ELECTROLYTE

IMBALANCES
sss
1. SODIUM IMBALANCES
a. Hyponatremia (Sodium Deficit)

The clinical manifestation of hyponatremia are as

It is caused by the sodium loss or water
follows: (These are due to decreased ECF volume and
excess
increased ICF volume)
The causes of hyponatremia are as
a. Headache
follows: Diuretics, Low Sodium Diet,
b. Muscle weakness, fatigue, and apathy
Decreased Aldosterone Secretion
c. Anorexia, nausea and vomiting
(Addison’s Disease), Edema, Ascites,
d. Abdominal cramps
Burns, Diaphoresis
e. Weight loss
f. Postural hypotension
g. Seizures, Coma
sss
1. SODIUM IMBALANCES
a. Hyponatremia (Sodium Deficit)

Collaborative Management for hyponatremia include the following:

a. Administer NaCL 0.9% per IV, plasma expanders (e.g., hestastarch). to
prevent shock
b. Sodium-rich food in diet
c. Safety precautions, e.g., use of side rails, supervision of ambulation
sss
1. SODIUM IMBALANCES
b. Hypernatremia (Sodium Excess, Edema)
Sodium and water excess results to
edema
The causes of hypernatremia are as
follows: Hyperventilation and Diarrhea
(more water is lost than sodium); high
sodium intake, sodium tablets, water
deprivation
The clinical manifestation of hypernatremia are as
follows: (These are due to increased ECF volume and
decreased ICF volume, ICF dehydration)
a. Extreme thirst
b. Dry, sticky mucous membrane
c. Oliguria
d. Firm, rubbery tissue turgor
e. Red, dry, swollen tongue
f. Restlessnes. tachycardia, fatigure
g. Disorientation, hallucination
sss
1. SODIUM IMBALANCES
b. Hypernatremia (Sodium Excess, Edema)

Collaborative management for hypernatremia include the following:

a. Monitor intake and output
b. Restrict sodium diet
c. Increase oral fluids or administer D5W per IV as prescribed
d. Administer diuretics as prescribed
e. Dialysis as indicated
f. Promote safety, monitor behavior changes
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1. SODIUM IMBALANCES
High Impacts Concepts

Hyponatremia- Increases ICF volume- “CELLS SWELL”

Hypernatremia- Decrease ICF volume- “CELLS SHRINK”
2. POTASSIUM IMBALANCES
a. Hypokalemia (Potassium Deficit)
The causes of hypokalemia are as
follows: decreased food and fluid
intake (starvation; increased loss
of potassium (hypersecretion of
aldosterone, gastrointestinal
losses, potassium- wasting
diuretics); shifting of potassium
into cells treatment of DKA,
metabolic alkalosis).
The clinical manifestation of hypokalemia are as follows:
(these are due to decreased neuromuscular irritability).
-Gastrointestinal Tract: anorexia, nausea and vomiting,
abdominal distention, paralytic ileus
- Central Nervous System: lethargy, diminished deep tendon
reflexes, confusion, mental depression.
- Muscle: weakness, flaccid paralysis, weakness of respiratory
muscle, respiratory arrest
-Cardiovascular System: hypotension, dysrhythmias,
myocardial damage, cardiac arrest
- Kidneys: water loss, thirst, renal damage
2. POTASSIUM IMBALANCES
a. Hypokalemia (Potassium Deficit)
Collaborative management for hypokalemia include the
High Impacts Concepts: following:
a. Include potassium rich foods in the diet, e.g. banana, dried fruit.,
Hypokalemia is characterized by orange, raw carrot, raw tomato, baked potato, melon (cantaloupe).
the decreased neuromuscular watermelon
irritability. b. Fresh fuits in general, have high potassium content except apple

In Hypokalemia “Everything NURSE ALERT

is low and slow” c. Administer potassium supplement (potassium chloride) per slow IV
drip. NEVER administer Potassium Chloride per IV push or direct
IV. this may cause dysrhythmias and cardiac arrest
d. Administer potassium- sparing diuretics as prescribed
2. POTASSIUM IMBALANCES
b. Hyperkalemia (Potassium Excess)

The causes of hyperkalemia are as The clinical manifestation of hyperkalemia are as

follows: excess dietary intake of follows: (these are due to increased neuromuscular
potassium- rich foods, excess irritability).
parenteral administration of -Gastrointestinal Tract: nausea, vomiting, diarrhea,
potassium; decreased excretion of colic
potassium (potassium sparng - Central Nervous System: numbness, tingling
diuretics, renal failure, adrenal - Muscle: iirtability (early), weakness(late), flaccid
insufficiency); shifting of potassium paralyis
out of cells (extensive trauma, -Cardiovascular System: ventricular fibrlliation, cardiac
crushing injuries, metabolic arrest
acidosis) - Kidneys: oliguria, anuria
2. POTASSIUM IMBALANCES
b. Hyperkalemia (Potassium Excess)

Common Clinical manifestation of

High Impacts Concepts:
Hyperkalmia is characterized by the hypokalemia and hyperkalemia:
increased neuromuscular irritability.

In Hypokalemia “Everything is high and Muscle weakness

fast” Paralysis
(the major route of excretion of Dysrrthmias
potassium are the kidneys) Cardiac arrest
Renal Damage
2. POTASSIUM IMBALANCES
b. Hyperkalemia (Potassium Excess)

Collaborative management for hyperkalemia include the following:

-Low potassium diet
-Dextrose 10% in water with regular insulin per IV as prescribed. Potassium
attaches to glucose. Then, insulin transport glucose with attached potassium into the
cells. this lowers serum potassium levels.
-Polyesterene Sulfonate (exchange resin kayexalate) by mouh or per enema
as prescribed. Sodiu ions exchange with ppotassium ions in G.I. tract. This prevents
absorptions of potassium is excreted via the feces.
-Calcium gluconate per IV as prescribed, this is the antidote for hyperkalemia
-Dialysis as indicated
3. CALCIUM IMBALANCES
a. Hypocalcemia
The causes of hypocalcemia
are as follows:
- Decreased ionized calcium
(large blood transfusion with
citrated blood; alkalosis)
-Excess loss of calcium
(renal disease; draining fistulas
- Inadequate dieatry intake
of calcium- rich foods
-Decreased calcium
absorptions (decreased vitamin d;
hypoparathyroidsm;
hyperthyroidism;
hypergmagnesernia)
The clinical manifestation of hypocalcemia are as follows:
(these are due to increased cell membrane permeability
that results to increased neuromuscular irritabilty).
-Central Nervous System: tingling, convulsions
-Gastrointestinal Tract: increased peristalsis, nausea and
vomiting, diarrhea
-Muscle: muscle spasm, tetany (Chvostek’s sign and
Trousseau’s sign)
-Cardiovascular System: dysrhythmias, cardiac arrest
Other signs ans symptoms:
-Bones: osteoporosis, fracture. These are due to decreased
calcium deposited into the bones
3. CALCIUM IMBALANCES
a. Hypocalcemia
High Impact Concept:
To remember signs and symptoms of
hypocalcemia
Inreased cell membrane
permeability
Increased neuromuscular
irritability
“Everything is high and fast”
Collaborative management for hypocalcemia are as
follows:
-High Calcium Diet
-Oral calcium salts as prescribed
- Vitamin D and Parathormone supplements as ordered
- Amphogel (Aluminum Hydroxide) as prescribed, this is
a phosphate- binder, As it lowers phosphate levels, calcium
levels will increase
- Calcium Gluconate 10% per IV as prescribed. This is
indicated if hypocalcemia is severe
- Promote safety, seizures may occur
- Protect from trauma. To prevent Fracture
- Monitor breathing, laryngospasm may occur
3. CALCIUM IMBALANCES
b. Hypercalcemia
The causes of hypocalcemia
are as follows:
-Calcium loss from bones
(immobilization; carcinoma with
bone metastases);
-Excessive intake of
calcium 9high calciumdiet,
calcium- containing antacids);
-Hyperparathyroidism;
hypervitaminosis D; steroid
theraphy
The clinical manifestation of hypercalcemia are as follows:
(these are due to decreased cell membrane permeability that
results to decreased neuromuscular irritabilty).
-Central Nervous System: diminished deep-tendon reflexes,
lethargy, coma
-Gastrointestinal Tract: decreased peristalsis (constipation,
paralthics ileus).
-Muscle: muscle fatigue, hypotonia
-Cardiovascular System: depressed electrical activity
(dysrhythmias), cardiac arrest
Other signs ans symptoms:
-Bones: osteoporosis, fracture.
-Kidneys: polyuria, dehydration, stones, renal damage