First up, we have sodium, which is instrumental for
maintaining the fluid balance in the body and for nerve
and muscle function.
The normal range for sodium is between 136 and 145.
Different sources will have slightly different ranges, and I
wouldn't get hung up on that because when you're given
an out-of-range number for sodium or another electrolyte
on a nursing exam, it will likely be very out of range, on the
high side or the low side, so when I go through these
ranges, just kind of keep that in mind.
In terms of hypernatremia, this is where we have a sodium
level above 145, causes can include excess sodium intake,
as well as disorders such as Cushing's syndrome or
diabetes, and insipidus.
Signs and symptoms can include thirst, agitation, muscle
weakness, as well as GI upset.
In terms of treatment, we can provide hypertonic IV fluids
such as 0.45% and ACL. Any time we're trying to correct a
patient's sodium balance, we want to do so slowly in order
to avoid causing cerebral edema or seizures. So again,
we're not trying to pop that sodium level up or down very
quickly. We're going to correct it slowly. We can also use
diuretics to help reduce the patient's sodium level.
So furosemide is an example of a diuretic that promotes
sodium loss so that could be used. In addition, we can
restrict the patient's intake of sodium and increase their
intake of water.
All right. Next, we have hyponatremia, this is where we
have a sodium level that is below 136.
Possible causes include diuretics, kidney failure, diathesis,
as well as SIADH, hypoglycemia and heart failure.
Signs and symptoms include confusion, which is very
common in the elderly in particular. So when an older
patient presents at the hospital with new onset confusion,
a lot of times it's due to an electrolyte imbalance such as
hyponatremia, or sometimes it's caused by something like
a UTI.
So you definitely want to get the patient's blood, check for
those electrolyte imbalances and maybe get a urine
sample as well.
Aside from confusion, other side effects of-- or rather
other signs and symptoms of hyponatremia include
fatigue, nausea and vomiting, as well as headache.
In terms of treatment, we can provide a hypertonic IV fluid
replacement, so this would be 2 to 3 percent NACl. Again,
we're going to correct that sodium level slowly. We can
also encourage increased sodium intake and restrict the
patient's fluid intake as well.
Next, we have calcium, which is an electrolyte that is
important for bone and teeth formation, nerve and muscle
function, as well as clotting.
The normal range for calcium is between 9 and 10.5. So
my way of remembering this range, when I see CA for
calcium, it makes me think of California, which is due for
the big earthquake sometime. And when that earthquake
comes, it may register between 9 and 10.5 on the Richter
scale. I've seen another tip about calcium levels, call 911,
which will help you remember that calcium levels should
be between 9 and 11, roughly. So hopefully one of those
two tricks will help you. If you have another pneumonic or
trick for remembering an electrolyte range, definitely
leave it in the comments.
So with hypercalcemia, we have a calcium level that is
above 10.5.
This can be caused by hyperparathyroidism, so that
parathyroid gland is responsible for regulating calcium,
and if it's out of control for whatever reason, then we can
end up with excess calcium. We also have causes such as
corticosteroids and bone cancer that can cause
hypercalcemia.
In terms of signs and symptoms, those include
constipation, decreased deep tendon reflexes, as well as
kidney stones, lethargy and weakness.
In terms of treatment, we can provide 0.9% IV fluids, so
0.9% NACL. We can give the patient calcitonin, which
tones down the amount of calcium in the bloodstream.
And then for severe hypercalcemia, dialysis may be
necessary.
All right.
With hypocalcemia, we have a calcium level that is under
9. And this can be caused by diarrhea, as well as a vitamin
D deficiency. So vitamin D is essential for the absorption of
calcium in the body. So if we don't have enough vitamin D
on board, we are not going to be absorbing calcium.
Hypercalcemia can also be caused by hypoparathyroidism.
So if that parathyroid gland is not functioning well, then
we can have decreased levels of calcium. And this can also
occur if the patient is getting their thyroid gland removed,
so a thyroidectomy sometimes that parathyroid gland can
be nicked. And if that's the case, that can cause decreased
calcium levels.
In terms of signs and symptoms, one important sign and
symptom to understand is a positive Chvostek sign. This is
where if you tap the patient's cheek, it will twitch. So if
you look at the word Chvostek, it starts with CH and so
does the word cheek, so that will help you remember what
that sign is all about. We will also see a positive Trousseau
sign. This is where we inflate a blood pressure cuff on the
arm, and it causes the contraction of the hand and fingers
to make this kind of shape. Other signs and symptoms
include muscle spasms, numbness and tingling in the lips
and fingers, as well as GI upset.
In terms of treatment for hypocalcemia, we can provide
the patient with calcium supplements either orally or
through their IV.
And we should also encourage an increased intake of
calcium rich foods.
Next, we have potassium, which is an important
electrolyte in maintaining the ICF, and in nerve and muscle
function.
So the normal range for potassium is between 3.2 and 5.
So my ways of remembering this range, when I think about
running a 5K, then that's about 3.2 miles, roughly, so that
helps me to remember 3.2 to 5. You can also think about
buying bananas in a bunch of 3 to 5, and that will help you
remember roughly that expected range for potassium and
also help you remember that bananas are rich in
potassium. So hopefully one of those two tricks will help
you.
In terms of hyperkalemia, this is where we have a
potassium level above 5.
This can be caused by kidney disease. It can also be caused
by excess intake of antacids or laxatives that contain
magnesium.
In terms of signs and symptoms-- signs and symptoms of
hypermagnesemia include hypotension, lethargy, muscle
weakness, decreased deep tendon reflexes, as well as
respiratory and cardiac arrest. So when magnesium is too
high, we're going to have all these things go low.
In terms of treatment, we can provide furosemide to help
bring down those magnesium levels. We also want to
provide the patient with calcium to help reverse the
cardiac effects of having excessive magnesium.
With hypomagnesemia, this is where we have a
magnesium level that is below 1.3. This could be caused by
GI losses, as well as diuretics, malnutrition and alcohol
abuse. So when we get patients in the hospital who have
an alcohol abuse disorder, their magnesium levels are
often very low, and they require supplements.

Signs and symptoms of hypomagnesemia include

dysrhythmia, including one dysrhythmia called Torsades
de pointes.

It can also cause tachycardia, hypertension, increased

deep tendon reflexes, as well as tremors and seizures. So
as magnesium levels are down, we have an increase of all
this stuff, so it's kind of an opposite situation.

In terms of treatment, we can provide a patient with

hypomagnesemia with magnesium supplements, either PO
or IV, and then we can encourage increased intake of
magnesium rich foods as well.