Electrolyte Levels and Imbalances

Question 1

Potassium Normal Range

Answer 1

3.5-5 mEq/L

Potassium is the main intracellular ion

Question 2

Hypokalemia

Answer 2

CRITICAL

Question 3

Sodium Normal Range

Answer 3

135-145 mEq/L

Sodium is the main extracellular ion

Question 4

Hyponatremia

Answer 4

Causes: too much H20, psychogenic polydipsia, D5W, SIADH
S/S: headache, seizure, coma
Tx: hypertonic solution (3% NS or 5% NS - both packed with sodium)

Question 5

Hypernatremia

Answer 5

> 145
Cause: hypertonic tube feedings w/o H20 supplements, hyperventilation, DI, Alka seltzer, near drowning in the ocean, inadequate H20 ingestion
S/S: elevated temp, weakness, disoriented, irritability/restless, thirst, dry swollen toungue, postural hypotension with low ECF and hypertension with normal or high ECF, tachycardia
Management: IV hypotonic solution (0.3% NaCl or 0.45% NaCl, 5% dextrose in H20, daily wt, decrease Na in diet

Question 6

Hypercalcemia

Answer 6

> 10.2
Cause: malignant neoplastic dx, hyperparathroidism, prolonged immobilization, excessive intake, excessive intake of calcium carbonate antacids
S/S: lack of coordination, anorexia, n/v, confusion, decreased LOC, personality changes, dysrhythmias, heart block and cardiac arrest
Management: IV admin of 0.45% NaCl or 0.9% NaCl, encourage fluids, lasix, calcitonin to decrease Ca level, prevent kidney stones, encourage ambulation

Question 7

Hypomangesemia

Answer 7

Causes: diarrhea (lots of Mg in intestines normally), alfoholism.
S/S: think NOT Sedated. Ms tone: rigid tight, seizures, stridor/laryngospasm, +Chvostek, +Trousseau, DTR increase, swallowing issues, mind issue
CRITICAL VALUE

Question 8

Hypermagnesemia

Answer 8

> 2.3 mEq/L
Cause: renal failure, excessive magnesium admin
S/S: THINK SOMEONE SEDATED. Mag Depresses the CNS, depress cardiac impulse transmission, cardiac arrest, facial flushing, ms weakness, absent deep tendon reflexes, paralysis, shallow respirations
Management: discontinue oral and IV Mag. Emergency: 1) support ventilation and 2) IV calcium gluconate, hemodialysis, monitor reflexes, monitor cardiac rhythm have calcium preparations available to antagonize cardiac depressant
CRITICAL >3

Question 9

Calcium Normal Range

Answer 9

Total Ca: 8.6-10.2 mg/dL
Ionized serum Ca level: 4.5-5.2
Calcium is regulated by the parathyroid hormone and vitamin D which facilitate reabsorption of Ca from bone

Question 10

Hypocalcemia

Answer 10

Causes: hypoprathyroidism, radical neck, throidectomy
(S/S: think NOT Sedated. Ms tone: rigid tight, seizures, stridor/laryngospasm, +Chvostek, +Trousseau, DTR increase, swallowing issues, mind issues)

Question 11

Hypercalcemia

Answer 11

> 10.2
Cause: malignant neoplastic dx, hyperparathroidism, prolonged immobilization, excessive intake, excessive intake of calcium carbonate antacids
S/S: lack of coordination, anorexia, n/v, confusion, decreased LOC, personality changes, dysrhythmias, heart block and cardiac arrest
Management: IV admin of 0.45% NaCl or 0.9% naCl, encourage fluids, lasix, calcitonin to decrease Ca level, prevent kidney stones, encourage ambulation

Question 12

Magnesium

Answer 12

1.3-2.3 mEq/L

Question 13

Hypomangesemia

Answer 13

CRITICAL:

Question 14

Hypermagnesemia

Answer 14

> 2.3 mEq/L
Cause: renal failure, excessive magnesium admin
S/S: Depress the CNS, depress cardiac impulse transmission, cardiac arrest, facial flushing, ms weakness, absent deep tendon reflexes, paralysis, shallow respirations
Management: discontinue oral and IV Mag. Emergency: 1) support ventilation and 2) IV calcium gluconate, hemodialysis, monitor reflexes, monitor cardiac rhythm have calcium preparations available to antagonize cardiac depressant
CRITICAL: >3

Question 15

RBC

Answer 15

Adult: 4.2-6.2

Man: 4.6 -6.2 million/mm3
Women: 4.2-5.4 million/mm3
Child: 3.2 -5.2 million/mm3

Question 16

WBC

Answer 16

Adult: 5,000-10,000/mm3
Child: 5,000-13,000/mm3

Question 17

Hemoglobin

Answer 17

12-18 g/dL

Question 18

Hematocrit

Answer 18

35-52%

Men: 42-52% and Women: 35%-47% and Children: 35-45%

Question 19

Bleeding Time

Answer 19

1.5-9.5 minutes

Question 20

PTT

Answer 20

20-39 sec
Lower limit of normal: 20-24 sec
Upper limit of normal: 32-39 sec

Question 21

Platelet count

thrombocyte count

Answer 21

150,000-450,000/mm3

Question 22

PT

monitors effect of Coumadin therapy, detects coagulation disorders

Answer 22

9.5-12 sec

Question 23

INR

Answer 23

1.0
(2-3 for therapy in a fib, DVT, and PE)
(2.5-3.5 for therapy in prosthetic heart valves)

Question 24

Sedimentation Rate

ESR

Answer 24

Man less than 50 yrs

Question 25

Total Cholesterol

Answer 25

150-200 mg/dL

Question 26

LDL

Answer 26

Less than 160 mg/dL if no CAD and less than 2 risk factors Less than 130 mg/dL if no CAD and 2 or more risk factors Less than 100 mg/dL if CAD present

Question 27

HDL

Answer 27

Men 35-70 | Women 35-85

Question 28

Creatinine

Answer 28

Adult 0.7-1.4 mg/dL Child 0.4 -1.2 Infant 0.3-0.6

Question 29

Alkaline phosphatase

Answer 29

Adult 50-120 | Infant and adolescent up to 104

Question 30

Creatine kinase (CK)

Answer 30

MM bands present = skeletal ms damage | MB bands present = heart ms damage

Question 31

Serum albumin

Answer 31

3.5-5.5 g/dL

Question 32

BUN

Answer 32

10-20 mg/dL

Question 33

Triglycerides

Answer 33

100-200 mg/dL

Question 34

``` Alanine aminotransferase (ALT) Aspartate aminotransferase ```

Answer 34

10-40 units

Question 35

Lithium level

Answer 35

0.6 -1.2 meq/L

Question 36

Ammonia

Answer 36

10-80

Question 37

Phosphorous/Phosphate

Answer 37

3.0 - 4.5