Electrolyte Relationships

ELECTROLYTE RELATIONSHIPS SODIUM/POTASSIUM = INVERSE_ ↑ Na+ = ↓ K+ CALCIUM/PHOSPHATE = INVERSE ↑Ca+ = PO4 RSE CALCIUM/VITAMIN D = SIMILAR MAGNESIUM/CALCIUM = SIMILAR ↑Mg = ↑ Ca+ MAGNESIUM/POTASSIUM = SIMILAR ↓Mg = K+ MAGNESIUM/PHOSPHATE=INVERSE_ ↓Mg=↑PO4 INVERSE Both electrolytes will go in opposite directions Think FRATERNAL TWINS SIMILAR- Both electrolytes will go in the same direction THINK IDENTICAL TWINS VITAMIN D The "big sister" to calcium. She helps calcium be absorbed HYPERNATREMIA→ OVER 145 CAUSES > overproduction of Aldosterone >↑ Na intake (oral/IV) > GI Tube feedings > Hypertonic solutions in excess > corticosteroids=Na+ excretion decreases > Loss of fluids too much free salt Dehydrated, infection, diarrhea >Diabetes insipidus INTERVENTIONS 1. Restrict sodium intake 2. Patient safety (confured patient) CALL LIGHT 3. IV Isotonio or hypotonic solution (cells are valty and shrunken) GIVO SLOWLY = RISK for cerebral edema 4. Educate on DIET SIGNS + SYMPTOMS BIG AND BLOATE D > Flushed skin > Fever > Agitated, confused >ffivid Retention = EDEMA >↓ vrine output > Dry mouth+ skin -DIET-LIMIT > canned foods > Frozen dinner > Fried food > Tomato sauce SODIUM > cheese > salad dressing. > salty rice cakes > Pizza, hot dogs Chips, lunch meat RANGE: 135-145mEq/L GOAL MAINTAIN BP+ Blood Volume MAINTAIN fluid balance Regulated by Aldosterone HYPONATREMIA → UNDER 135 CAUSES NO Na > ↑Na+ excretion= Renal probleme. No ruction, vomiting, wweating, diuretics, DI & Aldosterone secretion) > Overload of fluids = DILUTED -CHF. Hypotonic fluids, Liver Failure > Na intake is insufficient Diet/NPO > ADH overvecretion = SIADH INTERVENTIONS 1. Watch HR, RR, GI, Renal, Neuro 2. Administer IV Hypertonio Fluid Hard on veins 3. Restrict Fluids/Divretios SIGNS + SYMPTOMS Risk Fluid overload 4. Antidiuretic Hormone antagonist (for SIADH) Declomycin Do not give with food! 5. Patients on Lithium watch drug levels 6. DIET Nat Lithium) WEAK AND SHAKEY > seizurer/stupor > Abdominal cramping >confusion/lethargic/trouble OTR concentrating > Lord of urine aid appetite >BP, Bowel rounds >Challow respirations = LATE Vign due to muscle weakness -DIET-ENCOURAGE >salty foods in moderation HYPERKALEMIA → OVER 5.0 > AGE Inhibitors (Retain K+) ? >Addisons > Spiriolactone > NOAIDE > Burns or trauma Aldosterone that > IV Fividr > Renal impairment (Kidney disease or disyer) (K exploders out of cells that are lysed) INTERVENTIONS > IV sodium bicarbonate > IV calcium givconate "givere the muscios down" > Albuterol > Furovermides/Hydrochlorothiazidu WATCH EKG > Οιαίφετε > vodium polycystrene sulfonate SIGNS + SYMPTOMS TIGHT CONTRAGTED > irregular heartbeat = VT elevation, peak T wave BP, HR, vevere Vfib! > Respiratory Fanure > Hурыгасtivе bowel sounds Diarrhea > Brain strain = confusion > B16 muscle weakness cramping, DTR tingling, burning, numbnes - DIET- No valt substitute No fruit No green leafy veggier POTASSIUM RANGE: 3.5-5.0 mmol/L GOAL: MANAGE heart murcio function MAINTAIN flind balance + BP REGULATED by kidneys CAUSES LIMIT- P-potatoes/pork 0-oranges T-tomatoes A-avocado -vtrawberries - spinach flch mushrooms + BANANASS HYPOKALEMIA → UNDER 3.5 > Dehydration Diuretics (Furosemide) Diarrhea/vomiting > Drains (NG Tubes) > vevere acid imbalance > HYPERaldosteronum >corticosteroids water retention insulin, albuterol pushes Kt in the cell INTERVENTIONS 1. Watch: EKG, respirations, 61. I 90's. BUN, creatinine 2. watch Mg+ levels K+ and Mg are bif's Melons SIGNS + SYMPTOMS LOW SLOW Irregular, thready puises BP HR, orthostatic hypotension PEEING ALOT! › Bowel sounds > DTR, flaccid paralysis, weak, leg cramps > confusion shallow respiration, diminished breath sounds EKG STregment, inverted T wave, prominent U wave 3 watch glucose, ca and Na+ Cat. Na+, K+ are inversesey related 4 give oral supplement WITH FOOD 5 2.5 potassium infusion ONLY IN SLOWLY > watch for infutration .HOLD Potassium wasting diuretics! why? + K+ causer DIGOXIN TOXICITY K+ sparing diuretics: >spirno actone aldactone dyazıde triamterine Maxide HYPOCALCEMIA-UNDER 9.0 Hypoparathyroidism Thyroidectomy Pantreatitis releases calcium soaps + calcitONIN "Puts a TON of calcium in the bone" Loop diuretios, laxatives, long term steroids. Phenytoin Phosphate enemas Phor = ca+ + Mg+ GI wounds •Chronic diseases celiac, crohns, CKD Phor, vitamin D, magnesium INTERVENTIONS 1. Give food high in calcium 2. caicium acetate (watch phos levers) SIGNS + SYMPTOMS WILD+CRAZY • Prolonged QT/ST (vevere: VTach) • Heart Failure Trousseau sign arm sparm with BP CUFF Chvostek sign = smile when touching temporal lobe viow clotting factors= bleeding Glrystem going crazy = diarrhea Laryngospasms, dyspnea ALOC, seizurer, confused Watch EKG's 3. IV calcium 4. Oral calcium with vitamin D 5. Magnesium Hydroxide CALCIUM RANGE:9-11 GOAL: affects bones, heart beats, and clotting factors JOB: stabilize neuron excitability CAUSES Encourage Dairy sardmes canned salmon Leafy greens Tofu Edamame Restrict HYPERCALCEMIA-OVER 11.0 SIGNS + SYMPTOMS Hyperparathyroidism Antacids with calcium (TUMS) •Malignant cancer cells • Low phosphate (Fraternal Twins) INTERVENTIONS 1. Loop diuretior 2. Monitor EKG + urine output 3. IV normal saline for kidney stoner 4. IV phosphate (Fraternal Twin) 5. calcium reabsorption inhibitors (calcitonin, Aspirin, NSAIDS) 10. Fall RISK 7 Last Resort= DIALYSIS 8. DIET SLOW+SWOLLEN HRRR BP Short QT, wide Twave muscle spasm SOB, weak respirations Hypoactive Gi = constipation Nausea, vomiting, ALÓC Renal calculi DTR, muscle excitability If severe muscle weaknets Bone pain excess calcium was taken from bone