nursing electrolyte balance
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- Normal serum sodium level
- 135-145 mEq/L
- causes of hyponatremia
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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
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actual loss: Na+ replacement diet (PMS), saline IV
relative deficit: diuretic Osmitrol (mannitol), free water restriction - causes of hypernatremia
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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
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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
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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
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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
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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-
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Normal serum sodium level
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135-145 mEq/L