Electrolytes Imbalances

8/10/2019 Electrolytes Imbalances

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I. POTASSIUM IMBALANCES

main intracellular ion; involved in cardiac rhythm, nerve transmission (normal level 3.55.0 mEq/ L)

Hypokalemia (< 3.5 mEq/ L)

Causes:

a. Vomiting

b. Gastric suction

c. Prolonged diarrhea

d. Diuretics and steroidse. Inadequate intake

Signs and symptoms:

a. Anorexia, nausea, vomiting

b. Weak peripheral pulses

c. Muscle weakness, paresthesias; decreased deep tendon

reflexes

d. Impaired urine concentration

e. Ventricular dysrhythmias

f. Potential for digitalis toxicity

g. Shallow respirations

Nursing management:

a. Administration of oral potassium supplementsdilute

in juice and give with meals to avoid gastric irritation

b. Increase dietary intakeraisins, bananas, apricots,

oranges, beans, potatoes, carrots, celery

c. IV supplements2040 mEq/ L usual concentration;

cannot give concentration greater than 1 mEq/ 10mL into

peripheral IV, or without cardiac monitor; do not exceed

20 mEq/ h infusion rate; stop solution immediately if

burning occurs

d. Assess renal function prior to administratione. Risk for digitalis toxicity

Hyperkalemia (> 5.0 mEq/ L)

Causes:

a. Renal failure

b. Use of potassium supplements

c. Burns

d. Crushing injuriese. Severe infection

f. Potassium-sparing diuretics

g. ACE inhibitors

Signs and symptoms

a. EKG changespeaked T waves, wide QRS complexes

b. Dysrhythmias, ventricular fibrillation, heart block

c. Cardiac arrest

d. Muscle twitching and weakness

e. Numbness in hands and feet and around mouth

f. Nausea

g. Diarrhea

Nursing management

a. Restrict dietary potassium and potassium-containing

medications or IV solutions

b. Sodium polystyrene sulfonate (Kayexalate)cation-

exchange resin (causes diarrhea)

1) Orallydilute to make more palatable

2) Rectallygive in conjunction with sorbitol to avoid

fecal impaction

c. In emergency situation

1) Calcium gluconate given IV2) Sodium bicarbonate given IV

d. IV administration of regular insulin and dextrose shifts

potassium into the cells

e. Peritoneal or hemodialysis f. Diuretics


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II. SODIUM IMBALANCES

main extracellular ion; responsible for water balance (normal: 135145 mEq/ L)

Hyponatremia (< 135 mEq/ L)

Causes:

a. Vomiting

b. Diuretics

c. Excessive administration of dextrose and water IVs

d. Burns, wound drainagee. Excessive water intake

f. Syndrome of inappropriate antidiuretic hormone

secretion (SIADH)

g. Elderlykidneys unable to excrete free water

Signs and symptoms:

a. Nausea

b. Muscle cramps

c. Confusion

d. Muscular twitching, coma

e. Seizures

f. Headache

g. Delirium in older adults

Nursing management:

a. Oral administration of sodium-rich foodsbeef broth,

tomato juice

b. IV lactated Ringers or high concentrations of NaCl

(0.9%)

c. Water restriction (safer method)

d. I and O

e. Daily weight

Hypernatremia (> 145 mEq/ L)

Causes:

a. Hypertonic tube feedings without water supplements

b. Hyperventilation

c. Diabetes insipidus

d. Ingestion of OTC drugs such as Alka-Seltzere. Inhaling large amounts of saltwater (near drowning)

f. Inadequate water ingestion

Signs and symptoms:

a. Elevated temperature

b. Weakness

c. Disorientation

d. Irritability and restlessness

e. Thirst

f. Dry, swollen tongue

g. Sticky mucous membranes

h. Postural hypotension with ECF Hypertension with

normal or ECF

i. Tachycardia

j. Elderlymental status changes, coma

Nursing management:

a. IV administration of hypotonic solution0.3% NaCl or

0.45% NaCl; 5% dextrose in water

b. Offer fluids at regular intervals

c. Decrease sodium in diet

d. Daily weight


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III. CALCIUM IMBALANCES

need for blood clotting, skeletal muscle contraction (normal ionized serum calcium level: 4.55.2 mg/ dL;

normal total serum calcium level: 8.510.5 mg/ dL);regulated by the parathyroid hormone and vitamin D,

which facilitates reabsorption of calcium from bone and enhances reabsorption from the GI tract

Hypocalcemia (< 4.5 mg/ dL [ionized serum calcium] or 5.2 mg/ dL [ionized serum calcium] or >

10.5 mg/ dL [total serum calcium])

Causes:

a. Malignant neoplastic diseases

b. Hyperparathyroidism

c. Prolonged immobilization

d. Excessive intake

e. Immobility

f. Excessive intake of calcium carbonate antacids

Signs and symptoms:

a. Lack of coordination

b. Anorexia, nausea, and vomiting

c. Confusion, decreased level of consciousness

d. Personality changes

e. Dysrhythmias, heart block, cardiac arrest

Nursing management:

a. IV administration of 0.45% NaCl or 0.9% NaCl

b. Encourage fluids

c. Lasix

d. Calcitonindecreases calcium level

e. Mobilizing the patient

f. Dietary calcium restriction

g. Prevent development of renal calculi

1) Increase fluid intake

2) Maintain acidic urine3) Prevent urinary tract infection

h. Injury prevention

i. Limit intake of calcium carbonate antacids

j. Surgical intervention may be indicated in

hyperparathyroidism (cause of hypercalcemia)

1) Preoperativelydirected toward preventing

dangerously high serum calcium levels

2) Postoperatively

a) Observe for signs of hypocalcemia (reverse of

preop)

b) Due to calcium drop postop, large quantities of

calcium salts may be required

c) Encourage early ambulation to aid in

recalcification of bones


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IV. MAGNESIUM IMBALANCE

interdependent with calcium (normal: 1.53.0 mEq/ L)

Hypomagnesemia (< 1.5 mEq/ L)

Causes:

a. Alcoholism

b. GI suction

c. Diarrhea

d. Intestinal fistulase. Poorly controlled diabetes mellitus

f. Malabsorption syndrome

Signs and symptoms:

a. Increased neuromuscular irritability

b. Tremors

c. Tetany

d. Hyperactive deep tendon reflexes

e. Seizures

f. Dysrhythmias especially if hypokalemia present

g. Disorientation

h. Confusion

Nursing management:

a. Increased intake of dietary Mggreen vegetables, nuts,

bananas, oranges, peanut butter, chocolate

b. Parenteral administration of supplementsmagnesium

sulfate

1) Monitor cardiac rhythm and reflexes to detect

depressive effects of magnesium

2) Keep self-inflating breathing bag, airways, and

oxygen at bedside in case of respiratory emergency

3) Calcium preparations may be given to counteractthe potential danger of myocardial dysfunction that

may result from magnesium intoxication secondary to

rapid infusions

c. Orallong-term maintenance with oral magnesium

d. IVassess renal function

e. Monitor for digitalis toxicity

f. Seizure precautions

g. Safety measures for confusion

h. Test ability to swallow before PO fluids/ food because of

dysphagia

Hypermagnesemia (> 2.5 mEq/ L)potent vasodilator

Causes:

a. Renal failure

b. Excessive magnesium administration (antacids,

cathartics)

Signs and symptoms:

a. Depresses the CNS

b. Depresses cardiac impulse transmission

c. Cardiac arrest

d. Facial flushing

e. Muscle weakness

f. Absent deep tendon reflexes

g. Paralysis

h. Shallow respirations

Nursing management:

a. Discontinue oral and IV Mg

b. Emergency

1) Support ventilation

2) IV calcium gluconate

c. Hemodialysis

d. Monitor reflexes

e. Teach regarding over-the-counter drugs containing Mg

f. Monitor respiratory status

g. Monitor cardiac rhythm; have calcium preparations

available to antagonize cardiac depressant

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Electrolytes Imbalances