Glossary of nursing electrolyte balance

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Normal serum sodium level
135-145 mEq/L
causes of hyponatremia
actual loss: excess sweat, diuretics, GI wound drainage, decr. aldosterone, renal disease
relative deficit: overuse of D5W, low Na+ diet, SIADH, CHF, freshwater drowning
s/s of hyponatremia
anorexia, N/V, cramps, muscle weakness, lethargy, confusion, seizures, Na+ <135 mEq/L
treatment of hyponatremia
actual loss: Na+ replacement diet (PMS), saline IV
relative deficit: diuretic Osmitrol (mannitol), free water restriction
causes of hypernatremia
actual excess: excess IV saline, hypertonic tube feeds w/o enough water
relative excess: decr. Na+ excretion - hyperaldosteronism, CRF, corticosteroid Tx, Cushing's synd.
relative excess: fluid loss/defic. - decr. water intake, NPO, fever, hypervent., sweat, diarrhea
s/s of hypernatremia
thirst, + temp, restlessness, seizures, muscle twitch, rubbery skin, dry MMs, tachycardia, fast thready pulse, decr. urine output, Na+ >145 mEq/L
treatment of hypernatremia
relative excess from fluid loss: D5W
relative excess from decr. Na+ excretion: 1/2 NS + diuretic
actual excess: Na+ restriction
normal serum potassium
3.5-5.0 mEq/L
causes of hypokalemia
actual deficit: diuretics, Cushing's synd, diarrhea, vomiting, NG suctioning, wound drainage, endstage CRF
relative deficit: alkalosis, water intoxication
s/s of hypokalemia
muscle weakness, leg cramps, constipation, paralytic ileus, irritability, confusion, irregular pulse, heart block, orthostatic BP, shallow resp, K+ <3.5 mEq/L
treatment of hypokalemia
K+ supplement (oral or IV), USE CAUTION WITH IV K+, K-sparing diuretics, caution w/ digoxin, diet
causes of hyperkalemia
actual excess: overuse of salt substitutes, rapid IV LR, multiple blood transfusions
relative excess: CRF, overuse of K-sparing diuretics, tissue damage, acidosis
s/s of hyperkalemia
diarrhea, abd cramps, muscle twitch, cardiac irregularities, resp. failiure, K+ >5.0 mEq/L
treatment of hyperkalemia
diuretics, cation exchange resin, glucose IV fluids + insulin, hemodialysis, low-K diet
normal serum calcium
total: 8.4-10.2 mg/dL
ionized: 4.65-5.28 mg/dL
causes of hypocalcemia
pancreatic/small intestine disease, acute renal failure, vit D deficiency, hypoparathyroidism, hyperphosphatemia
s/s of hypocalcemia
tetany, tingling/numbness in extremities, facial muscle spasm (Chovstek's sign), carpopedal spasm (Trousseau's sign), laryngospasm, dyspnea, hyperactive reflexes, seizures, arrhythmias
treatment of hypocalcemia
oral Ca, Vit D3, IV Ca, parathyroid hormone, diet
causes of hypercalcemia
immobility, bone Ca, excess intake, incr. parathyroid hormone (CRF, adenoma of parathyroid), thiazide diuretic
s/s of hypercalcemia
constiptaion, N/V, polyurea, renal stones, decr. muscle tone, deep bone pain, reflexes decr., lethargy, coma
treatment of hypercalcemia
NS IV with Lasix, push fluids, avoid high Ca foods
normal serum magnesium
1.3-2.6 mEq/L
causes of hypomagnesemia
loss of intestinal fluids, malnutrition, renal probs, loop diuretics, parathyroid hormone deficiency
s/s of hypomagnesemia
confusion, hallucinations, seizures, incr. reflexes, parasthesias, tremors, spasms, arrhythmias
treatment of hypomagnesemia
magnesium-sulfate IM or Iv, diet
causes of hypermagnesemia
rare, renal failure, excess use of magnesium-containing antacids
s/s of hypermagnesemia
hypotension, cardiac arrest, resp. depression, reflexes decr.
treatment of hypermagnesemia
dialysis, calcium gluconate (magnesium antagonist)
Phosphate imbalance
assoc. with Ca++ and parathyroid probs, corrected with Ca++ imbalance, req. adequate renal function
chloride imbalance
rarely occur alone, closely assoc. with Na+ balance; inverse relationship with HCO3-
Normal serum sodium level

135-145 mEq/L

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