Electrolyte Imbalances  Fluid and dietary management

o Processed meat and fish

Electrolyte o Canned foods
o Dairy products
 substance capable of breaking into electrically charged o Snack foods
ions when dissolved in a solution o Condiments (bbq sauce, ketchup, salad
dressing)
Sodium
o Seafoods, dried fruits, carrots, spinach,
brains
 chief electrolyte of ECF that moves easily between
intravascular and interstitial
 Nursing diagnoses
 spaces and moves across cell membranes by active
o Risk for imbalance fluid volume (FVD,
transport
FVE may occur)
 influential in many chemical reactions in body, particularly
o Risk for decreased intracranial
nervous and muscle tissue cells
 controls and regulates volume of body fluids; maintains adaptive capacity
water balance throughout the body
2. Hypernatremia
 primary regulator of ECF volume and influences ICF
 participates in generation and transmission of nerve
 Develops when sodium is gained in excess of
impulses
water or when water is lost in excess of sodium
 essential electrolyte in sodium-potassium pump
 Surplus of sodium in ECF that can result from
 normal extracellular concentration: 135 – 145 mEq/L
excess water loss or an overall excess of sodium
 Restricted access to water and ADH
1. Hyponatremia
abnormalities are often the causes
o Water deprivation
 sodium deficit in ECF caused by loss of sodium or
o Near drowning
gain of water
 osmotic pressure changes result in ECF moving o Seawater, heatstroke
into cells causing prints from examiner’s fingers
to remain on pt’s skin over the sternum when  Causes
pressure is applied o Excessive intake of salt
o Excessive loss of water
 Symptoms (depends on the rapidity, onset, o Diarrhea
severity and cause) o High fever
o Decreased water intake
o Anorexia, nausea and vomiting, o Severe burns
abdominal cramping, diarrhea
o Headache  Symptoms
o Altered mental status o Intense thirst
o Muscle cramps, weakness and tremors o Coma
o Seizures and coma o Postural hypotension
o Tachycardia
 Diagnostic tests o Dry tongue and mucus membranes
o Serum sodium level less than 135 o Decreased urine output
meq/L o Fever
o Lethargy, fatigue, irritability
 Collaborative care o Severe delusions, hallucinations and
o Medications death
 sodium-containing fluids
 ringer’s solution  Diagnostic evaluations
 0.9% NaCl o Serum sodium levels greater than 145
meq/L
 loop diuretics o Water deprivation test – to identify DI
 D5 sodium chloride via slow
intravenous infusion
Potassium  diseases associated with hypokalemia
o hepatic disease
 major cation of ICF working in reciprocal fashion with o hyperaldosteronism
sodium (excessive intake of sodium results in excretion of
o acute alcoholism
potassium, vice versa)
o heart failure
 chief regulator of cellular enzyme activity and cellular
o nephritis
water content
o acute leukemias
 plays vital role in such processes as transmission of electric
impulses, particularly nerve, heart, skeletal, intestinal, and
 danger signs
lung tissue; protein and carbohydrate metabolism, and
o arrhythmias
cellular bldg.
o cardiac arrest
 adequate qty. usually in well-balanced dietfood sources
o digoxin toxicity
include bananas, peaches, kiwi, figs, dates, apricots,
o muscle paralysis
oranges, prunes, melons, raisins, broccoli, potatoes, meat
and dairy products o paralytic ileus, bowel sounds,
 excreted primarily by kidneys, however, there are large constipation
amts in GI secretions and some in perspiration and saliva o respiratory arrest
 normal range for serum: 3.5 – 5 mEq/L o orthostatic hypotension, palpitations

1. Hypokalemia  SUCTION
 potassium deficit in ECF o Skeletal muscle weakness
 extracellular potassium level falls, potassium o U wave
moves from cell creating intracellular potassium o Constipation
deficiency o Toxic effects of digoxin
 sodium and hydrogen ions are retained to o Irregular weak pulse
maintain isotonic fluids o Orthostatic hypotension
 influences normal cellular functioning, pH of o Numbness
ECF, and functions of most body systems o
 skeletal muscles are generally 1st to demonstrate  Diagnostic assessment
signs/symptoms
 typical signs include muscle weakness and leg o Serum electrolytes < 3.5 meq/L
cramps Potassium, Mg level
o ABG: Alkalosis can cause potassium to
 Causes shift from extracellular to intrecellular
o Prolonged intestinal suction o BUN and Creatinine level
o Ileostomy o Glucose, calcium, magnesium and
o Prolonged vomiting phosphorus level if coexistent
o Diarrhea electrolyte disturbances are suspected.
o Laxative abuse o Consider digoxin level if the patient is
o Fistulas on a digitalis preparation, hypokalemia
o Severe diaphoresis can potentiate digitalis-induced
o Dieresis arrhythmias

 Drugs associated with Hypokalemia o ECG

o Diuretics  T wave flattening or inverted T
o Corticosteroids waves
o Insulin  Prominent U wave that appears
o Cisplatin after QT prolongation
 ST segment depression
o Antibiotics- gentamycin amphotericin
 Ventricular arrhythmias
B
(premature ven. Contractions
o Laxatives
PVC, torsade de pointes, ven fib)
 Atrial arrhythmias (PAC, atrial fib)

 Complications
o Hyperkalemia – caused by quick
replacement of potassium
o Cardiac complications
o Hypomagnesemia- hypokalemia may
be refractory to treatment until
hypomagnesemia is corrected
 Collaborative care
o Less than 2.5 meq/L of potassium, IV
potassium should be given
o Continue Iv replacement as needed
o Continue cardiac monitoring in severe
hypokalemia
o Repeat potassium level measurement
every 1-3 hours
o Increase intake of
 Bananas,
 Tomatoes
 Oranges
 peaches
o identify the cause
o be attentive to ABC’s
o if bradycardic or w/ cardiac
arrhythmias, appropriate
pharmacologic therapy or cardiac
pacing should be considered
o cardiac, monitor, establish IV access
and access respiratory status
*NEVER hive potassium by IV bolus/ push
2. Hyperkalemia
 A condition caused by higher than normal levels
of potassium in the bloodstream
 can be hazardous - - transmission of stimuli
through heart muscle is slowed or prevented,
and cardiac arrest eventually occurs if not
corrected
 causes
o increased intake of potassium
o medications
 potassium sparing diuretics
o potassium supplements
 IV Potassium
 NSAID
 Heparin
 Antibiotics
 Chemotherapy
 signs and symptoms
o irregular heartbeat
o nausea
o slow, weak or absent pulse
o skeletal muscle weakness
o cardiac output
o deep tendon reflex
o arrhythmias- tall t wave
 danger signs
o absent or weak pulse
o changes in breathing pattern
o loss of consciousness
o nausea
o weakness
 diagnostic test
o ECG
o Arrhythmias
 Heart block that may become a
complete heart block
 Slower than normal heartbeat
that progressively slows
 Ventricular fibrillation
o Pulse may be slow or irregular
o Serum potassium is HIGH
o ABG
 Interventions
o Cation-exchange resin mediactions,
such as sodium polysystrene suofunate
(Kayexalate)
 To attach potassium and
cause it to be removed from
the gastrointestinal tract
o Dialysis
 to reduce body potassium
levels especially if the kidney
function is compromised.
 Treatment
o Diuretics- to decrease total body
potassium
o Intravenous calcium- to temporarily
treat muscle and heart effects of
hyperkalemia
o Intravenous glucose and insulin- to
reverse severe symptoms long enough
 to correct the cause of the  depressions, personality
hyperkalemia changes
o Sodium bicarbonate- to reverse  arrhythmias, decrease
hyperkalemia caused by acidosis cardiac output
 hyperactive tendon reflexes

Calcium
 classic signs
o chvostek’s sign
 most abundant electrolyte, with up to 99% of total found
o trousseau’s sign- tetany
in iodized form of bones and teeth
 close link between concentrations of calcium and o diarrhea
phosphorus
 necessary for nerve impulse transmission and blood  diagnostic tests
clotting o serum calcium
 catalyst for muscle contraction o ECG
 needed for vitamin B12 absorption and its use by body cells o Albumin level
 acts as catalyst for most cell chemical activities
 necessary for strong bones and teeth  Treatment
 determines thickness and strength of cell membranes o IV calcium gluconate/ calcium
 adult avg. daily requirement about 1 g, higher amts. chloride
according to body wt. required for children and pregnant o Give oral supplements 1-1 ½ after
and lactating women meals
 1,500 mg/day recommended consumption for older o Give milk if GI upset occurs
adults, particularly postmenopausal women and men older
than 65  Nursing diagnoses
 sources include milk, cheese, and dried beans, some o Risk for injury
present in meats and vegetables o Disturbed though processes
 excreted in urine, feces, bile, digestive secretions, and
perspiration.  Interventions
o Monitor neuro and cardiovascular
1. Hypocalcemia o Continue ECG monitoring
 calcium deficit in ECF o Provide a quiet environment
 if prolonged, calcium is taken from bones, o High calcium diet
resulting in osteomalacia, characterized by soft o Monitor VS, resp status
and pliable bones o Keep tracheostomy, handheld
 common signs include numbness and tingling of resuscitation bag at the bedside
fingers, muscle cramps, and tetany
2. Hypercalcemia
 Causes  excess of calcium of ECF
o Vitamin D deficiency  emergency situation leading to cardiac arrest
o Chronic renal failure  Considered a metabolic disorder
o Magnesium deficiency
o Alcoholism  Causes
o Biphosphanate therapy- drugs used to
treat high blood calcium levels or pills  Signs and symptoms
used to treat osteoporosis
o Certain types of leukemia or blood  Diagnostic tests
disorders
 Treatment
 signs and symptoms
o neuromuscular and cardiovascular  Nursing diagnoses
 fatigue
 lethargy
 altered mental status