ELECTROLYT E IMBALANCE S

CONDITIO N
Hyponatremi a Cells swell as water is pulled from the ECF.

LEVELS
Low Serum Sodium < 135 Low Serum Osmolality < 200

CAUSES
(DIGS) Diuretics Intoxication (water) GI fluid loss Sweating

CLINICAL MANIFESTATIONS
(A,B,C,D,G,H,I) Abdominal cramping Bad turgor Confusion Dry mucous membranes GI upset (N/V) Hypotension(orthostati c) ICP (intracranial pressure) (NEED T) Neurological changes Edema Excessive thirst Dry, swollen tongue Tachycardia

INTERVENTIONS
Monitor I & O Limit fluids/water Encourage sodiumrich foods IF SEVERE give Hypertonic IV fluids (anything with Dextrose)

Hypernatremi High Serum a Sodium > 145 Cells shrink as water is pulled out of High Serum the ICF and Osmalality into the ECF > 300 as well as 3rd spacing Cells are dehydrating. Hypokalemia Low Serum Potassium < 3.5

(ONE) Fluid deprivation

Monitor I & O Monitor behavior changes Encourage fluids Limit sodium Lower levels gradually IF needed, give a hypotonic IV, or NS solution Monitor rate/rhythm Give Oral K+ (KDur)

(PANGE) Potassium-wasting diuretics Alcoholism

(DIM

FLAG) Dysrhythmia (cardiac) Irregular, weak pulse Muscle weakness

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Hyperkalemia High Serum Potassium > 5

Nasogastric suctioning GI distress (N/V) Eating disorders

(RECK) Renal failure Excessive use of salt substitute Crush injuries K+ sparing diuretics

Hypocalcemi a

Low Serum Calcium < 9

(VA ROCK) Vitamin D intake is insufficient Alcoholism Removal of parathyroid gland Osteoporosis Crohns disease Kidney failure (PELT) Prolonged

Fatigue/lethargy Leg cramps Anorexia GI upset (N/V/Decreased motility) (4 / GAMP) Dysrhythmia Arrest Bradycardia Irregular pulse GI hyperactivity/diarrhea Areflexia Muscle weakness Paresthesias (CPTTV) Chvosteks sign Paresthesias Tetany Trousseaus sign V-Tach (quiver in ventricle)

Give IV K+ (must be diluted and given SLOWLY!) Educate about K+ rich foods Monitor cardiac changes Monitor labs Give oral Kayexalate For a SUPER HIGH K+ level, give Calcium Glutonate by IV Calcium supplements Increase dietary calcium Weight-bearing exercises Estrogen replacement in post-menopausal women Oral fluids (dilute urine)

Hypercalcemi a

High Serum Calcium >

(DMC/5 GI) Depressed DTRs

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11

immobilization Excessive dietary intake Loss from the bones Too much parathyroid production

1. 2. 3. 4. 5.

Mental status: lethargy, confusion, weakness Cardiac dysrhythmia GI decreased motility GI constipation GI nausea GI vomiting GI anorexia

Hypomagnesem ia

Low Serum Magnesium < 1.5

Hypermagnese mia

High Serum Magnesium > 2.5

(BP ALE) Burns Pancreatitis Alcoholism Long-term use of diuretics or aminoglycosides Excessive GI loss from nasogastric suctioning/diarrhea (RAT) Renal failure Adrenal insufficiency Treatment with magnesium salts

(4 Increases/ DRS) Heart rate BP Dysrhythmia Vertigo Disorientation Respiratory difficulty Seizures (BB, CD, FH, LM, P) Bradycardia Bradypnea Coma Drowsiness Flushing Hypotension

Increase fiber Limit dietary intake IF NO kidney disease or heart failure give diuretics and NS IF THERE IS kidney disease or heart failure- give CALCITONIN (helps to excrete calcium) Provide safety for seizure risk Increase dietary intake of Magnesium: whole grains, nuts, chocolate, seafood Give IV magnesium sulfate BUT check reflexes every hour Monitor vital signs Monitor LOC Provide dialysis is the level is critically high

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Hypochloremi Low Serum a Chloride < 95 Hyperchlore mia High Serum Chloride > 108

Lethargy Muscle weakness Paralysis Administer NS or NS Discontinue diuretics Administer NaHCO3- (Sodium Bicarbonate)