Magnesium Range Mg+
Phosphorus Range P+
Potassium Range K+
Calcium Range Ca+
Sodium Range Na+
Hematocrit Range Hct
37-47 (women) 40-54 (men)
Magnesium deficiency or total serum Mg+ level of less than 1.3 mEq/L.
Most Common Cause of Hypomagnesemia
Present when Mg+ level rises above 2.5 mEq/L. Due to decreased intake or decreased excretion.
Causes of Hypomagnesemia
Mg+ deficit, diuretics, chronic alcoholism, or malnutrition.
SxS of Hypomagnesemia
CNS excitability, hyperactive deep tendon reflexes, painful parasthesias (numbness or prickly, stinging, or burning feeling), tetany (intermittent muscle spasms), cardiac dysrhythmias, confusion, constipation, or abdominal distention.
Labs & Diagnostics of Hypomagnesemia
Serum Mg+ levels <1.3 mEq/L and/or EKG changes.
Tx of Hypomagnesemia
If mild increase dietary MgSO4. If severe MgSO4 IV. Monitor cardiac and renal function.
Causes of Hypermagnesemia
Renal insufficiency or failure, excessive use of Mg+, antacids, or IVMgSO4.
SXS of Hypermagnesemia
Early flushing or sense of warmth, Mg+ causes vasodilation decreasing B/P. If mild, decreased LOC and nausea or vomiting. If severe, loss of deep tendon reflexes, cardiac dysrhythmias; arrest, or respiratory arrest.
Labs & Diagnostics for Hypermagnesemia
Serum Mg+ >2.3 mEq/L and/or EKG changes.
Tx of Hypermagnesemia
Discontinue all meds containing MgSO4, Dietary restrictions, Ventilator if resp below 12, if emergency IV calcium chloride or calcium gluconate which will inactivate Mg+, increase fluids/excretion (dialysis if kidneys shut down).
Causes of Hypophosphatemia
P+ deficit, malnutrition, hypercalcemia, and/or renal failure.
SxS of Hypophosphatemia
Muscle weakness & breakdown, decreased DTR, decreased contractility of cardiac muscle, slowed peripheral pulses, irritability, confusion, seizures, and/or increased bleeding.
Labs & Diagnostics for Hypophosphatemia
P+ levels <2.5 mEq/L, Ca+ levels >10.5 mg/dL, & Mg levels >1.3 mEq/L.
Tx of Hypophophatemia
Treat the hypercalcemia, oral supplements along with vit.D, diet high in P+ rich foods and low in Ca+, avoid P+ binding antacids, if severe admin IV infusion of P+.
Causes of Hyperphophatemia
Renal insufficiency, Hypoparathyroidism, increased intake of P+, and/or certain cancer Tx's.
SxS of Hyperphosphatemia
Tetany, muscle cramping, & pain related to low Ca+ levels.
Tx of Hyperphosphatemia
Management of hypocalcemia and restrict foods high in P+.
Causes of Hypokalemia
Urinary loss, diuretics (except K+ sparing), diabetes, Abnormal losses from GI tract, vomiting & diarrhea, and/or malnutrition.
SxS of Hypokalemia
Cardiac dysrhythmias, generalized muscle weakness, leg cramps, decreased reflexes, nausea, vomiting, and/or lethargy.
Labs & Diagnostics for Hypokalemia
K+ levels <3.5 mEq/L and/or EKG changes.
Tx of Hypokalemia
Oral K+ replacement, dietary intake of K+, and/or oral supplements (may cause GI irritation, do NOT give unless urinary output >30 mL/hr).
Causes of Hyperkalemia
Inadequate excretion of K+, renal disease/failure, use of K+ sparing diuretics, excessively high intake or IV admin of K+, rapid blood transfusion, shift of K+ from ICF to ECF, and/or severe infection.
SxS of Hyperkalemia
Cardiac dysrhythmias, diarrhea, abdominal cramping, anxiety, irritability, muscle twitching, tremors, and/or seizures.
Labs & Diagnostics for Hyperkalemia
K+ levels >5.0 mEq/L and/or EKG changes.
Tx of Hyperkalemia
Decreased intake of K+, loop diuretics, dialysis (if kidneys aren't working), calcium bicarbonate IV (decreases arrhythmias), calcium gluconate IV (decreases arrhythmias), and/or glucose 10% with insulin IV.
NEVER give....it can kill.
Causes of Hyponatremia
Loss of Na+ from body, renal losses, external losses, FVE resulting in Na+ dilution, CHF, renal failure, and/or cirrhosis (kidney failure).
Early SxS of Hyponatremia
Na+ levels >125 mEq/L, altered GI function: anorexia, abdominal cramping, nausea, vomiting, and/or diarrhea.
Later SxS of Hyponatremia
Na+ levels <120 mEq/L, neurologic changes: headache, altered mental status, muscle twitching, convulsions, coma.
Labs & Diagnostics for Hyponatremia
Na+ levels <135 mEq/L, Osmolality <275 mOsm/kg, and/or 24-hr urine test.
Tx for Hyponatremia if FVD or Normal Fluid
FV replacement with Na+ PO, NGT, or IV.
Tx for Hyponatremia if FVE or Na+ Dilution
Restrict fluids and admin diuretics per order.
Causes of Hypernatremia
Water loss or Na+ gain, decreased oral intake, high fever, chronic diarrhea, increased resp rate, tube feeding, and/or hypertonic IV solutions.
SxS of Hypernatremia
Neurological changes: disorientation, confusion, lethargy; Restlessness, muscle weakness, thirst, edema, and/or hypertension.
Labs & Diagnostics for Hypernatremia
Na= levels >145 mEq/L and/or Omolality >295 mOsm/kg.
Tx for Hypernatremia
Prevention, PO & IV Na+ replacement, diuretics, and/or low Na+ diet. **Correction must be done slowly.
Causes of Hypocalemia
Ca+ deficit, inadequate oral Ca+ intake, vit D deficit, wound drainage from GI surgery, Hypoparathyroidism, and/or acute pancreatitis.
SxS of of Hypocalemia
Parasthesias, tetany, muscle twitching, cardiac dysrhythmias, diarrhea, resp arrest, Trousseau's sign, and/or Chvostek's sign.
Labs & diagnostics for Hypocalemia
Ca+ levels <8.5 mg/dL, Mg+ decreased, and HPO4 elevated.
Tx for Mild Hypocalemia
High Ca+ diet or calcium supplements.
Tx for Severe Hypocalemia
IV 10% Ca+ gluconate slowly, Vit D supplements, and Magnesium Sulfate to decrease nerve excitability.
Causes of Hypercalemia
Ca+ excess, vit D overdose, excessive oral Ca+ intake, renal failure, Hyperparathyroidism, prolonged immobilization, and/or use of lithium.
SxS of Hypercalemia
Cardiac dysrhythmias, risk for clot formation, severe muscle weakness, decreased LOC, confusion, lethargy, constipation, renal calculi, nausea, vomiting, and/or abdominal pain.
Labs & Diagnostics for hypercalemia
Ca+ 10.5 mg/dL and EKG changes.
Tx for Hypercalemia
Loop diuretics, IV NaCl, Calcitonin, Phosphorous, and restricting dietary Ca+.
Numbness, prickly, stinging, or burning feeling.
Intermittent muscle spasms.