ELECTROLYTES

SODIUM (Na+)
- Normal: 135-145 mEq/L
- Functions: Maintain osmotic pressure
Transmit nerve impulses
- Changes in Na+ balance = related to fluid balance

Hyponatremia:
D/t loss of Na+ or rise in H 2O in body
Causes: Excessive H 2O intake
Diuretics (loss of Na+ through urine)
Excessive sweating
CKD (dilutional hyponatremia)
Symptoms: Muscle cramps
Weakness
Headache
Nursing interventions: H 2O gain = water restriction + diuretic
Na+ loss: Hypertonic solution

Hypernatremia:
D/t H2O loss or excess in NaCl intake (dietary)
Causes: Dehydration from insensible water loss loose water from bloodstream [Na+]
increases and pulls water from ICF into ECF/blood.
Hypovolemia
Impaired kidney function
Increase intake of dietary Na+
Diabetes (glucose pulls water and is excreted)
Symptoms: Thirst
Muscle irritability/arrhythmia
Edema
Hypertension
Nursing interventions: Treat underlying cause (fluid loss (hypotonic solution) /Na+ retention)
Diuretics (Lasix/K+ sparing)
Na+ restriction diet

- Assessments: Serum electrolytes

I&O
Cardiovascular : Hyper/hypotension, arrythmia, change in pulse characteristic
Respiratory : pulmonary edema (hypervolemia)
POTASSIUM (K+)
- Normal: 3.5-5 mmol/L
- Functions: Helps transmit nerve impulses
Assists in skeletal and muscle contractions
- Changes in K+ can affect neuromuscular and cardiac functioning

Hypokalemia:
D/t loss of or poor intake of K+
Causes: Diuretics (Lasix)
Inadequate K+ intake
Increased insulin
Increased epinephrine (stimulates beta receptors)
Alkalosis
Diarrhea/vomiting
Symptoms: Palpitations
Ventricular dysrrhythmias
Bradycardia/Tachycardia
Weakness
Muscle cramps
Nursing interventions: PO/IV KCl (bananas, leafy greens)

Hyperkalemia:
D/t decreased K+ excretion or high intake
Causes: Renal failure
Too rapid KCl IV infusion
ACE inhibitors
Acidosis
K+ sparing diuretics
Symptoms: Muscle weakness
Fatigue
Dysrrhythmias
Nursing interventions: Insulin drip + D10W
Ventolin/Epinephrine (beta agonist)
Calcium gluconate (to regulate arrythmias)
IV sodium bicarbonate (if acidotic)
CHLORIDE (CL-)
- Normal: 98-107 mmol/L
- Functions: Helps maintain acid-base balance
Helps maintain osmotic pressure and water balance
- Changes in Cl- are in direct proportion with changes in Na+

Hypochloremia:
D/t decreased Cl- intake/absorption or increased Cl- losses
Causes: Vomiting
Gastric Suction
Diarhea
Diuretics
Symptoms: Dehydration
Muscle spasms/weakness
Shallow, depressed breathing

Hyperchloremia:
D/t increase in Cl- intake/absorption or Cl- retention
Causes: Increased NaCl intake
Dehydration
Renal failure
Certain drugs (ex. cortisone)
Symptoms: Dehydration
High blood sugar
Kussmauls respirations
Weakness
MAGNESIUM (Mg2+)
- Normal: 1.8-3.0 mg/dL or 0.8-1.2 mmol/L or 1.5-2.1 mEq/L
- Function: Influences vasodilation + contractibility of cardiac muscle
Helps Na+ and K= cross cell membrane

Hypomagnesemia:
D/t chronic problem with decreased Mg2+ intake over time
Causes: Chronic malnutrition
Diarrhea
Diuretics
Diabetes
Refeeding syndrome
Symptoms: Weakness
Vertigo
Muscle twitching
Tachycardia
Nursing Interventions: Oral/diet supplement (leafy greens, fish, yogourt)

Hypermagnesemia:
D/t increase in Mg2+ intake
Causes: Kidney failure
IV MgSO4
MOM (antacid/laxative)
Symptoms: N&V
Hypotension
Lethargy
Decreased deep tendon reflex
Nursing Interventions: IV Ca+Cl-
Increase fluids
CALCIUM (Ca+)

- Normal: 2.25-2.74 mmol/L

- Functions: Transmission of nerve impulses
Muscle contractility
Formation of teeth + bone

Hypocalcemia:
Causes: Vitamin D deficiency
CKD
Hyperphosphatemia
Symptoms: Hyperreflexia
Trousseaus sign
Chvosteks sign
Nursing interventions: PO Ca+/IV Calcium gluconate
Vitamin D supplements
Careful post-op monitoring of thyroidectomy pts (keep Ca+ gluconate at
bedside)

Hypercalcemia:
Causes: Excess intake
Vit D overdose
Symptoms: Lethargy
Bone pain (coming out of bone)
Confusion
Kidney stones
Nursing interventions: Ca+ restriction
Lasix (eliminate through urine)
Isotonic solution/ PO fluids (to promote excretion)
Calcitonin (move Ca+ into bones)
PHOSPHATE (PO4)

- Normal: 0.97-1.45
- Functions: Muscle contraction
RBC & nervous system

Hypophosphatemia:
Causes: PO4 binding antacid
Malnutrition
Symptoms: Muscle weakness
LOC
Nursing interventions: Increase PO4 (milk, meat (animal protein), whole grains, beans)
Feeds
IV NaPO4

Hyperphosphatemia:
Causes: CKD
Phosphate laxatives
Manifestations: hypocalcemia (manifestations)
Nursing interventions: Decrease phosphate intake
Correct Ca+ imbalance