Electrolyte imbalances

• Electrolytes are regulated by?

  Regulated by:

  -normal organ and gland function

  -intake and output

  -acid base balance

  -hormones

  -cell integrity
• what organs and glands are associated with fluid and electrolyte balance?

  -Kidneys: water, electrolytes;K+, Na+, urea and H+ ions

  -GI tract: absorbs fluids and electrolytes

  -Lungs and liver: water and sodium balance

  -Sweat glands: excrete Na+, K+, Cl-, water

  -Heart: excretes sodium via release of atrial natriuretic peptide(ANP)
• What is sodium? what does it do? relation to water?

  -Major extracellular electrolyte

  -Controls and regulate water balance

  -Where sodium goes water follows OR water follows sodium
• what is potassium? what does it do?

  -Major intracellular electrolyte

  -Helps maintain intracellular water balance

  -Transmit nerve impulses to muscles and contract skeletal and smooth muscles(e.g.Cardiac)
• What is Hypernatraemia? what causes it?

  -Is an imbalance of sodium of increased sodium

  Causes:

  -excess Na+ intake

  -Inadequate water intake

  -Excess water loss

  -Results in fluid shift from ICF to ECF (as water follows sodium)

  -water moves out of cell to try and balance osmolarity in ECF and causes cell to shrink
• What are the signs and symptoms of hypernatremia? Hint-Fried

  F= fever(low grade, flushed skin)

  R= restless(irritable)

  I= increased fluid retention and Increased BP

  E= edema(peripheral and pitting)

  D= decreased urine output, dry mouth
• How do you treat Hypernatremia?

  -Treat the underlying cause as interventions relate to cause

  -Diuretics

  -Sodium restriction

  -give salt free IV fluids

  -Seizure precautions= is vulnerable to seizures

  -If severe= Dialysis

  -Action: reduce sodium slowly to avoid brain swelling
• What is Hyponatremia? Dilution? Excretion? Intake?

  -Is a imbalance of sodium of decreased sodium levels through water excess or loss of Na+,

  Causes:

  -Dilution: polydipsia, fresh water drowning, ADH, CHF(excess H20)

  -Excretion: sweating, diuretics, GI wound drainage, renal disease(excess Na+ loss), Diuretics(at risk due to fluid loss)

  -Intake: low salt diet, severe vomiting/diarrhoea(inadequate Na+ intake to balance loss)
• Signs and symptoms of Hyponatremia? hint- Salt Loss

  S- Stupor/coma

  A-Anorexia, N&V

  L-Lethargy

  T-tendon reflexes decreased

  L-Limp muscle(weakness)

  O-Orthostatic hypotension

  S-Seizures/headache

  S-stomach cramping
• How can you treat Hyponatremia?

  -Identify underlying cause to treat it

  -3% saline, watch for fluid overload as by increasing sodium be aware water follows sodium so could cause excess fluid

  -If caused by fluid excess, will need fluid restriction

  -Can’t be fixed by adding sodium to the diet

  -Replace sodium slowly to avoid brain swelling
• what is hyperkalemia? what causes it?

  -Is increased levels of potassium causing an electrolyte ima balance of potassium

  Causes:

  -Kidneys failure(most common)

  -Use of salt or potassium supplements

  -receiving old blood=causes cell destruction

  -Acidosis

  -Exercise

  -Catabolic state

  -Hypoxia

  -Use of potassium-sparing diuretics

  Note: can get false high K+ if sample not handled properly
• what are the signs and symptoms of Hyperkalemia? Hint- Murder

  M-Muscle weakness

  U-Urine, Oliguria, anuria

  R-Respiratory distress

  D-Decreased cardiac contractility

  E-ECG changes

  R-Reflexes, hyperreflexi or areflexia
• what changes in an ECG when the patient has Hyperkalemia?

  Peaked T wave, Decreased R wave, Depressed ST segment, Widened QRS, Wide flat P wave, prolonged PR interval

  
• How can you treat Hyperkalemia?

  -cardiac Monitor

  -Lasix if kidneys are functioning

  -Stop potassium in IV fluids

  -Have patients avoid foods high in potassium

  -Dialysis if severe
• What is Hypokalemia? what causes it?

  -is a decrease in potassium causing an electrolyte imbalance

  Causes:

  -Vomiting

  -NG suction

  -Diarrhoea

  -medications(diuretics, laxatives, insulin)
• What are the signs and symptoms of Hypokalemia?

  -Dysrhythmias

  -Weakness

  -Low BP

  -Weak pulse, so feel pulse

  -Muscle weakness and paralysis

  -Diuresis=excess urine output
• How does Hypokalemia effect ECG?

  Slightly prolonged PR interval, Slightly peaked P wave, ST depression, shallow T wave, Prominent U wave

  
• How can you treat Hypokalemia?

  -cardiac monitor

  -foods high in potassium

  -potassium IV, only if good urine output

  -Keep patient safe from falls
• Explain what each of these terms are?

  Hyponatremia? Hypernatremia?

  Hyponatremia: not enough salt/ increase in secretion/dilution leading to cells swelling, causes confusion, headaches and cramps

  Hypernatremia: eating too much Na+/waterloss/kidney failure= cells shrinking, causing fluid retention oedema
• Expalin what hypokalaemia and hyperkalaemia are?

  Hypokalaemia: caused by vomiting, diarrhoea and diuretics, leading to dysrhythmias and weakness

  Hyperkalaemia: Kidney failure/ingesting too much K+/ acidosis= cause hyperkalaemia, will stop cardiac function/cause ECG changes
• U+E means?

  Urea and electrolytes blood panel BMP(basic metabolic panel)
• Blood pH levels? Explain?

  -Dependant on hydrogen ion concentration

  -Hydrogen ion concentration is maintained within narrow range of 7.35-7.45

  
• Explain how acid-base homeostasis/balance is maintained by buffers?

  Buffers-(HCO3) bicarbonate, react rapidly, less than a second. Chemically change strong acids to weaker acids or bind to neutralize effect. Body’s first response to keep pH balanced and neutralizes H+ if too many H+ making blood more acidic

  -are the primary regulator of acid—base balance

  
• how does the respiratory system act to maintain acid-base balance?

  -reacts rapidly within seconds to minutes, if the buffer can’t fix the issue it steps in and controls CO2. as if too much CO2= increase in carbonic acid H2CO3

  
• how does the renal system maintain acid-base balance?

  -The renal system reacts slowly, takes hours, it controls bicarbonate( HCO3-) to neutralize it.

  
• if pH decrease and H+ increases?

  blood is acidic
• if Ph increases and H+ decreases?

  blood is alkalotic
• reading arterial blood gases(ABG), explain normal ABG figures for pH, PO2,PCO2,HCO3?

  pH: 7.35-7.45 PO2: 80-100 mmHg PCO2: 35-45 mmHg HCO3: 22-28 mEq/L
• what happens to pH, PaCO2, HCO3 when respiratory acidosis occurs?

  Ph= decrease(below 7.35)

  PaCO2= increases (above 45)

  HCO3= normal
• what happens to pH, PaCO2, HCO3 when respiratory alkalosis occurs?

  pH= increase( above 7.45)

  PaCO2= decrease( below 35)

  HCO3= normal
• what happens to pH, PaCO2, HCO3 during metabolic acidosis?

  Ph= decrease(below 7.35)

  PaCO2= normal

  HCO3= decrease(below 22)
• what happens to pH, PaCO2, HCO3 during metabolic alkalosis?

  pH= increase (above 7.45)

  PaCO2=normal

  HCO3= increase(above 28)
• Sodium? What’s its normal range? Function?

  135-145mmol/L

  Important cation in the generation of action potentials. Plays a key role in fluid and electrolyte imbalance
• what can cause Hyponatraemia?

  -water retention

  -solute loss

  -vomiting and diarrhea

  -excessive diuretic use

  -burns

  -aldosterone deficiency

  -Excess antidiuretic hormone

  -excess water intake

  -renal disease
• what are the possible causes of hypernatraemia?

  -dehydration

  -excessive intravenous NaCl administration

  -uncommon in healthy people
• what is the normal range for potassium? what’s its function?

  3.5-5.2 mmol/L

  important cation in establishing resting membrane potential. regulates pH balance, maintains intracellular fluid volume
• what can cause hypokalaemia?

  -digestive disturbances

  -Cushing syndrome

  -starvation

  -excess aldosterone

  -diuretic therapy
• what can cause hyperkalaemia?

  -renal failure

  -burns

  -severe tissue injury

  -aldosterone deficit
• Explain the movement of electrolytes and water

  the movement of electrolytes and water between ICF and ECF to maintain homeostasis involves processes such as simple diffusion, facilitated diffusion and active transport. Water moves by two forces hydrostatic pressure and osmotic pressure
• What is facilitated diffusion?

  Involves the use of a protein carrier in the cell membrane, if passive and requires no energy