Potassium Hyperkalemia Hypokalemia

- cation that is more prevalent inside - serum potassium level signs and symptoms: Interventions: - serum potassium level of signs and symptoms : Interventions:
- used to transmit and conduct greater than • Nausea. risk for seizures, injury related less than • Leg cramps. risk for injury related to
neurological impulses and to maintain 5.3 mEq/L. • Cold skin; grayish pallor. to muscle weakness, and 3.5 mEq/L • Muscle weakness. muscle weakness and
cardiac rhythms • Hypotension. cardiac arrhythmias. Factors • Vomiting. cardiac arrhythmias.
- used to contract skeletal and Factors: • Mental confusion and • Diarrhea. • Fatigue. • Increase dietary intake
smooth muscles. • Impaired renal excretion irritability. • Restrict intake of potassium • Vomiting. • Decreased reflexes. of potassium.
- regulates intracellular osmolality (most common) • Abdominal cramps. rich foods. • Fistulas. • Polyuria. • Teach the patient how
and promotes cell growth • Massive intake of • Oliguria (decreased urine • Administer diuretics and ion- • Nasogastric suctionings. • Irregular pulse. to prevent hypokalemia
- normal serum potassium is between potassium. output). exchange resins such as • Diuretics. • Bradycardia. by maintaining an adq.
3.5 to 5.3 (mEq/L). • Medications such as • Tachycardia (fast pulse) Kayexalate (retention enema) • Hyperaldosteronism. The patient may also exhibit dietary intake. These
potassium-sparing diuretics and later bradycardia (slow as directed to increase the • Magnesium depletion. an abnormal EKG that include fruits, fruit juices,
- Caution: Serum potassium less than Aldactone and Dyrenium, pulse). elimination of potassium. • Diaphoresis. shows: vegetables,
2.5 mEq/L or greater angiotensin-converting • Muscle weakness to • Dialysis therapy may be • Dialysis. • Depressed ST segment. or potassium
than 7.0 mEq/L can cause the patient enzyme (ACE) inhibitors flaccid paralysis. ordered in critical cases to • Increased insulin. • Flattened T wave. supplements. Bananas
to have a cardiac arrest. Vasotec and Prinivil, • Numbness or tingling in remove potassium. • Alkalosis. • Presence of U wave. and dried fruits are higher
- Dse such as which reduce the kidney’s the extremities. • Administer insulin and • Stress (increases • Premature ventricular in potassium
kidney disease can cause potassium ability to secrete potassium. • Peaked T waves on the glucose parenterally to force epinephrine). contractions. than oranges and fruit
to become imbalanced. EKG. potassium back • Starvation. juices.
- Caution: This deficit cannot be inside cells. • Low potassium in diet. • Administer potassium
corrected rapidly. The infusion should • Administer sodium chloride supplements
not exceed 10 to 20 mEq per hour or bicarbonate intravenously to orally (may take 30
the patient may experience correct the acidosis (elevate minutes for onset) or IV.
hyperkalemia and can pH). Use a central IV line for
experience cardiac arrest. • Administer calcium rapid infusion in critical
- Be alert that infusions containing gluconate intravenously to conditions. Take with at
potassium may cause pain at the IV decrease the irritability of least a half a glass of
insertion site. the heart; it does not promote fluid (juice or water)
- If urine output is <30 mL/hour notify potassium loss. because
doc . potassium is extremely
- Infusions should not contain >60 irritating to the gastric
mEq/L KCl and intestinal mucosa.
40 mEq/L is the preferred amount to • Teach patients the signs
add to 1000 mL of IV and symptoms of
- Warning: NEVER give potassium as hypokalemia and to call
an IV push or intravenous the healthcare provider if
bolus. This will cause immediate any of these are
cardiac arrest which is not reversible experienced.
with cardiopulmonary resuscitation.
Potassium must be diluted in IV fluids
as stated above. Don’t give
potassium if the patient suffers from
renal insufficiency, renal failure, or
Addison’s disease. Do not give
potassium if the patient has
hyperkalemia, severe dehydration,
acidosis, or takes potassium-sparing
diuretics. Use with caution with
patients who have cardiac disorders
or burns.
Sodium
- major cation in extracellular fluid
found in tissue spaces and vessels.
- important role in the regeneration
and transmission of nerve impulses
and affects water distribution inside
and outside cells
- part of the sodium/potassium pump
that causes cellular activity
- When it shifts into the cell,
depolarization (contraction) occurs;
when it shifts out of the cell, otassium
goes back into the cell and
repolarization (relaxation) occurs.
- combines readily in the body with
chloride (Cl) or bicarbonate (HCO3)
to promote acid-base balance (pH).
- kidneys regulate the sodium
balance by retaining urine when the
sodium concentration is low and
excreting urine when the sodium
concentration is high. Most excess
sodium is excreted in urine although
sodium also leaves the patient as
perspiration and in feces.
- serum sodium level, which is the
ratio of sodium to water, is the
indicator of the sodium level in a
patient’s body.
- normal range of serum sodium is
from 135 mEq/L to 145 mEq/L.
- A patient’s serum sodium level
moves out of the normal range when
the patient is retaining too much or
too little water, has a high or low
concentrations of sodium, or a
combination of both.
Hypernatremia
- serum sodium is greater
than 145 mEq/L.
Reasons:
- sodium concentration has
increased while the volume
of water remains
unchanged - water volume
has decreased while the
sodium concentration
remains unchanged.
- Regardless of what
happened, the patient
experiences
hyperosmolality, which is a
higher-than-normal
concentration of sodium.
This causes water to shift
out of cells and into
extracellular space resulting
in cellular dehydration.
- A patient who is alert and
can drink water to quench a
thirst is at less risk for
hypernatremia. However, a
patient whose
consciousness is impaired
or who cannot swallow,
such as a frail elderly
patient, is at risk for
hypernatremia.
- Hypernatremia caused by:
• Inadequate water intake.
• Inability of the
hypothalamus gland to
synthesize anti-diuretic
hormone (ADH) (which the
kidneys require to regulate
sodium).
• Inability of the pituitary
gland to release ADH.
• Inability of the kidneys to
respond to ADH.
• Excess sodium (such as
from a hypertonic IV sol’n).
• Inappropriate use of
sodium-containing drugs.
• Ingestion of excessive
amounts of sodium such as
seawater.
signs and symptoms : Interventions:
• Agitation • Replacing water using an IV
• Restlessness of 5% dextrose in water or a
• Weakness hypotonic saline solution as
• Seizures ordered.
• Twitching • Lowering the serum sodium
• Coma level slowly to avoid the risk of
• Intense thirst cerebral edema (brain
• Dry swollen tongue swelling).
• Edematous (swollen) • Restricting sodium intake.
extremities • Monitoring patient’s weight.
• Assessing extremities for
edema (swelling).
• Monitoring breath sounds
and respiratory effort for signs
of heart failure.
Hyponatremia symptoms of hyponatremia: Interventions:
- serum sodium is less than • Fatigue, • Treating the underlying
135 mEq/L. • Headache, cause.
- reasons: • Muscle cramps, • Administering
- patient has increased the • Nausea, hypertonic saline solution
volume of water while the • Seizures, IV such as Dextrose 5%
sodium concentration remains • Coma. in saline
normal to restore the serum
- patient losses sodium sodium level.
while the water volume • Replacing fluid loss with
remains normal commercially available
electrolytic fluids.
- Hyponatremia is caused by:
• Profuse sweating on a hot Monitor:
day or after running a • Vital signs
marathon • Fluid intake and output
• Inappropriate administration • Serum sodium levels
of a hypotonic IV solution • Dietary sodium intake
(sodium loss), • Breath sounds and
• The result of major trauma or signs of respiratory
after surgery (sodium loss) distress.
• Excessive ingestion of water
(water gain)
• Syndrome of Inappropriate
Anti-Diuretic Hormone
(SIADH), which causes
abnormal water retention
(sodium loss) or Addison’s
Disease
• Loss of sodium from the GI
tract as a result of diarrhea
and vomiting (sodium loss)
• The use of potent diuretics
(lose water and salt together),
• Burns and wound drainage
(sodium loss)
• Intake of too much water
caused by polydipsia
(excessive thirst)
Calcium Hypercalcemia signs and symptoms: • If kidney function is Hypocalcemia symptoms: Calcium preparations can
- equal proportion in intracellular fluid - serum calcium level is • Patients with mild adequate: - serum calcium level is lower • Depression. be given PO in tablet,
and extracellular fluid. higher than 10.5 mg/dL hypercalcemia may have no  A dminister isotonic saline IV than 8.5 mg/dL. This usually • Memory loss. capsule, or powder form
- combined with phosphate in bone - produces a low serum signs and symptoms to hydrate the patient. produces a high serum • Confusion. or IV. If given IV, then mix
and with protein (albumin) in the phosphorus level. • Nausea, Make sure the patient phosphorus level. Too little • Hallucinations. with 5% dextrose in
serum. • Vomiting, drinks 3000 to 4000 ml of fluid calcium intake causes calcium • Numbness and tingling in water.
- plays a critical role in transmission Hypercalcemia can be • Constipation, to excrete the calcium in to leave the bone to maintain the face, around the mouth,
of nerve impulses, blood clotting, caused by: • Anorexia, urine. a normal calcium level. and in the hands Do not mix with a
muscle contraction, and the formation • Renal failure. • Abdominal pain, A  dminister furosemide Fractures (broken bones) may and feet. saline solution because
of teeth and bone • Immobility. • Polyuria (frequent (Lasix) or ethcrynic acid occur if a calcium deficit • Muscle spasms in the sodium encourages the
- three forms of calcium in serum that • Cancer. urination), (Edecrin) loop diuretics persists because of calcium face, around the mouth, loss of calcium.
can fluctuate among forms • Hyperparathyroidism. • Polydipsia (extreme thirst), after adequate fluid intake is loss from the bones and in the hands and feet.
depending on changes to the serum • Excess intake of calcium • Decreased memory, established. (demineralization). • Hyperreflexia. • Administer parenteral
pH and/or serum protein (albumin) supplements (such as in • Personality changes or • Administer synthetic • Ventricular tachycardia. calcium. Caution: tissue
levels. Tums and other mood swings, calcitonin to lower serum Hypocalcemia is caused by: infiltration leads to
1. Free ionized form, which is the medications • Confusion, calcium concentration • Hypoparathyroidism. necrosis and sloughing.
biologically active form. Half of the to prevent and treat • Depressed reflexes, • Administer plicamycin • Thyroid or neck surgery Calcium increases the
patient’s total calcium is in the free osteoporosis). • Muscular weakness, (Mithracin) to increase where the parathyroid gland is action of digoxin and can
ionized form. • Overuse of antacids for GI • Bone pain, absorption of calcium in bone. removed or injured. result in cardiac arrest.
2. Protein bound, which binds disturbances. • Fractures (occur when • Provide a low-calcium diet. Hypomagnesium caused by Don’t add calcium to
primarily with albumin. • Prolonged diarrhea. calcium leaves the bone • Make sure the patient alcoholism. bicarbonate or hosphorus
3. Complex form, which is where • Excessive use of diuretics. due to cancer, performs weight-bearing • Ingestion of phosphates. because precipitates
calcium is combined with phosphate, osteoporosis, activities. • Inadequate intake of dietary form.
citrate, or carbonate. and other disorders), • Take safety measure to calcium and/or Vitamin D. • Administer the following
- normal serum calcium ranges Meds That Increases • Kidney stones, protect the patient who medication intravenously
between 8.5 mg/dL to 10.5 mg/dL. Serum Calcium • Hypertension, experiences neuromuscular if ordered:
This reflects the calcium level for all Calcium salts • Cardiac arrhythmias, effects. Hemodialysis is the Meds that Decreases Serum Calcium chloride IV 10mL
three forms of calcium. However, Vitamin D • Coma. most effective method to Calcium Calcium gluceptate 5 mL
ionized calcium (iC) levels are IV lipids lower calcium levels in severe Magnesium sulfate Calcium gluconate 10 mL
sometimes reported separately (4–5 Kayexalate androgens cases when kidney function is Propylthiouracil (propacil) • Administer the following
mg/dL). Diuretics (Thiazides, not normal. Colchicines medication PO if ordered:
- There is a balance between calcium Chlorthalidone, Hygroten) Pliamythin Calcium carbonate (Os-
and phosphorus. As serum calcium Neomycin cal, Tums, Caltrate,
increases, serum phosphorus Acetazolamide Megacal) 650–1500 mg
decreases. Conversely, as serum Aspirin tablets
calcium decreases, serum Anticonvulsants Calcium gluconate
phosphorus increases. Glutethimide (Kalcinate) 500–1000 mg
- The level of calcium is regulated by Estrogens tablets
the PTH, calcitonin, and vitamin D. Aminoglycosides (gentamicin, Calcium lactate 325–650
Low serum calcium causes an amikacin, tobramycin) mg tablets
increase in the production of PTH. Phosphate preparations: Calcium citrate 950 mg
PTH moves calcium out of bone and oral, enema, and IV (sodium tablet
into the serum, increases the phosphate, potassium • Take safety precautions
absorption of calcium from the GI phosphate) because the patient is at
tract, increases reabsorption of Corticosteroids (cortisone, risk for tetany and
calcium in the kidneys. Calcitonin is prednisone) seizures.
produced by the thyroid gland. Loop diuretics (furosemide • Tell the patient to refrain
Production is increased when there is [Lasix]) from alcohol and caffeine
a high serum calcium level. It because they inhibit
reverses action of PTH by increasing calcium absorption.
the absorption of calcium by bone, • Increase dietary calcium
decreases calcium absorption in to 1500 mg/day by eating
the GI tract, and causes an increase green leafy vegetables
in urine to excrete calcium. and fresh oysters and
milk products.
Administer vitamin D.
Magnesium Hypermagnesemia signs and symptoms: Hypomagnesemia Treatment includes:
- sister cation to potassium and is - serum magnesium • Lethargy. - serum magnesium level is • Administering
higher in intracellular fluid (ICF). If level is greater than 2.5 • Drowsiness. less than 1.5 mEq/L. intravenous magnesium
there is a loss of potassium there is mEq/L. • Weakness. - This can be caused by long- sulfate in solution slowly.
also a loss of magnesium. • Paralysis. term administration of saline Use an infusion pump to
- Magnesium is the coenzyme that - Major cause: • Cardiac (ventricular) infusions which can result in prevent rapid infusion
metabolizes carbohydrates and excessive intake of arrhythmias. the loss of magnesium and that might result in
proteins and is involved in magnesium salts in • Heart block. calcium. cardiac arrest.
metabolizing nucleic acids within the laxatives such as • Loss of deep tendon - Diuretics, certain • Monitoring signs of
cell. Magnesium also has a key role magnesium sulfate, reflexes. antibiotics, laxatives, and magnesium toxicity such
in neuromuscular excitability. The milk of magnesia, and • Hypotension. steroids are drug groups that as hot flushed skin,
patient acquires magnesium by magnesium citrate. promote magnesium loss. nxiety,
ingesting magnesium-rich food, Antacids such as Maalox, Hypomagnesemia also lethargy, hypotension and
where it is absorbed in the GI tract Mylanta, enhances the action of laryngeal stridor.
and then excreted in urine. and DiGel can also cause digitalis and can cause • Monitoring EKG and
- There is a close relationship hypermagnesemia. digitalis toxicity. pulse.
between magnesium, potassium, and Patients who take lithium - Px with hypomagnesemia • Taking safety
calcium. (antipsychotic may exhibit no signs and precautions for patients
- PTH, which regulates calcium, also medication) are also at risk symptoms until the serum who are at risk for
influences the magnesium balance. for hypermagnesemia. level approaches 1.0 mEq/L. seizures and mental
Typically, you’ll assess serum Signs of severe confusion.
magnesium, calcium, and potassium hypomagnesemia • Increasing the dietary
together. include tetany-like symptoms sources of magnesium
- normal serum magnesium level is caused by hyperexcitability including nuts, whole
between 1.5 mEq/L and 2.5 mEq/L. (tremors, twitching of the grains, cornmeal,
face), ventricular tachycardia spinach, bananas, and
that leads to ventricular oranges.
fibrillation, and hypertension Keep calcium gluconate
available for emergency
reversal of
hypermagnesemia
as a result of
overcorrecting
hypomagnesemia.
Phosphorus Hyperphosphatemia signs and symptoms: Treatment includes: Hypophosphatemia signs and symptoms: Intervention:
- primary anion inside the cell and - serum phosphate • Muscle problems. • Restricting foods and drinks - serum phosphate is less • Bone and muscle pain. • Administering
plays a key role in the function is greater than 4.5 mg/dL: • Hyperreflexia. (carbonated soda) high in than • Muscle weakness. phosphate supplements
of red blood cells, muscles, and the • Kidney disease. • Soft tissue calcification. phosphate. 2.5 mg/dL • Rhabdomyolysis. such as Neutra-Phos PO.
nervous system. • Underactive parathyroid • Nausea. • Treating the underlying - caused by: • Confusion. • Administering sodium
- also involved the acid–base glands. • Vomiting. cause. • Inadequate intake. • Osteomalacia. phosphate IV.
buffering and is involved with • Acromegaly. • Hypocalcemia. • Institute seizure precautions. • Diuresis. • Coma. • Administering
metabolizing carbohydrates, proteins, • Rhabdomyolysis. • Tachycardia. • Administering sevelamer • Dialysis. potassium phosphate IV.
and fats. • Healing fractures. • Anorexia. (Renagel). • Alcoholism. • Assessing vital signs.
- Most of the body’s phosphate • Untreated diabetic • Tetany. • Administering calcium • Steroids. • Assessing changes in
(about 85%) is found in bones. The ketoacidosis. supplements. • Overuse of phosphate- metal status.
rest of it is stored in tissues • Certain bone diseases. binding antacids. • Institute seizure
throughout the body. • Excessive ingestion of precautions.
Phosphorus is acquired by eating phosphate-containing • Monitor blood levels.
phosphorus-rich foods. Phosphorus laxatives.
is absorbed in the GI tract and • Excessive drinking of milk.
excreted in urine and a small amount • Chemotherapy for
in feces. It is converted to phosphate neoplastic disease.
in the body. • Excessive intake of
- Both phosphate and calcium levels vitamin D.
are regulated by parathyroid hormone • Decrease in magnesium
(PTH). The amount of phosphate in levels as in alcoholism.
the blood effects the level of calcium • Increased phosphate
in the blood. Both levels are usually levels during the last
measured at the same time. As the trimester of pregnancy.
serum calcium
concentration increases, the
concentration of serum phosphorus
decreases and conversely as serum
phosphorus increases, serum
calcium decreases.

- normal range of serum phosphorus

is between 2.5 mg/dL and 4.5 mg/dL.

- kidneys regulate the amount of

phosphate in the blood. Abnormally
high levels of serum phosphate are
usually caused by kidney
malfunction.