Na Serum Levels: 135-145 mEq/L

Sodium
Imbalances:
Diagnostic Tests:
Causes:

Symptoms:
(All have seizures
and coma!)

Treatment:

Nursing
Considerations:

Hyponatremia
Na Serum Levels: <135 mEq/L
Urine Specific Gravity: <1.005
1. Disease States: Hypoaldosteronism, HF, Hormones (ADH; SIADH)
2. Inadequate Salt Intake
3. Excessive Sodium Loss (Diarrhea, vomiting, fistulas, drainage,
diuretics, burns)
4. Excessive H2O Intake

ECF deficit:
1. Apprehension (Irritability)
2. Confusion, dizziness.
3. Personality changes.
4. Tremors.
5. Dry mucous membranes.
6. Cold clammy skin.
7. Postural hypotension, CVP
and JVD, Pulse (thready).

ECF normal/excess:
1. Headache
2. Confusion
3. Apathy
4. Muscle spasms
8. Nausea, vomiting.
9. Diarrhea, abdominal cramps.
10. Weight gain, ( BP, CVP)

Hypernatremia
Na Serum Levels: >145 mEq/L
Urine Specific Gravity >1.035
MODEL:
Medication, Meals (intake; hypotonic and
isotonic NaCl solutions)
Osmotic Diuretics
Diabetes Insipidus and Mellitus
Excessive H2O Loss (Insensible & Diarrhea)
Low H2O Intake
ECF normal/excess (FRIED):
Fever (low grade), flushed skin.
Restless (Irritable)
Increased fluid retention ( BP, CVP, and
Weight)*
*opposite if caused by ECF deficit!
Edema (Peripheral and Pulmonary)
Decreased urine output, dry mouth and skin.
Goal: Dilute the sodium concentration.
1. Administer isotonic or hypotonic fluids to
dilute the sodium concentration.
2. Administer diuretics to promote the
excretion of sodium.

Administer Isotonic
Administer hypertonic solutions.
Solutions for ECF
Water restriction: 1-1.5L/day
replacement.
Administer diuretics or ACE
Increase food containing
inhibitors. (Ex. Tolvaptan inhibits
sodium or salt tablets.
ADH caused by disease states.
1. 24 hr. I&O record.
2. Urine Specific Gravity <1.005
3. Check and compare daily weight.
4. Check pitting edema, skin turgor, and mucous membranes (fluid volume).
5. Check for pulse, BP or RR, or JVD changes (fluid volume).
6. Chase Na and assess neuro system to prevent cerebral edema from causing permanent neurological damage.
(5o % corrected during the 1st day and the rest over 1 2 days)
7. Protect client from injuries R/T seizures.

K Imbalances:
Diagnostic:
Causes:

Symptoms:

Treatment:

Nursing
Considerations
:

Potassium Serum Levels: 3.5-5mEq/L

Hypokalemia
Hyperkalemia
K Serum Levels <3.5 mEq/L
K Serum Levels >5 mEq/L
Potassium Loss:
MACHINE:
1. GI Loss: Diarrhea, Vomiting, Fistulas, Suction,
Medication (ACE inhibitors, NSAIDs, K sparing diuretics
K wasting diuretics (Lasix)
[amiloride or spironolactone])
2. Renal Loss: Hyperaldosteronism, Mg depletion
Acidosis (Metabolic and Respiratory)
3. Skin Loss: Diaphoresis
Cellular Destruction (Burns, Traumatic Injury)
4. Dialysis
Hypoaldosteronism
Potassium Movement
Intake Excessive (Salt Substitutes or Parenteral)
1. Insulin, Alkalosis, Tissue Repair, Epinephrine
Nephrons, Renal Failure
(Stress)
Excretion Impaired
Decreased Intake
1. Fatigue, Muscle Weakness/Flaccid, Leg Cramps
MURDER:
2. Polyuria
Muscle Weakness, Mental (Irritability and Anxiety)
3. Weakness or Paralysis of Respiratory Muscles
Urine, Oliguria, Anuria
4. Decreased GI Motility: Nausea, Vomiting, Paralytic Respiratory Distress
Ileus, Abdominal Distention
Diarrhea, cramping
5. Weak, Irregular Pulse; Lethal Ventricular
ECG Changes (decreased cardiac contractility and irregular pulse)
Dysrhythmias , Bradycardia
Reflexes, Hyperreflexia, or Arrlexia (Flaccid)
6. Decreased Reflexes, Paresthesia
7. Hyperglycemia (impaired insulin release)
Severe: Cardiac Arrest!
1. Increase K Intake (5-100 mEq/day):
Decrease K intake (salt substitutes, bananas, green leafy
A. Oral KCl supplements (20mEq) after meals.
vegetables, raisin, all-bran cereals, potatoes, dried beef and
B. IV KCl at a rate <10mEq/hr (20mEq/hr for
fruit, cantaloupe, carrots, mangos, broccoli) and fluids.
central vein) because potassium can sting.
Remove Excess K: Dialysis, Sorbitol; Lasix and Thiazide (K
Wasting Diuretics)
Administer Calcium Gluconate (Heart), sodium bicarbonate
(Acidosis); Insulin and Kayexalate (drives K into the cell).
1. Monitor Lab values: K, Ca, Mg.
1. Monitor serum levels.
2. Monitor I&O (alkalosis, urine)
2. Monitor ECG.
3. Must have a urine output of at least 0.5 mL/kg/hr.
3. Check bicarbonate levels () for metabolic acidosis.
4. Check renal function and I&Os ( Urine)
for treatment!

4. Slow rate and use lidocaine to prevent stinging.

5. Assess for phlebitis and infiltration necrosis and
sloughing.
6. Toxic Effects of Digoxin.

5. Check blood sugars.

6. Vitals: HR and BP (CO), RR (Acidosis)