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Electrolytes Exam 2

electrolytes

are solutes that generate an electrical charge when in solution

normal levels of Na:

135-145

tassium and sodium are ______ charged ions while chloride and phosphate are ______ charged ions.

potassium and sodium are + charged ions while chloride and phosphate are - charged ions.

normal levels of Ca:

9-11 mg/dL

normal levels of K:

3.5-5.3 mEq/L

normal levels of Phophorus:

2.8-4.5 mg/dL

normal levels of Mg:

1.5-2.5 mg/dL

normal protein levels:

6-8 mg/dL

what are the 4 reasons that can cause too much (HYPER) of an electrolyte?

1. increased consumption
2. increased holding onto/decreased excretion
3. high concentration
4. increased amount coming into vessels from bone, tissue, and cells

to measure serum electrolytes and protein, where are you measuring?

you are measuring how much of something is inside of the VESSELS, not the tissue, bone, or cells

what are the 4 reasons that you would too little of something in your blood (HYPO)?

1. decreased consumption/absorption
2. increased excretion/decreased holding on to
3. increased circulating blood volume (dilutes it)
4. increased giving off of substance outside of vessel and into the tissue, cells, and bone

what are the principle ways of repairing a HYPER condition of a substance?

1. decrease PO and IV consumption/administration
2. increase excretion
3. dilute the blood or increase circulating volume
4. increase the "pushing out" of the substance out of vessels and into cells, tissues, and bones

what are the principle ways of repairing a HYPO condition of a substance?

1. increase IV PO administration/consumption
2. decrease excretion/increase holding onto
3. concentrate the blood
4. increase "pulling in" of the substance into the vessels from the cells, tissue and bones

Na

1. extracellular cation
2. necessary for protein synthesis and impulse nerve transmission
3. regulated by water retention and reabsorption
4. eliminated through the kidneys
5. influenced by glomerular filtration rate (GFR) and aldosterone which regulates Na reabsorption

wherever Na goes,

water follows

Table Salt

NaCl

Hypernatremia

hypernatremia is an increased level of sodium in the blood that causes cellular shrinking since there is a higher concentration of Na outside of the cell, osmosis pulls water out of the cell

Causes of hypernatremia

1. decreased fluid intake
2. increased Na/saline intake
3. increased protein feedings

S&S Hypernatremia

1. weight gain
2. tachycardia
3. thirst/dry mucous membranes
4. agitation
5. seizure/coma

Treatment for Hypernatremia

1. increase fluid intake
2. decrease Na intake
3. give diuretics
4. dilute blood concentration
5. give HYPOtonic fluids to rehydrate cells

Hyponatremia

too little sodium in the blood which causes cellular swelling

Causes of hyponatremia

1. increased fluid intake
2. decreased renal function
3. adrenal insufficiency

S& S of hyponatremia

1. weight loss
2. confusion
3. hypotension
4. seizure/coma

Treatment of hypnatremia

1. increase Na intake
2. restrict fluids
3. give hypertonic fluids like 3% NaCl
4. monitor weight and vitals
5. perform oral and skin care

Hyperkalemia

is when there is too much potassium in the blood.

Causes of Hyperkalemia

1. kidney disease/renal failure: causes there to be a decrease in excretion, therefore an increase left in the body
2. rapid K infusion via IV
3. too much K entering blood from tissues like broken crushed bones or an MI
4. excessive ecchymosis

S&S of hyperkalemia

1. weakness
2. fatigue
3. lethargy
4. numbness
5. muscle cramps
6. arrhythmias

Treament of hyperkalemia

1. decrease K intake
2. give Kayexelate to increase K excretion but it will cause diarrhea and also check for hypokalemia
3. give insulin with D50 glucose to cause K to temporarily shift intracellularly and the glucose will prevent hypoglycemia. This is temporary and the K will come back out. This is used in life-threatening situations like life threatening arrythmias.
4. give diuretics that are NOT potassium sparing like Lasix (Furosemide), Bumex, and Demodex
5. give isotonic fluids, PO and IV
6. if severe then they will need dialysis

Fact

NEVER ever give K IV push or gravity hang. Always administer it slowly through an IV pump in diluted form. But in this case, where we are dealing with HYPERkalemia, or too much K, we don't need to worry about administering K unless our patient becomes hypokalemic from the Kayexalate

hypokalemia

Too little potassium in the blood

Causes of hypokalemia

1. nausea/vomiting/diarrhea
2. diuretics
3. NG tubes: nasogastric tubes
4. shift of K into the cells (like with insulin)

S&S hypokalemia

1. N/V
2. fatigue
3. malaise
4. weakness
5. muscle cramps
6. arrythmias
7. shallow respirations
8. confusion

hypokalemia treament

1. treat the cause
2. provide K supplements
3. monitor K levels every 2-4 hours post Tx
4. educate pt on S/S

Important reminders for hypokalemia

1. giving K is contraindicated for renal failure patients
2. K should NEVER be given IV push or gravity hang. It should always be given SLOWLY on an IV pump in diluted form
3. At a K level of less than 2.0 cardiac arrest can occur

What level of K will cardiac arrest occur?

2.0 or below

According to FH's K protocol, what is the MAXIMUM dose of K that can be given on an IV pump?

10 mEq/100 mL/ hr
If patient's K is below 2.5, then it can be increased to 20 mEq/ 100 ml/ hr

what foods are high in K

1. baked potatoes
2. broccoli
3. bananas

how is Ca regulated?

by filtration and reabsorption of the kidneys

what is the most important Ca regulator in the body?

parathyroid gland

what does the parathyroid gland release to regulate Ca in the body. What does this do?

parathyroid hormone (PTH)

PTH is secreted when there are low levels of calcium (hypocalcemia) in the blood. PTH prevents the excretion of calcium, increases calcium reabsorption by the kidneys and Ca and P release from the bones since Ca is bound in the bones by Phosphorous

what substance increases the absorption of Ca particularly in the GI tract?

vitamin D

what type of relationship does Ca have with Phospherous?

an inverse relationship,
an increase in Ca leads to a decrease in P vice versa

Hypercalcemia

Too much calcium in the blood

Causes of hypercalcemia

1. metastatic bone disease- excessive release of Ca from the bones
2. hyperparathyroidism- since PTH prevents the excretion of Ca and increases its release from bones and absorption, too much leads to hypercalcemia
3. immobility- causes too much release of Ca from the bones due to no weight bearing excercises
4. excessive vitamin D- increases the absorption of Ca
5. thiazide diuretics- has the body hold on the Ca

S&S of Hypercalcemia

1. lethargy
2. slurred speech
3. kidney stones
4. decreased reflexes
5. potential death is Ca is above 15

Treatment of Hypercalcemia

1. assess cardio/neuro
2. address the cause
3. give isotonic fluids, loop diuretics, and P
4. limit Ca intake
5. meds:
a. biphosphanates: increase Ca holding in the bones which decreases Ca in the blood
1. alendronate (fosamax)
2. ibandronate (boniva)
3. risendronate (actonel)
b. calcitonin- opposes PTH
1. myacalcin

what drugs are used to treat hypercalcemia?

a. biphosphanates: increase Ca holding in the bones which decreases Ca in the blood
1. alendronate (fosamax)
2. ibandronate (boniva)
3. risendronate (actonel)
b. calcitonin- opposes PTH
1. myacalcin

Hypocalcemia

Too little calcium in the blood

Causes of hypocalcemia

1. deficient vitamin D intake
2. removal of the parathyroid
3. acute pancreaitis
4. renal failure

S&S of hypcalcemia

1. increased deep tendon reflex:
a. Chvostek's sign: facial twitching when you tap on face
b. Trosseau's sign: carpal spasms after 3 min of BP cuff inflation to a level above systolic pressure
2. tingling in fingers and toes

Treatment of Hypocalcemia

1. limit fluid intake
2. give more Ca and prevent Ca excretion
3. Increase Ca in diet and decrease P
4. give P binding antacids
5. give IV gluconate not IM to avoid Ca precipitation in the muscles

What patient's need to be monitored for hypocalcemia?

always monitor patient who have recently had neck surgery closely for this

Ph04 is excreted by?

The kidneys

why does kidney damage have an impact on Ph04?

because Ph04 is excreted by the kidneys

what are the clinical manifestations of hyperphosphatemia?

the same as hypocalcemia due to their inverse relationship

hyperphosphatemia Causes

1. renal failure
2. chemotherapy
3. increased PO intake

S& S hyperphosphatemia

same as hypocalcemia
1. fatigue
2. anxiety
3. confusion
4. hyperrelexia
5. tetany
6. seizure

Treatment hyperphosphatemia

1. treat cause
2. increase Ca intake to decrease P
3. give PO4 binding agents to decrease serum level
a. renvela (sevalamen carbonate)
b. renegel (sevalamen HCl)
4. control P level

important reminders:hyperphosphatemia

1. frequently assess CKD patients

in hypermagnesia, what is the goal?

to reduce Ph04 while slowly replacing Ca

hypophosphatemia Causes

1. malnourishment
2. malabsorption syndromes
3. alcoholism

S&S hypophospatemia

1. impaired cellular energy production
2. muscle weakness
3. cardiac arrhythmia
4. decreased O2 delivery causes patient confusion and come

Treatment of hypophosphatemia

1. oral Ph04 in diet

Important reminders in hypophospatemia

1. remember, an increase in P will cause a decrease in Ca

what does magnesium aid in?

neuromuscular transmission and cardiac contractility

Mg is regulated by the same factors that regulate

K and Ca

what electrolyte is known as the "me too" electrolyte? what electrolyte does the "me too" electrolyte act like?

MG
K

when K is high then _____ is high as well:

Mg is high as well

hypermagnesia S&S

1. depression of CNS and neuromuscular function
2. N/V
3. lethargy
4. somnolence
5. coma/death

Treatment of hypermagnesia

1. prevention
2. administer IV Ca to counteract cardiac muscle inhibition
3. diuretics to excrete Mg

important reminders hypermagnesia

1. NO Mg or K for patients in renal failure

hypomagnesium

1. confusion
2. hyperactive reflexes
3. seizures
4. cardiac arrythmias
5. hypocalcemia/hypokalemia

treatment hypomagnesium

1. oral Mg in diet
2. IV Mg SLOWLY NO IV PUSH OR GRAVITY, drip slowly!!!!!!!!!!!!

Important reminders hypomagnesium

. if Mg < 1.5 then patient maybe unresponsive, Mg must be replaced before K replacement is given

hyperproteinemia:

is it common or rare?

rare

Causes of hyperproteinemia

1. dehydration
2. hemoconcentration

Treatment for hyperprotienemia

1. rehydration with hypotonic IV fluids

hypoproteinemia:

is it common or rare:

this is more common

Causes of hypoprotienemia

1. malnutrition
2. liver/renal disease
3. burns
4. malignancy/sepsis

Hypoprotienemia leads to?

1. ascites (pot belly)
2. edema
3. muscle wasting
4. pulmonary edema

Management of hyprotienemia

1. increase protein, carb in diet along with protein supplements
2. some may need TPN and IV albumin to correct protein levels

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