ELECTROLYTES

• Sodium

  136 - 145 mEq/L
• Where sodium goes

  Water follows
• Sodium

  Often enters through foods and fluids (smoked or pickled foods, snack foods, condiments)
• Causes of ACTUAL Sodium Excess


  • Hyperaldosteronism
  • Kidney failure (dec excretion)
  • Corticosteroids
  • Cushing syndrome
  • Excessive ingestion of NA
  • Excessive admin of NA fluid
• Causes of ACTUAL Sodium Deficit


  • Excessive diaphoresis
  • Diuretics (overuse)
  • Wound drainage
  • Decreased Aldosterone
  • Kidney dx
  • NPO or low salt diet
  • Severe vomiting/diarrhea
• Causes of RELATIVE Sodium Excess (Conc)


  • NPO
  • Fever
  • Infection
  • Excessive sweating
  • Water diarrhea
  • Diabetes INSIPIDUS
• Causes of RELATIVE Sodium Deficit (Dilution)


  • Hyperglycemia
  • Excessive hypo NA fluids
  • SIADH
  • Excess water intake
  • Burns
• Manifestations/NSG Considerations of Sodium Excess


  • Seizure precautions (if severe)
  • Edema
  • Decreased urine, thirst, dry mucous membranes, restless
• Manifestations/NSG Considerations of Sodium Deficit


  • Excitable membranes are less excitable
  • Confusion, cognition, seizure precautions
  • Cerebral changes due to cerebral edema & inc ICP
  • Weakness, dec DTR, limp, nausea
  • Orthostatic hypotension, weak thready pulse (unless dilutional)
• Treatment of Sodium Excess


  1. Slow fluid placement

  2. Restrict fluid and salt intake

  3. Diuretics
• Treatment of Sodium Deficit


  1. Increase NA foods (if mild)

  2. Give NA fluids

  3. Diuretics (if dilutional)
• Potassium

  3.4 -5 mEq/L
• Potassium

  Major CATION of intracellular fluid (ICF)
• Potassium

  Highest in meat, fish, vegetables & fruits
• Functions of Potassium

  • Skeletal, cardiac & smooth muscle, Cell metabolism, Nerve impulses
• Causes of Hyperkalemia


  • Excessive potassium foods or medication or salt substitutes
  • Rapid IV infusion with potassium solutions
  • Blood transfusions of whole or packed cells
  • Kidney failure/adrenal insufficiency
  • Potassium sparing diuretics
  • ACE's & ARB's
  • Acidosis (DKA) or infection
• Causes of Hypokalemia


  • Diuretics or corticosteroids
  • Increased secretion of aldosterone
  • vomiting/diarrhea
  • Prolong NG suctioning/wound drainage
  • Kidney disease impairing absorption
  • Heat stroke
  • NPO or too little potassium rich foods
  • Total parenteral nutrition
• Manifestations/NSG Considerations of Hyperkalemia


  • Dysrhythmias (tall peaked T waves, wide QRS)
  • Muscle twitching/Paresthesias/↑DTRs
  • Prolonged=muscle weakness to flaccid paralysis
  • diarrhea/hyperactive bowels
• Manifestations/NSG Considerations of Hypokalemia


  • Reduced cellular excitability (age increases loss)
  • Dysrhythmias (ST depression, flat or inverted T waves)
  • Weakness, orthostatic hypotension, ↓DTR
  • Decreased bowel sounds, ileus
• Treatment of Hyperkalemia


  1. Restrict K intake (diet or meds)

  2. Calcium Gluconates (protect heart)

  3. Insulin & Glucose simultaneously

  4. Patiromer or Sodium Polystyrene Sulfonate (Kayexalate)
• Treatment of Hypokalemia


  1. Give potassium (ant and route depends on severity)

  2. HIGH drug alert, never IV push, IM or SQ. PO or IV infusion

  3. Slow infusion at proper dilution
• Calcium

  9 -10.5 mg/dl
• Calcium

  Enters the body by dietary intake/absorption through the intestinal tract
• Calcium absorption

  Requires active from VITAMIN D (primarily stored in bone)
• When more calcium is needed in blood


  PARATHYROID HORMONE (PTH) is released
• When excess calcium in the blood


  The THYROID gland secretes CALCITONIN
• Causes of Hypercalcemia


  • Excessive intake of calcium and/or Vit D
  • Kidney failure
  • Thiazide Diuretics
  • Hyperparathyroidism
• Causes of Hypocalcemia


  • Inadequate intake or inadequate Vit D level
  • Malabsorption issues: Celiac, Crohn's
  • End stage renal dx
  • Diarrhea
  • Wound change
  • Immobility
  • h/o Parathyroid gland removal or hypo function
• Manifestations/NSG Considerations of Hypercalcemia


  • Decreased neuroexcitability
  • fatigue/weakness/↓DTRs
  • Calcifications (eyes, kidney stones)
  • confused/lethargic
  • severe/prolonged causes slowed cardiac impulses
  • HYPOactive bowels/constipation
• Manifestations/NSG Considerations of Hypocalcemia


  • Increased neuroexcitability
  • Paresthesias initially that can lead to muscle spasms
  • Brittle bones/Osteoporosis
  • HYPERactive bowels/diarrhea
  • Seizure precautions
  • POSITIVE TROUSSEAU'S or CHVOSTEK'S signs
• Treatment of Hypercalcemia


  1. reduce/remove Vit D supplements/Low calcium diet

  2. Parathyroidectomy

  3. NS fluids which cause calcium excretion by kidneys

  4. Consider d/c or change drug causing/Calcium binders
• Treatment of Hypocalcemia


  1. Replacement depending on severity (PO/IV)

  2. Increase calcium rich foods/CA or Vit D supplements

  3. Reduce stimuli
• Magnesium

  1.8 - 2.6 mEq/L
• Magnesium

  Stored mostly in bones and cartilage. Some ICF.
• Functions of Magnesium

  • Assists with skeletal muscle contraction, carbohydrate metabolism, generation of energy stores, vitamin activation & blood coagulation
• Causes of Hypermagnesemia (RARE)


  • Excessive intake of magnesium (TUMS, laxatives)
  • IV mag replacement
  • Kidney dx reducing excretion
• Causes of Hypomagnesemia


  • Inadequate intake magnesium (malnutrition)
  • Loop or Thiazide diuretics
  • Chronic alcohol use
  • Malabsorption (Celiac, Crohn's)
• Manifestations/NSG Considerations of Hypermagnesemia

  • Reduced membrane excitability
  • Flaccid muscles/decreased or absent DTRs
  • drowsy /lethargic
  • Cardiac monitoring (low BP and bradycardia)
• Manifestations/NSG Considerations of Hypomagnesemia


  • Increased membrane excitability & nerve impulses
  • Paresthesias & muscle spasms & increase DTRs
  • Cardiac monitoring (due to decrease K when Mg is low)
  • Seizure precautions
  • POSITIVE TROUSSEAU'S or CHVOSTEK'S signs
• Treatment of Hypermagnesemia


  1. d/c meds or oral intake

  2. Loop diuretics (if kidney function okay)

  3. Hemodialysis (if severe)