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Electrolytes
Imbalances
Prepared By: Mr. Charlie C. Falguera, RN
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Sodium ImbalancesHyponatremia
- A plasma sodium level below 135 mEq/L.
Types:
1. Hypovolemic hyponatremia
- When sodium loss is greater than water loss.
2. Euvolemic hyponatremia
- When the total body water is moderately increased and the total body
sodium remains at a normal level.
3. Hypervolemic hyponatremia
- When a greater increase occurs in TBW than in total body sodium.
4. Redistributive hyponatremia
- No change occur in TBW or total body sodium; water merely shifts
between the intracellular & extracellular compartments relative to
the sodium concentration.
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Etiology:
1. Hypovolemia hyponatremia
- Renal loss of sodium from diuretic use, diabetic glycosuria,
aldosterone deficiency, intrinsic renal disease
- Extrarenal loss of sodium from vomiting, diarrhea, increased
sweating, burns, high-volume ileostomy.
2. Euvolemic hyponatremia
- Sodium deficit resulting from SIADH or the continuous
secretion of ADH due to pain, emotion, medications,
cancers, CNS disorders
3. Hypervolemic hyponatremia
- Edematous disorder resulting in sodium deficit, CHF, livercirrhosis, nephrotic syndrome, acute & chronic renal
failure
4. Redistributive hyponatremia
- Pseudohyponatremia, hyperglycemia, hyperlipidemia
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Pathophysiology:
1. Decreased excitability of the membranes.
2. ECF becomes hypo-osmolar.
Clinical Manifestations:
1. Headache 11. Tachypnea, dyspnea
2. Apprehension 12. Cheyne-stokes respi,3. Confusion neurogenic hyperventilation
4. Hallucinations apneustic breathing
5. Behavioral changes ataxic breathing
6. Seizures 13. Nausea & vomiting
7. Hypotension 14. Hyperactive bowel sounds
8. Weak thready pulse 15. Abdominal cramping
9. Tachycardia 16. Diarrhea
10. Crackles 17. Dryness of skin & mucous
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Diagnostic Findings;
1. Plasma sodium level below 135 mEq/L
2. Plasma chloride level below 98 mEq/L.
3. Plasma osmolality less than 275 mOsm/kg.
Management:
1. Treat the underlying cause.
2. Restrict fluid intake.3. Dietary supplementation.
4. IV infusionPNSS or LR solution, 3% NaCl
5. Meds: Diuretics, Demeclocycline
6. Safety precautions.
Complications:
1. Brain herniation, coma, death
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Hypernatremia
- A plasma sodium level above 145 mEq/L.
Types:
1. Hypovolemic hypernatremia
- When TBW is greatly decreased relative to sodium.
2. Euvolemic hypernatremia
- When the total body water is decreased relative to the normal total
body sodium.
3. Hypervolemic hypernatremia
- When TBW is increased but the sodium gain exceeds the water gain.
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Etiology:
1. Hypovolemia hypernatremia
- Renal loss of, osmotic diuresis, diuretics, severe
hyperglycemia
- Extrarenal loss: profuse diaphoresis, decreased thirst,
diarrhea occuring with inadequate volume replacement or
fluid replacement with hyperosmolar solutions, burns.
2. Euvolemic hypernatremia
- Excess fluid loss from the skin & lungs, hypodipsia in
the elderly & infants, DI
3. Hypervolemic hyponatremia
- Administration of concentrated saline solutions,hypertonic feedings, excess mineralocorticoids, accidental
or intentional salt ingestion, commercially preapred soups
& canned vegetables.
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Pathophysiology:
1. Water shift from ICF to ECF.
2. Na competes with Ca in the Ca channels for cardiac musclecontraction..
Clinical Manifestations:
1. Polyuria, oliguria 13. Weight gain
2. Anorexia, N & V, weakness 14. Edema
3. Restlessness, agitation, irritability 15. Dysrhythmia4. Dry, flushed skin 16. Crackles
5. Dry, sticky mucous mem 17. Dyspnea
6. Tongue furrows 18. Pleural effusion
7. Increase thirst
8. Fever
9. Orthostatic hypotension/HPN
10. Tachycardia
11. Jugular vein distention
12. S3 gallop
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Diagnostic Findings;
1. Plasma sodium level above 145 mEq/L
2. Plasma chloride level above 106 mEq/L.
3. Plasma osmolality more than 295 mOsm/kg.
Management:
1. Treat the underlying cause.
2. Increase fluid intake.
3. Restrict sodium.4. IV infusion0.3%, 0.45% NaCl, or D5W
5. Meds: Diuretics, Desmopressin acetate
6. Safety precautions.
Complications:
1. Coma, irreversible brain damage, death
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Potassium Imbalances
Hypokalemia
- A plasma potassium level below 3.5 mEq/L. Etiology & Risk Factors:
1. Inadequate K-intake.
- Debilitated, confused, restrained, or lack access to dietary
intake.- Malnourished, anorexic, bulimic, K-restricted diets, K-free IV
solutions, older adults
2. Excessive K-loss.
- Vomiting & diarrhea, nasogastric suctioning, intestinal fistulae,
ileostomy.
- Osmotic diuresis, post-op clients, alcoholism,
- Meds: K-wasting diuretics, cathartics, steroids,
aminoglycosides, amphotericin B, digitalis preparations, beta-
adrenergic drugs, cisplatin, bicarbonate, natural licorice
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Etiology & Risk Factors:
1. Redistribution of potassium
- Increased levels of insulin, alkalosis, burns, sever tissue injury2. Others
- Cushings syndrome, diuretic phase of renal failure,
hyperaldosteronism, liver disease, cancer, wounds, Bartters
syndrome
Pathophysiology:
1. Decreased gradient between ICF & plasma.
2. Increase excitability.
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Clinical Manifestations:
1. Anorexia 16. Apnea
2. Abdominal distention 17. Dysphasia
3. Constipation 18. Areflexia4. Muscle weakness 19. Confusion
5. Flabbiness 20. Vomiting
6. Leg cramps 21. Ileus
7. Fatigue 22. Polyuria8. Paresthesias 23. Nocturia
9. Hyporeflexia
10. Irritability
11. Dysrhythmias
12. Hypotension
13. Slow, weakened pulse
14. Shallo respirations
15. SOB
Di ti Fi di
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Diagnostic Findings:
1. ECG results:- Depressed & prolonged ST segment
- Depressed & inverted T wave
- Prominent U wave2. Lab test:- Plasma potassium level below 3.5 mEq/L
Management:
1. Treat the underlying cause.
2. Foods high in K.
3. K-supplementation.
(eg. K-chloride, K-gluconateIV or PO)
4. Safety precautions.
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Hyperkalemia
- A plasma potassium level above 5.0 mEq/L.
Etiology & Risk Factors:
1. Retention of K by body because of decreased or inadequate
urine output.
2. Excessive release of potassium from the cells during the first
24-72 hours after traumatic injury or burns, or from cell lysis
or acidosis
3. Excessive infusion of IV solutions that contain K or
excessive oral intake, especially in a person who has renal
disaese.
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Pathophysiology:
1. Increase cell membranes excitation threshold.
Clinical Manifestations:
1. Paresthesia
2. Tachycardia
3. Intestinal colic
4. Diarrhea
5. Hypotension
6. Convulsions
7. Impaired cardiac conduction8. Muscle weakness
9. Paralysis
10. Flaccid muscles
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Diagnostic Findings;
1. Plasma potassium level above 5 mEq/L
2. Plasma BUN above 20 mg/dL.
3. Plasma creatinine more than 2.5 mg/dL.
4. ECG reveals: Peak T-wave
Management:
1. Treat the underlying cause.
2. Dietary restriction of foods high in K.3. Infusion of IV Calcium gluconate.
4. Infusion of insulin & glucose.
5. IV Beta-agonist albuterol.
6. Na-polystyrene sulfonate (Kayexalate)PO or rectal
7. Allopurinol & diuretics
8. Safety precautions
Complications:
1. Cardiac arrest, respiratory muscle paralysis
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Calcium Imbalances
Hypocalcemia-A plasma calcium level below 4.5 mEq/L or
8.5 mg/dL.
Etiology & Risk Factors:
1. Inadequate intake
- Older adult, decreased Vit. D, lactose intolerance, GI disease, liverdisease, alcoholism, anorexia, bulimia, prolong NPO, prolong
intsitutionalization
2. Hypoparathyroidism, inadvertent removal of PT gland,
Pancreatitis, open wounds, Cushings disease, alkalosis,
multiple BT.3. Meds: Mg So4, colchicine, neomycin, aspirin,
anticonvulsants, estrogen, phosphate preps, steroids, loop
diuretics, antacids & laxatives
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Pathophysiology:
1. Decrease in threshold potential.
Clinical Manifestations:
1. Numbness & tingling sensations 17. Fractures
2. Emotional lability 18. Diarrhea
3. Cardiac insufficiency
4. Hypotension
5. Dysrhythmias
6. Trousseaus sign
7. Chvosteks sign
8. Prolonged bleeding time
9. Seizures
10. Catarcts
11. Dry, sparse hair
12. Rough skin
13. Laryngeal stridor
14. Tetany
15. Hemorrhage
16. Cardiac collapse
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Hypercalcemia
- A plasma calcium level over 5.5 mEq/L or 11 mg/dL.
Etiology & Risk Factors:
1. Metastatic malignancy
2. Hyperparathyroidism.3. Thiazide diuretic therapy
4. Excessive intake of Ca & vit D supplements.
5. Calcium-containing anatcids
6. Prolonged immobilization7. Metabolic acidosis
8. Hypophosphatemia
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Pathophysiology:
1. Increase in threshold potential.
Clinical Manifestations:
1. Anorexia
2. Nausea & vomiting
3. Polyuria
4. Muscle weakness
5. Fatigue
6. Lethargy
7. Dehydration
8. Constipation
9. Colicky pain
10. Bone pain
Diagnostic Findings:
1. Plasma calcium levelabove 5.5 mEq/L or 11.5 mg/dL
2. ECG: widened T wave, shortened QT interval.
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Management:
1. Assess V/S, & ECG.
2. Assess bowel sounds & renal function.
3. Increase fluid intake.
4. Sodium intake is increased.
5. Consumption of high fiber foods.
6. Safety precautions.
7. Meds:
- IV normal saline
- Cortocosteroids
- IV phosphate
- Calcitonin
- Etidronate disodium (Didronel)
- Gallum nitrate
Complications:
1. Renal stones, renal failure, coma
h h b l
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Phosphate Imbalances Hypophosphatemia
A plasma phosphorous level less than 1.2 mEq/L.
Etiology & Risk Factors:
1. Loss or long-term lack of intake
2. Increased growth or tissue repair3. Recovery from malnourished state.
4. Prolonged & excessive intake of antacids
5. Admin of high levels of glucose via tube feedings or IV line
6. Cushings syndrome7. Hyperparathyroidism
8. Respiratory/Metabolic Alkalosis
9. Lead poisoning
10. Burns
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Pathophysiology:
1. Impairs the conversion of glucose & other substances to ATP.
Clinical Manifestations:1. Decreased cardiac or respiratory functions
2. Muscle weakness
3. Fatigue
4. Brittle bones
5. Bone pain6. Confusion
7. Seizures
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Management:
1. Diet & dietary supplementation.
2. TPN
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Hyperphosphatemia
A plasma phosphorous level greater than 3
mEq/L.
Etiology & Risk Factors:
1. Excessive intake of high-phosphate foods
2. Excess vitamin D3. Impaired colonic motility
4. Hypoparathyroidism
5. Addisons disease
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Clinical Manifestations:
1. Tachycardia
2. Palpitations3. Restlessness
4. Anorexia
5. Nausea & vomiting
6. Hyperreflexia
7. Tetany
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Manifestations:
1. Anorexia
2. Nausea
3. Abdominal distention
4. Depression
5. Psychosis
6. Confusion
7. Chvosteks sign
8. Trousseaus sign
9. Tetany
10. Convulsion
11. Vasospasm
Diagnostic Tests:
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Diagnostic Tests:
1. ECGProlonged QT intervals, widened QRS complex,
broadening T waves
Management:
1. Increase intake of Mg rich foods.
2. Safety & seizure precautions.
3. Assess DTR.
4. Supplementation:
1. Oral magnesium replacement
2. Parenteral Mg So4
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Hypermagnesemia
A plasma megnesium level above 2.5 mEq/L.
Etiology & Risk Factors:
1. Renal insufficiency
2. Excessive use of Mg-containing antacids or laxatives3. Potassium-sparing diuretics
4. Dehydration from ketoacidosis
5. Overuse of IV MgSO4
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Manifestations:
1. Peripheral vasodilation
2. Hypotension
3. Severe muscle weakness
4. Lethargy
5. Drowsiness
6. Loss of DTR
7. Respiratory paralysis
8. PVC
Diagnostic Test:
ECGProlonged PR, QT intervals
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Management:
1. Assess V/S, respiratory function, ECG recordings, urine
output.
2. Safety & seizure precaution.3. Drugs:
1. IV calcium salts
2. Albuterol
4. Avoid constant use of laxatives & antacids containing Mg.
5. Diet: High fiber.
6. Increase fluid intake.
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Thank
You!!!