electrolyte

• the normal range for sodium is 135-146 mmol/L
• Hyperosmolar imbalance, also known as dehydration, causes shifting of fluids from the intracellular fluid (ICF) and extracellular fluid (ECF).
• The initial manifestation of dehydration is thirst.
• The most objective indicator of dehydration is weight loss, followed by decreased urine output.
• Hyperthermia, tachycardia, tachypnea, hypotension are signs and symptoms of dehydration.
• Dry, mouth and throat, warm, flushed, dry skin, soft, sunken eyeballs, dark, concentrated urine, altered level of consciousness, increased hematocrit, BUN, serum electrolyte levels are other signs and symptoms of dehydration.
• Management of dehydration includes fluid replacement, oral care for dry mouth and throat, safety measures for altered level of consciousness, and identifying and treating underlying causes such as enteral feedings, renal failure, and diabetes mellitus.
• Hypoosmolar imbalance, also known as water intoxication, causes shifting of fluids from the extracellular fluid (ECF) to the intracellular fluid (ICF).
• The cells swell in hypoosmolar imbalance.
• There is sodium deficit or water excess in hypoosmolar imbalance.
• The most dangerous effects of water intoxication are increased intracranial pressure (ICP) and changes in mental status, including confusion, incoordination, and convulsions.
• Sudden weight gain and peripheral edema are other signs and symptoms of water intoxication.
• Hyponatremia is caused by sodium loss or water excess.
• Management of water intoxication includes fluid restriction, administration of diuretics as prescribed, infusion of hypertonic saline per IV, and promotion of safety, safety measures for altered level of consciousness, and identifying and treating underlying causes such as excess intake of electrolyte, free fluid, repeated tap water enema, SIADH, and sodium deficit.
• The causes of hyponatremia include diuretics, low sodium diet, decreased aldosterone secretion (Addison’s disease), edema, ascites, burns, and diaphoresis.
• Sodium is the most abundant electrolyte in the extracellular fluid (ECF), with a concentration range from 135-145mEq/L (135-145 mmol/L) and it is the primary determinant of ECF and osmolality.
• Sodium controls water distribution throughout the body because it does not easily cross the cell wall membrane and because of its abundance and high concentration in the body.
• The clinical manifestations of hyponatremia are due to decreased extracellular fluid (ECF) volume and increased intracellular fluid (ICF) volume.
• Sodium is regulated by ADH, thirst, and renin-angiotensin aldosterone system.
• A loss or gain of sodium by is usually accompanied by a loss or gain of water.
• Sodium also functions in establishing the electrochemical state necessary for muscle contraction and the transmission of nerve impulses.
• Symptoms of hyponatremia include headache, muscle weakness, fatigue, apathy, anorexia, nausea and vomiting, abdominal cramps, and weight loss.
• Hyponatremia can lead to seizures and coma.
• Hypernatremia is caused by sodium and water excess, resulting in edema.
• Hyperventilation and diarrhea can lead to more water loss than sodium, resulting in hypernatremia.
• The clinical manifestations of hypernatremia include extreme thirst, dry, sticky mucous membrane, oliguria, firm, rubbery tissue turgor, red, dry, swollen tongue, restlessness, tachycardia, fatigue, disorientation, and hallucination.
• Management of hypernatremia includes monitoring intake and output, restricting sodium in diet, increasing oral fluids or administering D5W as prescribed, administering diuretics as ordered, and dialysis as indicated.
• Promoting safety, monitoring behavior changes, and managing complications are important aspects of the management of hypernatremia.
• Potassium is the major intracellular electrolyte, with 98% of the body's potassium located inside the cells.
• The remaining 2% of potassium is located in the extracellular fluid (ECF) and is important in neuromuscular function.
• Potassium influences both skeletal and cardiac muscle activity.
• The normal serum potassium level is 3.5 to 5.0mEq/L (3.5 to 5mmol/L), and even minor variations are significant.
• Potassium imbalances are commonly associated with various diseases, injuries, medications, NSAIDS, and ACE inhibitors, and acid-base imbalances.
• Hypokalemia, or potassium deficit, can cause gastrointestinal symptoms such as anorexia, nausea, vomiting, abdominal distention, paralytic ileus, and central nervous system symptoms like lethargy, diminished deep tendon reflexes, confusion, mental depression.
• Hyperkalemia, or potassium excess, can cause gastrointestinal symptoms such as nausea, vomiting, diarrhea, colic, and central nervous system symptoms like numbness, tingling.
• Hyperkalemia can also cause muscle irritability in the early stages and weakness in the late stages.
• Hyperkalemia can lead to cardiovascular complications such as ventricular fibrillation and cardiac arrest.
• Hyperkalemia can also lead to kidney damage.
• Hyperkalemia can occur due to excess dietary intake of potassium rich foods, excess parenteral administration of potassium, decreased excretion of potassium, renal failure, adrenal insufficiency, or shifting of potassium out of cells due to extensive trauma or crushing injuries.
• Hyperkalemia can be managed with a low potassium diet, dextrose 10% in water with regular insulin per IV as prescribed, polysterene sulfonate (exchange resin Kayexalate) per mouth or enema as prescribed, calcium gluconate per IV, and dialysis as indicated.