Lecture 6.1 - Electrolyte Imbalances Flashcards by Sydney Denney

Which demographics are most vulnerable to dehydration from vomiting?

Older adults, children, and infants

How well did you know this?

Not at all

Perfectly

What is the normal range for sodium in blood?

136-145 mEq/L

How well did you know this?

Not at all

Perfectly

What cation is most common in ECF?

Na makes up 90% of ECF, being the main factor in determining ECF volume

How well did you know this?

Not at all

Perfectly

changes in K effect the heart. What do changes in Na do?

Effect the brain

How well did you know this?

Not at all

Perfectly

What can cause hypernatremia? What can it lead to and how does the body protect from it?

–> Excessive intake
–> Diabetes insopidus
–> Renal failure
–> Cushing Syndrome

Causes hyperosmolarity leading to cellular dehydration
Protected with thirst centre in hypothalamus

How well did you know this?

Not at all

Perfectly

What are the manifestations for moderate and severe hypernatremia?

Moderate: Confusion, thirst, dry mucous membranes, low urinary output

Severe: HTN, tachycardia, flushed skin
–> Restlessness, agitation, confusion, seizures, coma
–> Hyper-reflexia, muscle twitching
Nausea, vomiting
–> Poor tissue turgor

How well did you know this?

Not at all

Perfectly

How do we correct hypernatremia?

Fluids, diuretics to increase sodium output
–> Monitor daily weights, neuro deterioration, fluid imbalance

How well did you know this?

Not at all

Perfectly

What are some nursing diagnoses associated with hypernatremia?

Electrolyte imbalance
Risk for injury: seizures

How well did you know this?

Not at all

Perfectly

What is the normal potassium level?

3.5-5.1 mmol/L

How well did you know this?

Not at all

Perfectly

What is the major ICF cation?

Potassium

How well did you know this?

Not at all

Perfectly

Sodium is necessary for:

Maintaining fluid levels and regulating blood fluids to prevent low blood pressure.
Helps muscles contract, and sends nerve impulses throughout the body

How well did you know this?

Not at all

Perfectly

Potassium is necessary for:

–> Transmission and conduction of nerve and muscle impulses
–> Cellular growth
–> Maintain cardiac rhythms (depolarizes and generates APs, low K is shown as a flat T wave in cardiac rhythm)
–> Regulates protein synthesis, and glucose storage and use.

How well did you know this?

Not at all

Perfectly

K administration should never exceed what? Why?

20 mEq/hr
–> Prevents hyperK + cardiac arrest
–> Burns when infusing

How well did you know this?

Not at all

Perfectly

What is the normal range for calcium? What is is necessary for?

2.10-2.75 mmol/L
–> Blood clotting
–> Muscle contraction (including myocardium)
–> Nerve function

How well did you know this?

Not at all

Perfectly

What is the normal serum range for magnesium?

0.65-1.05 mml/L

How well did you know this?

Not at all

Perfectly

What is the normal serum level for phosphorus? What does it do?

1.0-1.5 mmol/L
–> Activates vitamins and enzymes, forms ATP, and assists in cell growth and metabolism
–> Maintains acid-base balance
–> Maintains calcium homeostasis.

How well did you know this?

Not at all

Perfectly

What are the different kinds of fluid spacing?

First Spacing
–> Normal distribution of ICF and ECF

Second Spacing
–> Abnormal accumulation on interstitial fluid (edema)

Third Spacing
–> Fluid accumulation in a part of the body not easily exchanged with ECF and in transcellular space
–> Fluid fills cavity and compresses soft structures, resulting in ascites, pleural effusions, pericardiac effusion or tamponade

How well did you know this?

Not at all

Perfectly

We have to have a normal ____ before administering IV P-dye

Creatinine - verifies kidney function

How well did you know this?

Not at all

Perfectly

What is pOSM?

Serum osmolarity by weight

How well did you know this?

Not at all

Perfectly

What is an eGFR?

Creatinine clearance/24 hours to measure kidney function

How well did you know this?

Not at all

Perfectly

What does ACTH do?

Triggers the release of aldosterone –> Sodium reapsorption

How well did you know this?

Not at all

Perfectly

What does ADH do?

Signals for water reabsorption in the renal tubules/collecting ducts.

How well did you know this?

Not at all

Perfectly

What does renin do?

Signals for Ang I (+ ACE) –> Vasoconstriction and aldosterone

How well did you know this?

Not at all

Perfectly

What are some potential causes for hyponatremia?

Excessive loss through sweat, GI loss, or renal dysfunction.

Excessive H2O gain

How well did you know this?

Not at all

Perfectly

What are the manifestations of hyponatremia?

HypoTN Seizures, decreased muscle tone, twitching, tremors, weakness V&D, cramping, anorexia

How can hyponatremia be treated?

Hypertonic IVF and fluid restriction --> Consume salty food Monitor for neuro and BP changes

What might cause hyperkalemia?

Massive cell destruction - such an in traumatic injury, severe infection, burns or anything that shifts ICF to ECF Drugs: K-Sparing (Spironolactone, amiloride), ACE Inhibitors Impaired renal excretion - renal failure most common

What are the manifestations of hyperkalemia?

Oliguria, renal failure Addison's disease, brady, arrhythmias Cramping leg pain, abd cramps or dirrhea.

How is hyperkalemia treated?

Monitor: ECG Hold K intake, use loop diuretics to excrete it. Force K back into ECF with insulin or sodium bicarb Calcium gluconate can reverse membrane effects of elevated ECF K. Dialysis.

What are some causes of hypokalemia?

GI/renal losses Mg deficiency Metabolic alkalosis

Manifestations of hypokalemia

Cardiac arrest/arrhythmias Skeletal muscle weakness, oliguria Decreased GI motility and impaired regulation of arteriolar blood flow.

What treatment can be used for hypokalemia?

Diet - K rich foods K supplementation --> IV should not exceed 10-20 mEq/hr to prevent hyperK and CA, and to decrease pain

What can cause hypercalcemia?

Hyperparathyroidism (most common) Malignant bone disease (cancer) Vit D overdose Prolonged immobilization Excessive supplements/antacids

What are some manifestations of hypercalcemia?

Kidney stones, muscle weakness, decreased reflexes. Decreased memory + Fatigue Personality changes and disorientation

How can hypercalcemia be treated?

Calcitonin, loop diuretics, mobilization, dialysis. Oral fluids 3-4 liters a day or isotonic IV

What causes hypocalcemia?

Renal failure, hypothyroidism multiple blood transfusions Alkalosis

What are some manifestations of hypocalcemia?

Trousseau + Chvostek's sign Laryngeal stridor Tingling around the mouth or extremities Muscle numbness

How can hypocalcemia be treated?

Calcium (not IM) Diet rich in protein, calcium, vitamin D Anticipate tracheostomy

What is Trousseau's sign?

When a BP cuff is inflated 220-230 mmHg and the forearm and hand flex Indicative of hypocalcemia

What is Chvostek's Sign?

When tapping on the cheek results in muscle spasm Indicative of hypocalcemia

What are some causes of hypermagnemesia?

Increased intake w renal insufficiency + renal failure Adrenal insufficiency

What are some manifestations of hypermagnesemia?

Brady/hypo Impaired reflexes Somnolence Respiratory + cardiac arrest

How can hypermagnesemia be treated?

IV calcium gluconate/chloride Fluids to promote excretion

What can cause hypomagnesemia?

Chronic alcoholism Prolonged fasting + Prolonged TPN w/o supplementation GI loss + diuretics DKA

What are manifestations of hypomagnesemia?

Skeletal muscle weakness and hyperactive tendon reflexes. Painful contractions Numbness + tingling Decreased GI motility

What treatment can help hypomagnesemia?

Supplementation and diet: nuts, peanut butter, bananas Monitor vitals IV but must be under 1g/h

What rate must magnesium be administered IV?

1 g/h max

What might cause hyperphosphatemia?

Excessive intake or renal failure

What are the manifestations of hyperphophatemia?

Same as hypocalcemia --> Muscle cramps, tingling, numbness --> Joint and bone pain Rash and pruritis

How is hyperphosphatemia treated?

Diet low in phosphorus: --> Pasta, bread, rice --> Limited meat --> Dairy substitutes

What might cause hypophosphatemia?

Alcohol withdrawal Recovery from DKA + glucose administration Malabsorption syndrome + TPN

What are the manifestations of hypophosphatemia?

Decreased cardiac output, weak peripheral pulses Skeletal muscle weakness

How is hypophosphatemia treated?

Diet high in phosphorus: meats, fish, nuts, beans, dairy products Vit D supplements Oral or IV calcium Sodium phosphate

What electrolyte imbalances can be caused by renal failure?

HyperNa, HyperMg, Hyperphosphatemia HypoCa

What electrolyte imbalances can be caused by TPN?

Hypo magnesium and phosphate with malabsorption syndrome

Which electrolyte imbalances cause hyperreflexia?

Hyper: Na, Phosphate Hypo Mg, Hypo Ca results in trousseau and Chvostek

Which electrolyte imbalances cause muscle weakness?

Hypo: Na, K, Mg

What is the normal bicarb range?

22-29 mEq/L

What is the normal Hgb level?

120-180 g/L

What is the normal WBC?

4.5-11.0 x 10^9/L

ACE inhibitors can cause which electrolyte imbalance?

hyperkalemia

What is the most common cause of renal failure?

Hyperkalemia

Magnesium deficiency can cause which other electrolyte imbalance?

hypokalemia

Alkalosis can cause which electrolyte imbalance?

HypoK, HypoCa

Which drug can reverse membrane effects during hyperkalemia?

Calcium gluconate

Which drugs can force potassium from the ECF to ICF?

Insulin and sodium bicarbonate

Prolonged immobilization can lead to which electrolyte imbalance?

hyperCa

Multiple blood transfusions can lead to which electrolyte imbalance?

HypoCa --> Ca is necessary for clotting factors

Which electrolyte imbalances can lead to tingling around the mouth or extremities?

HypoCa, Hyperphosphatemia, and hypoMg

The symptoms of hyperphosphatemia look like what other imbalance?

Hypocalcemia

Laryngeal stridor can occur with which electrolyte imbalance?

Hypocalcemia --> Anticipate tracheostomy

Chronic alcoholism can lead to which electrolyte imbalance?

Hypomagnesemia

TPN without supplementation can lead to which deficiency?

Hypophosphatemia