
Na containing IV fluids
Decreased urine output with increased urine concentration

8. HYPERNATREMIA (>145MEQ/L)
Contributing factors (cont’d):
Diarrhea
Dehydration
Fever
Hyperventilation

9. HYPERNATREMIA (>145MEQ/L)
Assessment findings:
Neuro - Spontaneous muscle twitches. Irregular contractions.
Skeletal muscle weakness. Diminished deep tendon reflexes
Resp. – Pulmonary edema
CV – Diminished CO. HR and BP depend on vascular volume.

10. HYPERNATREMIA (>145MEQ/L)
GU – Dec. urine output. Inc. specific gravity
Skin – Dry, flaky skin. Edema r/t fluid volume changes.

11. HYPERNATREMIA (>145MEQ/L)
Interventions/Treatment
Drug therapy
(FVD) .45% NSS. If caused by both Na and fluid loss, will
administer NaCL. If inadequate renal excretion of sodium, will
administer diuretics.
Diet therapy
Mild – Ensure water intake

12. POTASSIUM
Low concentrations in ECF
Normal 3.5-5.0 mEq/L
Major ICF cation
Normal daily intake : 40 -60 mEq/L
The rate of potassium excretion is regulated by aldosterone;
aldosterone stimulates potassium ion excretion.

13. HYPOKALEMIA (<3.5MEQ/L)
Pathophysiology –
Decrease in K+ causes decreased excitability of cells,
therefore cells are less responsive to normal stimuli

14. HYPOKALEMIA (<3.5MEQ/L)
Contributing factors:
Diuretics
Shift into cells
Digitalis
Water intoxication
Corticosteroids
Diarrhea
Vomiting

16. HYPOKALEMIA (<3.5MEQ/L)
Interventions
Assess and identify those at risk
Encourage potassium-rich foods
K+ replacement (IV or PO)
Monitor lab values
D/c potassium-wasting diuretics
Treat underlying cause

17. HYPERKALEMIA (>5.0MEQ/L)
Pathophysiology – An inc. in K+ causes increased excitability of
cells.

18. HYPERKALEMIA (>5.0MEQ/L)
Contributing factors:
Increase in K+ intake
Renal failure
K+ sparing diuretics
Shift of K+ out of the cells

20. HYPERKALEMIA (>5.0MEQ/L)
Interventions
Need to restore normal K+ balance:
Eliminate K+ administration
Inc. K+ excretion
Lasix
Kayexalate (Polystyrene sulfonate)
Infuse glucose and insulin
Cardiac Monitoring

21. CHLORIDE
Chloride (Cl-
) - 95-103 mEq/liter
Major ECF anion
helps balance osmotic potential and electrostatic equilibrium
between fluid compartments
plasma membranes tend to be leaky to Cl-
anions
Regulation:aldosterone

22. HOMEOSTATIC IMBALANCES
Hypochloremia - results in muscle spasms, coma [usually occurs
with hyponatremia] often due to prolonged vomiting
Causes:
metabolic alkalosis
Respiratory acidosis
emphysema
Adrenal cortical insufficiency
thiazides
diarrhea

23. HYPERCHLOREMIA
Causes:
hyper chloremic acidosis
Respiratory alkalosis
Dehydration
Diabetes insipidus
renal tubular acidosis

24. CALCIUM
Normal 4.5-5.5 mEq/L
99% of Ca in bones, other 1% in ECF and soft tissues
Total Calcium – bound to protein – levels influenced by nutritional
state
Ionized Calcium – used in physiologic activities – crucial for
neuromuscular activity

25. CALCIUM
Required for blood coagulation, neuromuscular contraction,
enzymatic activity, and strength and durability of bones and teeth
Nerve cell membranes less excitable with enough calcium
Ca absorption and concentration influenced by Vit D, calcitriol
(active form of Vitamin D), PTH, calcitonin, serum concentration of
Ca and Ph.

26. HYPOCALCEMIA (<9.0MG/DL)
Contributing factors:
Dec. oral intake
Lactose intolerance
Dec. Vitamin D intake
End stage renal disease
Diarrhea

27. HYPOCALCEMIA (<9.0MG/DL)
Contributing factors (cont’d):
Acute pancreatitis
Hyperphosphatemia
Immobility
Removal or destruction of parathyroid gland

28. HYPOCALCEMIA (<9.0MG/DL)
Assessment findings:
Neuro –Irritable muscle twitches.
Positive Trousseau’s sign.
Positive Chvostek’s sign.
Resp. – Resp. failure d/t muscle tetany.
CV – Dec. HR., dec. BP, diminished peripheral pulses
GI – Inc. motility. Inc. BS. Diarrhea

29. HYPOCALCEMIA (<9.0MG/DL)
Interventions/Treatment
Drug Therapy
Calcium supplements
Vitamin D
Diet Therapy
High calcium diet
Prevention of Injury
Seizure precautions

30. HYPERCALCEMIA (>10.5MG/DL)
Contributing factors:
Excessive calcium intake
Excessive vitamin D intake
Renal failure
Hyperparathyroidism
Malignancy
Hyperthyroidism

31. HYPERCALCEMIA
(>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

32. HYPERCALCEMIA
(>10.5MG/DL)
Interventions/Treatment
 Eliminate calcium administration
 Drug Therapy
 Isotonic NaCL (Inc. the excretion of Ca)
 Diuretics
 Calcium reabsorption inhibitors (Phosphorus)
 Cardiac Monitoring

33. MAGNESIUM
Normal 1.5 to 2.5 mEq/L
Ensures K and Na transport across cell membrane
Important in CHO and protein metabolism
Plays significant role in nerve cell conduction
Important in transmitting CNS messages and maintaining
neuromuscular activity

34. HYPOMAGNESEMIA
(<1.4MEQ/L)
Contributing factors:
 Malnutrition
 Starvation
 Diuretics
 Aminoglcoside antibiotics
 Hyperglycemia
 Insulin administration

35. HYPOMAGNESEMIA
(<1.4MEQ/L)
Assessment findings:
*Neuro - Positive Trousseau’s sign. Positive Chvostek’s sign.
Hyperreflexia. Seizures
*CV – ECG changes. Dysrhythmias. HTN
*Resp. – Shallow resp.
*GI – Dec. motility. Anorexia. Nausea

36. HYPOMAGNESEMIA
(<1.4MEQ/L)
Interventions:
 Eliminate contributing drugs
 IV MgSO4
 Assess DTR’s hourly with MgSO4
 Diet Therapy

37. HYPERMAGNESEMIA
(>2.0MEQ/L)
Contributing factors:
 Increased Mag intake
 Decreased renal excretion

38. HYPERMAGNESEMIA
(>2.0MEQ/L)
Assessment findings:
Neuro – Reduced or weak DTR’s. Weak voluntary muscle
contractions. Drowsy to the point of lethargy
CV – Bradycardia, peripheral vasodilatation, hypotension.
ECG changes.

39. HYPERMAGNESEMIA
(>2.0MG/DL)
Interventions
 Eliminate contributing drugs
 Administer diuretic
 Calcium gluconate reverses cardiac effects
 Diet restrictions

40. PHOSPHOROUS
Normal 2.5-4.9 mg/dL
Intracellular mineral
Essential to tissue oxygenation, normal CNS function and movement of
glucose into cells, assists in regulation of Ca and maintenance of acid-
base balance
Influenced by parathyroid hormone and has inverse relationship to
Calcium

41. HYPOPHOSPHATEMIA
(<2.5MG/L)
Contributing Factors:
 Malnutrition
 Starvation
 Hypercalcemia
 Renal failure
 Uncontrolled DM

42. HYPOPHOSPHATEMIA
(<2.5MG/L)
Assessment findings: (Chart 13-7)
Neuro – Irritability, confusion
CV – Dec. contractility
Resp. – Shallow respirations
Musculoskeletal - Rhabdomyolysis
Hematologic – Inc. bleeding
Dec. platelet aggregation

43. HYPOPHOSPHATEMIA
(<2.5MG/L)
Interventions
 Treat underlying cause
 Oral replacement with vit. D
 IV phosphorus (Severe)
 Diet therapy
 Foods high in oral phosphate

44. HYPERPHOSPHATEMIA
(>4.5MG/L)
Causes few direct problems with
body function. Care is directed to
hypocalcemia.
Rarely occurs