Fluid and Electrolytes

• Calcium range:

  • Total: 9-10.5
  • Partial: 4.5-5.1
• Sodium range: 136-145
• Potassium range: 3.5-5
• Magnesium range: 1.3-2.1
• Phosphorus range: 2.5-4.5
• Chloride range: 97-107
• Calcium:

  • Maintains bone health, stored in teeth and bones
  • Involved in muscle movement, nerve transmission, cell permeability, blood flow
  • Affected by parathyroid levels
• HYPOcalcemia:

  • Irregular heartbeat, Trousseau's sign, increased bowel sounds, bronchospasm, impaired clotting time, seizures, irritability, diarrhea, tetany, Chvostek's sign, hypotension/hyperactive deep tendon reflexes
• HYPOcalcemia interventions:

  • Seizure precautions, Ca+ supplements, dairy, greens
• HYPERcalcemia:

  • Bone pain, arrhythmias, cardiac arrest, kidney stones, muscle weakness, excessive urination
• HYPERcalcemia interventions:

  • Increase fluid, fiber, IV fluids, furosemide
• Sodium:

  • Supports nerve transmission, muscle function, BP, fluid balance
  • Regulated by ADH, thirst, RAAS
• HYPOnatremia:

  • Stupor, coma, anorexia, lethargy, tendon reflexes, limp muscles, orthostatic hypertension, seizures, headache, stomach cramping
• HYPOnatremia interventions:

  • Reduce fluids, increase salt intake, isotonic fluids, sodium tablets, electrolyte replacement
  • Seizure precautions, daily weight, I/Os, postural hypotension
• HYPERnatremia:

  • Flushed skin, restlessness, increased BP, edema, decreased urine output, dry mouth, agitation, low-grade fever, thirst
• HYPERnatremia interventions:

  • Diuretics, hypotonic fluids, low sodium intake, increase water intake, monitor renal output
• Potassium:

  • Intracellular cation, nerve conduction, muscle contraction, fluid balance
• HYPOkalemia:

  • Alkalosis, shallow respirations, irritability, confusion, weakness, fatigue, arrhythmias, tachycardia, lethargy, thready pulse, low intestinal mobility
• HYPOkalemia interventions:

  • Foods like squash, potatoes, avocados, cantaloupe, bananas, K+ supplements
  • Monitor U wave, respirations, arrhythmias
  • Dilute K+ supplements, monitor urine output, GI motility
• HYPERkalemia:

  • Muscle cramps, urine abnormalities, respiratory distress, decreased cardiac contractility, EKG changes, decreased reflexes
• HYPERkalemia interventions:

  • Stop K+ supplements, T waves, kayexalate, insulin with dextrose, K+ restricted foods, loop diuretics
• Chloride:

  • Anion in extracellular fluid, acid-base balance, gastric juice activity, nerve/muscle contraction
• Magnesium:

  • Neuromuscular transmission, myocardial contraction
• HYPOmagnesemia:

  • Neuromuscular irritability, Chvostek's sign, Trousseau's sign, insomnia, mood changes, anorexia, vomiting, increased reflexes, hypertension
• HYPOmagnesemia interventions:

  • Foods like meats, nuts, beans, fish, veggies, magnesium sulfate
• HYPERmagnesemia:

  • Flushing, hypotension, muscle weakness, drowsiness, coma, hypoactive reflexes, respiratory depression, cardiac arrest, diaphoresis, tachycardia, bradycardia
• HYPERmagnesemia interventions:

  • Restrict Mg-rich foods, avoid laxatives, antacids
• Phosphorus:

  • Bone/teeth formation, neuromuscular activity, cellular activity