Sodium
What are the normal values for Sodium?
135 - 145 mEq/L
Normal values for K+
3.5 - 5 mEq/L
Normal values for calcium:
8.6 - 10.2 mEq/L
Normal values for phosphorous:
2.4 - 4.4 mEq/L
What does ADH do?
renal cells reabsorb water
Name some S&S of HYPERNATREMIA
- dry STICKY mucous membranes
- increased thirst
- decreased LOC
- flushed skin
SEVERE: swollen dry tongue, N, V, increased muscle tone
Name some potassium rich foods:
bananas, coconut water, cantaloupe, oranges, avocado, cauliflower, mushrooms, spinach, potatoes, salmon, etc
Which type of diuretic may be discontinued if a patient may be experiencing HYPERcalcemia?
Thiazide diuretics
Phosphorous is inversely proportional to which other electrolyte?
Calcium
What does aldosterone do?
- reabsorption of water and Na+
- increases urinary excretion of K+ and H+
Name some S&S of HYPOnatremia
- cerebral dysfunction (cells swell)
- irritability
- dry mucous membranes
- tachycardia
- decreased LOC
- weak thready pulses
SEVERE: seizure, coma, resp arrest, neurological damage
Name some causes of HYPOkalemia..
- potassium-wasting diuretics
- acute/chronic diarrhea or vomiting
- aldosterone excess
- dialysis and insulin therapy
Name some causes of HYPOcalcemia:
CKD, decreased production of PTH, vitamin D deficiency, malabsorption diseases (like Chron's), laxative misuse, chronic diarrhea, calcium-deficient diet
Normal values for magnesium:
1.5 - 2.5 mEq/L
Signs of Hypervolemia:
sudden weight gain, pulmonary and cerebral edema, pitting edema, crackles, JVD, hypertension
decreased hematocrit, decreased BUN
Name some causes of HYPERnatremia:
- Cushing's syndrome
- diabetes insipidus (ADH deficiency -- increased urine output)
- diarrhea, not enough fluid intake,
- tube feedings, hypertonic parenteral fluids,
Your patient is currently experiencing heart arrythmias, increased DTRs, paresthesis, and bilateral muscle weakness. You suspect HYPERkalemia. What kind of waves do you expect to see on the heart monitor?
- Wide flat P wave
- Prolonged PR interval
- Widened QRS
- Tall T wave
- Depressed ST segment
- Increase dairy products: milk, cheese, yogurt, fortified cereals, sardines
- Oral or IV Ca2+
- supplements for: post-menopausal women, heavy alcohol drinkers, caffeine users,
- Fall precautions
if both K+ and Mg2+ are low, which do you replace forst and why?
Magnesium because low levels of Mg2+ stimulates renin to release aldosterone, which increases H2O and Na+ retention and K+ excretion. Mg2+ is also impairs the sodium potassium pump, which allows even more K+ to escape.
when do you NOT administer HYPOtonic solutions?
- increased intracranial pressure
- liver disease, trauma, burns
Treatment of choice for HYPERnatremia && HYPOnatremia.
What will you monitor for each of these treatments?
HYPERnatremia: treat underlying cause. give ISOtonic & HYPOtonic solution (give slowly b/c it can cause rapid shoft of water into cells causing cerebral edema)
HYPOnatremia: HYPERtonic solution (watch for fluid overload, check for any edema and crackles); possible water restriction (if cause is water excess)
Treatment for HYPERkalemia?
Any special considerations?
- dialysis,
-give Kayelxalate (binds to K+ & eliminated in stool)
- give insulin (pushed K+ back into cells) & give IV glucose (to prevent hypoglycemia)
Need to do cardiac monitoring
Patient teaching: diet, meds, s&s
Signs & Symptoms for HYPOcalcemia:
- Chvostek's signs
- Tetany
- Trousseau's signs
- fatigue, tingling of extremities, seizures, etc.
When treating HYPOmagnesemia, the IV pump can be no faster than ___ g/ hr because ____________.
1 g/hr because too rapid IV administration can lead to cardiac and respiratory arrest.
Describe the RAAS (Renin-Angiotensin-Aldosterone System):
Bp drops --> kidneys secrete renin --> angiotensinogen turns into angiotensin I --> in the lungs, ACE (angiotensin-converting enzyme) turns to angiotensin II
angiotensin II...
- causes vasoconstriction
- stimulates aldosterone: Na+ and H2O retention
----------------------> BP goes up.