Electrolyte Imbalances

Electrolytes

100

This electrolyte is vital for muscle contraction, cardiac contraction, and nerve impulse transmission.  Water tends to follow.

What is Sodium?

200

This electrolyte is critical for excitable tissues to be able to depolarize and generate action potentials.

Found in almost all foods.  A decrease of only 1 mEq/L is a 25% difference in total ECF concentration.

What is Potassium?

300

This electrolyte is important for maintaining bone strength and density, activating enzymes, allowing skeletal and cardiac muscle contraction, controlling nerve impulse transmission, and enhancing blood clotting

What is Calcium?

Clinical Manifestations

100

Level is below 136 mEq/L (mmol/L)

• Malaise
• Anorexia
• Decreased level of consciousness
• 
  
  • Confusion
  • Lethargy
  • Coma
• Seizures
• Serum osmolality less than 280 mOsm/kg

What is Hyponatremia?

200

Level below 3.5 mEq/L. 

• Dysrhythmia
• Abdominal distention
• Hypoactive bowel sounds
• Constipation
• Postural hypotension
• Transient abdominal cramping
• Bilateral muscle weakness, beginning in lower extremities and ascending, even to respiratory muscles
• Flaccid paralysis

What is hypokalemia?

300

concentrations fall below 8.5 mg/dL

• Increased neuromuscular excitability
  • Positive Chvostek sign
  • Positive Trousseau sign
  • Numbness and tingling of extremities
  • Muscle cramps that can progress to tetany
  • Hyperactive reflexes
  • Laryngospasm
  • Seizures
• Cardiac dysrhythmias

Hypocalcemia

Clinical Manifestations

100

Level greater than 145 mEq/L 

• Thirst
• Decreased level of consciousness
• 
  
  • Confusion
  • Lethargy
  • Coma
• Seizures
• Serum osmolality greater than 300 mOsm/kg

What is Hypernatremia?

200

Level greater than 5.0 mEq/L 

• Dysrhythmia, including bradycardia and heart block
• Peaked T-Waves seen on ECG
• Cardiac arrest
• Bilateral muscle weakness, beginning in lower extremities and ascending, but rarely to respiratory muscles
• Flaccid paralysis
• Transient abdominal cramping

What is Hyperkalemia?

300

• Decreased neuromuscular excitability
  • Anorexia
  • Nausea and vomiting
  • Constipation
  • Personality change
  • Lethargy
  • Stupor
  • Coma
  • Decreased muscle strength and tone
• Cardiac dysrhythmias

Hypercalcemia

Interventions

100

• Monitoring serum osmolality
• Monitoring intake and output
• Administering hypertonic IV solution as ordered in emergency situations
  • 0.25% NS is administered for hyponatremia
• Restricting water in the diet
• Adding table salt to foods

Interventions for Hyponatremia

200

• Give the supplements with juice or other flavored beverages due to their unpleasant taste.
• Careful monitoring of laboratory values is essential
  • It is always diluted; usually added to an IV bag in the pharmacy.

• SAFE PRACTICE ALERT

• The rate is never to exceed 20 mEq/hr (mmol/hr) under any circumstances.
  Never administer this electrolyte IV as a push or bolus medication.

  • Whole grains, Nuts, Broccoli, Cabbage, Cucumbers, Potatoes, Spinach, Tomatoes, Bananas, Cantaloupe, Oranges
    
    
    
    
    

Interventions for Hypokalemia

300

• Cheese, Ice cream, Spinach, Rhubarb, Yogurt, Milk, Tofu
  • Increase oral fluid intake to at least 2500 mL/day to prevent constipation and reduce the risk of kidney stones, which may occur with intake of increased amounts this electrolyte.

• Nursing Interventions

  • Monitor vital signs.
  • Monitor ECG.
  • Take precautions against fall and seizure.
  • Administer oral/IV calcium supplements (lactated ringers) as ordered.

Hypocalcemia

Interventions

100

Drug therapy is used to restore fluid balance when imbalance is caused by fluid loss. When caused by reduced kidney excretion requires drug therapy with diuretics that promote this electrolyte loss such as furosemide or bumetanide.

Dietary considerations include: adequate water intake and sodium restriction.

Interventions for Hypernatremia

200

• Monitor ECG.
• Monitor lab data
• IV fluids containing glucose and insulin may be prescribed to help decrease serum levels.
• The oral drug patiromer binds with electrolyte in the GI tract and decreases absorption

Interventions for Hyperkalemia

300

Drugs therapy includes calcitonin, furosemide and 0.9% Sodium Chloride

Monitor ECG and lab results

Intervention for Hypercalcemia