SODIUM (Na)

- Active ECF (Extracellular Fluid)

- Sodium is for maintaning acid base balance, and for neuromuscular functioning.

HYPERNATREMIA (↑ Na) HYPONATREMIA ( ↓ Na)

● More solutes than water. ● Kulang ka sa sodium na need mo sa katawan.
● Madaming salt sa body mo which then obstructs ● CAUSES:
your kidney that causes low urine output and ○ Diaphoresis (excessive sweating)
increased urine specific gravity. ○ Diuretics
● CAUSES: ○ Restricted Na intake
○ Rapid saline infusion ○ Addison’s dse
■ Plain NSS contains sodium ● S/Sx:
and H2O, if infusion is rapid, it ○ ↓ BP
can increase sodium levels. ○ Weight loss
○ High Na intake ○ Headache
○ Water deprivation ○ Muscle weakness
■ So since, kulang ka sa water ○ Lethargy
sa katawan tendency is ○ Decreased ECF (extracellular fluid)
matitira yung mga solutes ● Note: Sodium is the major osmotically active in
such as Na. the ECF. Kaya kapag mababa si sodium, matik
○ Hyperventilation na decreased ECF siya.
■ Overbreathing results to loss
of water vapors. ● MGT:
● S/Sx: ○ High salt diet
○ Oliguria or low UO ○ NSS (.9 NaCl)- an isotonic IVF to give
Sabi ni ma'am kapag ↓ UO = ↑ Urine specific more water. It contains Na and H2O.
gravity and vice versa. ○ Increase OFI pwede samahan ng ORS
○ Red dry swollen tongue or glossitis. solution such as Oresol that contains
○ ↓ BP ↓ LOC ↑ HR sodium, glucose and water.
○ Thirst (since more solutes nasa body
mo instead of water)
○ Poor skin turgor due to thirst, etc.

● MGT:
○ D5W- contains H2O and glucose, to
increase more fluids and dilute the
sodium excess with the help of glucose.
○ Diuretics- to increase urine output and
to remove Na excess.
○ Restrict Na diet.
○ Increased fluid intake

Note: ↓ UO = ↑ Urine specific gravity and vice versa.

● Kapag low urine ouput or oliguria, di ka nakakaihi either may blockage sa kidney mo na di niya mafilter. So
meaning mataas solutes mo sa body or ibig sabihin concentrated yung urine imbes na diluted kaya increased urine
specific gravity.

● Kapag increased urine output or polyuria, meaning nakakaihi ka sobra sa sobra, mababa naman yung USG
mo. Diluted si urine ibig sabihin. Di din toh maganda kasi kapag ihi ka ng ihi, it leads to fluid loss and dehydration.
POTASSIUM (K)
- Major ICF cation and regulates Intracellular Osmolality. (Meaning opposite siya ni Sodium, inner naman siya or
nasa INTRACELLULAR FLUIDS.)
- Important in nerve impulses, proper skeletal and muscle functioning.
- Dito papasok sina ACIDOSIS and ALKALOSIS.
- NOTE: potassium and magnesium both have ecg changes because they play a crucial role in the function of
the myocardium.

HYPERKALEMIA (↑ K) HYPOKALEMIA ( ↓ K)
● CAUSES: ● CAUSES:
○ Metabolic acidosis ○ Mga nagpapababa kay Potassium yung
○ Excessive potassium mga common such as vomiting and
○ Renal failure diarrhea.
○ Addison’s dse ○ Decreased K intake
● S/Sx: (More likely about sa muscle functioning ○ Excessive urinary loss (Polyuria)
problems niya and nerves.) ○ Alkalosis.
○ Flaccid paralysis or loss of muscle ● S/Sx:
tone ○ Loss of deep tendon reflexes (since
○ Abdominal cramps due to acidity (kaya kulang sa potassium, may decrease
nga tinawag na metabolic acidosis) siya sa muscle reflexes)
○ Ecg changes such as widened QRS ○ ↓ LOC (since affected si nerves)
complex, Tall tented T wave. ○ ↓ HR
● MGT: ○ Ecg changes such as prolonged pr
○ Avoid foods rick in K. interval, flat t waves, depressed st
○ Dialysis due to renal failure as one of segment. Meron din siyang
its causes. dysrhthymias.
○ 10% glucose w/ regular insulin (to ● MGT:
normalize ecg changes, not sure pero ○ High K diet.
ayun pagkakaintini ko since may mga ○ KCL per IV (Potassium Chloride)- slow
dysrhythmias din). infusion
○ Spironolactone (K sparer, or
potassium sparer)

CALCIUM (Ca)
- Neuromuscular din siya important.
- ↑ Ca -> Calcitonin = ↓ Ca (Kapag HYPERCALCEMIA, need mo ng Calcitonin to decrease it.)
- ↓ Ca -> PTH = ↑ Ca (Kapag HYPOCALCEMIA, need mo ng PTH supplements to increase it. Kasi ang
nagsesecrete ng Ca are the parathyroid glands.)

HYPERCALCEMIA (↑ Ca) HYPOCALCEMIA (↓ Ca)

● ↑ Ca, meaning nasobrahan masyado sa calcium. ● Low calcium levels.
Since Ca helps in bone formation/reabsorption, ● CAUSES
kapag increased yung levels niya tendency is ○ Long term immobilization or bedridden
maglilead siya sa self destruction ng bone. for a long time hindi na nagagamit
Parang magiging brittle na si bone kaysa maging bones and muscles mo.
strong. Kaya CAUSES niya are: ○ Calcium excreting drugs such as
○ Increased bone reabsorption diuretics.
○ Hyperthyroidism (since si Parathyroid ○ Inadequate vit. D consumption.
gland yung nagsesecrete ng Ca in our ○ Osteoporosis.
body, kapag too much secretion ni PTH ● S/Sx:
meaning increased PTH levels or ○ Paresthesia (prickling sensation sa
Hyperthyroidism ang tawag). extremities)
○ Multiple fractures (since ayun nga ○ Hyperactive reflexes/neuromuscular
kagaya ng sabi ko, brittle na si bone). excitability
 ○ Excessive adm of Vit. D (Vit. D ○ (+) Chvostek's sign (facial muscle
promotes absorption of Ca, so matik twitching) and (+) Trousseau's sign
kapag masyadong intake ka ng vit D, it (Carpopedal spasm, yung may bp
can affect your calcium levels) nakasuot then yung hand mo will have
● S/Sx: involuntary muscle twitching).
○ Deep bone pain ● MGT:
○ Hypotonicity of muscle (loss of muscle ○ PTH supplement (mas important)
tone) ○ Calcium gluconate (mas important)
○ Lethargy, muscle weakness -- in short, ○ Vit. D intake
about sa muscle and bones yung ○ High Ca diet
affected as well as;
○ Dysrhythmias since affected nga yung
muscle and there's muscle sa heart
which helps sa pagpump ng blood.
● MGT:
○ Calcitonin and Furosemide (loop
diuretic/potassium waster kasi need
niya iihi or ilabas yung excess calcium
sa body)
○ ACID ash diet (tomatoes, legumes,
cheese, eggs, meat, etc)
○ Strain urine to check for renal stones

MAGNESIUM (Mg)
- Plays a role in CHO (carbohydrates) and CHON (protein).
- Important in neuromuscular functioning.
- NOTE: potassium and magnesium both have ecg changes because they play a crucial role in the function of
the myocardium.

HYPERMAGNESEMIA (↑ Mg) HYPOMAGNESEMIA (↓ Mg)

● CAUSES:
○ DKA (diabetes ketoacidosis, happens
when there is a problem in the
carbohydrates)
○ Antacids w/ Mg.
● S/Sx: (same with Hypokalemia such as)
○ Loss of DTR (deep tendon reflexes)
○ Prolonged PR interval
○ ↓ RR
○ ↓ HR
○ ↓ LOC.
Note: In short, they have sumtn to do with the fucntioning
of neuromuscular, particularly due to problems with the
metabolism (CHO and CHON)
● MGT:
○ Ca gluconate (most important to
remember)
● CAUSES:
○ Decreased mg intake
○ Chronic alcohism
○ DKA (Diabetes Ketoacidosis)
○ Vomiting and diarrhea.
● S/Sx: (same with Hyperkalemia such as)
○ Widened QRS complex
○ Depressed ST segment.
○ (+) chvostek's and trousseau's sign, and
tetany.
● MGT:
○ Carbohydrates intake such as cereals,
milk, fruits, whole grain, etc.
○ Magnesium Sulfate IV (MgSO4)

PHOSPHATE
- Important in Muscle functioning and RBC.

HYPERPHOSPHATEMIA HYPOPHOSPHATEMIA
● CAUSES: ● Same with Hypercalcemia
○ Hypoparathyroidism ● CAUSES: Hyperthyroidism, lack of vit D.
 ○ Hormonal imblances ● S/Sx:
○ Excessive intake of Phosphorus and Vit ○ Weakness
D. ○ Fatigue
● S/Sx: Hyperreflexia, tetany, seizures. ○ Bone pain
● MGT: ○ ↑ RR
○ Decrease intake of foods high in ○ Pathological fractures.
phosphorus and phosphate containing ● MGT:
medications such as laxatives and ○ KPO4 (Potassium Phosphate)
enema. ○ Vit. D
○ Strain urine to check for renal stones.

CHLORIDE
- Produced in the stomach as Hydrochloric Acid (HCL)

HYPERCHLOREMIA
● CAUSES:
○ Loss of bicarbonate ions (HCO3)
○ Increased in chloride ions.
● S/Sx: Decreased CO, dysrhythmias,
hypertension, increased RR.
● MGT:
● LR solution
● Diuretics (to increase urine output)
● Restrict Na and Chloride.
HYPOCHLOREMIA
● CAUSES: Severe diarrhea and vomiting, sodium
restricted diets, chloride deficient formulas.
● S/Sx: Hyperactive DTR/muscles, twitching,
dysrhythmias.
● MGT:
● Hypertonic IVF (NSS)
● Foods high in chloride (tomato juice, salty broth,
processed meats and fruits)
● Ammonium Chloride to treat metabolic alkalosis
(idk explanation dito huhuhu)
Note: In short, mostly kung ano nakalagay sa
Hypernatremia or Hyponatremia is same sakanila. Basta
tandaan lang din itong drawing wait send k

Normal Values of Electrolytes:

Magnesium- 1.5- 2.5 mEq/L

Phosphate- 1.7 - 2.6 mEq/L

Potassium- 3.3 - 5 mEq/L

Chloride- 98 - 108 mEq/L

Sodium- 135 - 145 mEq/L