Electrolytes

• hypernatremia > 145mEq/L


  causes: medications / meals, osmotic diuresis, diabetes insipidus, excessive water loss, low water intake, impaired LOC, hyperglycemia
• hypernatremia> 145mEq/L


  manifestations: fever / flushed, restless / confused, increased fluids / BP, edema, decreased urine output, orthostatic hypotension, weakness / lethargy, weight loss, decreased skin turgor
• hypernatremia> 145mEq/L


  interventions: push PO fluids, D5W, restrict dietary intake, gradually reduce
• hyponatremia < 135mEq/L


  causes: excessive hypotonic IVF, SIADH, loss from GI / kidneys / skin
• hyponatremia < 135mEq/L


  manifestations: fluid overload in brain -> irritability, confusion, seizures, coma

  severe: irreversible brain damage, death
• hyponatremia < 135mEq/L


  interventions: fluid restriction, slow infusion of 3% NaCl (severe)
• hyperkalemia > 5mEq/L


  causes: renal failure, excessive intake, burns, medications (ACE, ARB, NSAIDs), potassium-sparing diuretics, adrenal insufficiency, metabolic acidosis
• hyperkalemia > 5mEq/L


  manifestations: leg cramps, weakness, paralysis of skeletal muscles, cardiac muscle irritability, vfib, vtach, PVC, asystole
• hyperkalemia > 5mEq/L


  interventions: decrease intake, cardiac monitoring, increase elimination, increase fluids, IV insulin -> IV glucose, IV calcium
• hypokalemia < 3.5mEq/L


  causes: loss via kidneys / GI, diuretics, elevated aldosterone, metabolic alkalosis, DKA treatment
• hypokalemia < 3.5mEq/L


  manifestations: reduced excitability, lethal ventricular dysrhythmias, digoxin toxicity, skeletal muscle weakness / paralysis, respiratory arrest (severe)
• hypokalemia < 3.5mEq/L


  interventions: potassium supplements, increase intake, cardiac monitoring
• hypercalcemia > 10.5mg/dL


  causes: hyperparathyroidism, malignancy, immobility
• hypercalcemia > 10.5mg/dL


  manifestations: reduced excitability of muscles / nerves, decreased memory, confusion, disorientation, fatigue
• hypercalcemia > 10.5mg/dL


  interventions: promote excretion, low calcium diet, increase activity, administer calcitonin
• hypocalcemia < 9mg/dL


  causes: decreased PTH, surgical removal of parathyroid, low intake
• hypocalcemia < 9mg/dL


  manifestations: increased nerve excitability (tetany), decreased cardiac contractility (vtach), chvostek's sign, trousseau's sign
• hypocalcemia < 9mg/dL


  interventions: increase PO intake, IV calcium gluconate (severe)
• hyperphosphatemia > 4.5mg/dL


  causes: acute / chronic renal failure, chemotherapy, excessive milk intake, excessive vitamin D intake
• hyperphosphatemia > 4.5mg/dL


  manifestations: calcified deposits in joints, arteries, skin, kidneys, corneas, neuromuscular irritability
• hyperphosphatemia > 4.5mg/dL


  interventions: limit foods (dairy), hydration, correct hypocalcemia
• hypophosphatemia < 3mg/dL


  causes: malnourished, malabsorption, alcohol withdrawal
• hypophosphatemia < 3mg/dL


  manifestations: mild often asymptomatic, decreased cell function, CNS depression, muscle weakness, pain, dysrhythmias, cardiomyopathy
• hypophosphatemia < 3mg/dL


  interventions: supplements, IV sodium / potassium phosphate (severe), monitor for symptomatic hypocalcemia
• hypermagnesemia > 2.1mEq/L


  causes: acute / chronic renal failure
• hypermagnesemia > 2.1mEq/L


  manifestations: lethargy, drowsiness, nausea / vomiting, loss of deep tendon reflexes, somnolence, respiratory / cardiac arrest
• hypermagnesemia > 2.1mEq/L


  interventions: IV calcium chloride / gluconate to oppose effects on cardiac muscle (emergency), fluids, diuretics, dialysis
• hypomagnesemia < 1.3mEq/L


  causes: prolonged fasting / starvation, chronic alcoholism, fluid loss, prolonged parenteral nutrition without supplement, diuretics
• hypomagnesemia < 1.3mEq/L


  manifestations: neuromuscular / CNS hyperirritability, confusion, hyperactive deep tendon reflexes, tremors, seizures, cardiac dysrhythmias
• hypomagnesemia < 1.3mEq/L


  interventions: supplements, IV magnesium sulfate (severe)
• fluids: D5W

  isotonic

  indications: hypernatremia

  no electrolytes
• fluids: .45NS

  hypotonic

  indications: replace hypotonic fluid loss, maintenance solution, no electrolytes
• fluids: .9NS

  isotonic

  indications: expand volume, replace fluid loss, no electrolytes
• fluids: D5.45NS & D5.9NS

  hypertonic

  indications: hypovolemia, hyponatremia
• fluids: lactated ringers

  isotonic

  indications: similar to plasma, no free water / calories, contain electrolytes
• fluid volume deficit: assessments

  neuro: restless, lethargy

  integumentary: dry mucous membranes, tenting

  CV/resp: tachycardia, rapid RR

  GU: decreased / concentrated urine

  labs: increased hemoglobin / hematocrit, BUN, electrolytes (K)
• fluid volume deficit: medical management

  replace fluids: 0.9NS or LR
• fluid volume deficit: nursing management

  vitals, daily weight, I&O, labs, UO, increase oral intake, assess hydration status, hypovolemic shock
• fluid volume excess: assessments

  neuro: LOC (confusion, headache, seizures)

  respiratory: pulmonary congestion, crackles, SOB

  CV: bounding pulse, increased BP, JVD, tachycardia, edema

  GI: anorexia, nausea

  labs: dilutional Na < 135mEq/L, decreased hemoglobin / hematocrit
• fluid volume excess: medical management

  diuretics, fluid restriction