Electrolyte Imbalances Chart

Electrolyte Imbalances Chart Electrolyte Imbalance Hypernatremia Signs and Symptoms Early symptoms may include a strong feeling of thirst, weakness, nausea, and loss of appetite. Severe symptoms include confusion, muscle twitching, and bleeding in or around the brain. >145 mmol/L - Clinical Hyponatremia Nausea and vomiting, Headache, Confusion., Lethargy, drowsiness and fatigue, Restlessness and irritability, Muscle weakness, spasms or cramps, Seizures, Coma. Clinical- below 135 mEq/L Electrolyte Imbalance Signs and Symptoms Causes Treatment High Concentration of Sodium in blood reducing the sodium concentration more slowly Low volume hypernatremia can occur from sweating, vomiting, diarrhea, diuretic medication, or kidney disease ½ NS if unable to tolerate oral water Nursing Consideration/ Interventions Due to the possibility of mental status changes, initiate and maintain appropriate safety measures. Monitor intake and output and assess the patient for subtle changes in mental status. Monitor serum sodium levels, hematocrit, and hemoglobin High volume hypernatremia can be due to hyperaldosteronism, excessive administration of intravenous hypertonic Saline or sodium bicarbonate, or rarely from eating too much salt profuse diaphoresis, draining wounds, excessive diarrhea or vomiting, trauma with significant blood loss, low sodium intake, hormonal changes associated with Addison disease or hypothyroidism, and overuse of thiazide diuretics Causes replace the lost sodium Oral sodium replacement IV LR Tolvaptan is an oral medication used to treat clinically significant hypervolemic and euvolemic hyponatremia Treatment Keep in mind that misuse of hypertonic saline can be extremely dangerous, so it should be administered cautiously. A possible result of correcting hyponatremia too rapidly is osmotic demyelination syndrome, which involves destruction of the myelin sheath of axons in the brain stem Nursing Consideration/ Interventions 1 Hyperkalemia tiredness or weakness, a feeling of numbness or tingling, nausea or vomiting, trouble breathing, chest pain, palpitations or irregular heartbeats (arrhythmia) Hypokalemia Weakness and Fatigue, Muscle Cramps and Spasms. Muscle cramps are sudden, uncontrolled contractions of the muscles, Digestive Problems, Heart Palpitations, Muscle Aches and Stiffness, Tingling and Numbness, Breathing Difficulties, Mood Changes. Clinical - below 3.5 mEq/L Electrolyte Imbalance Signs and Symptoms It may result from excessive intake of potassium and potassiumcontaining substances, impaired elimination of potassium, altered distribution shift from the intracellular to the extracellular spaces, or cellular injury (Compartment Syndrome) Acidosis Clinical - >5.0 mmol/L aldosterone helps regulate potassium levels K+ Source Removal ECF-to-ICF Shift The first treatment to shift potassium intracellularly involves intravenous administration of calcium salts Cellular uptake of potassium may be induced through use of the buffer sodium bicarbonate (NaHCO3), especially if the patient is acidotic Diarrhea, vomiting, diaphoresis, laxative or diuretic overuse, gastric suctioning, or alkalosis, the body compensates by shifting potassium from the intracellular space. Focus on restoring a normal potassium level in the body while treating the underlying cause of the deficiency and monitoring for potential complications Patients are placed on a high potassium diet Slow IV infusion – monitor ECG closely metabolic alkalosis Causes Treatment Nursing care for patients with hyperkalemia is multi-focused. Because potassium affects the functioning of all the body systems, it is important for the nurse to recognize abnormalities that may occur. Early identification of signs and symptoms of hyperkalemia is important for the nurse caring for the patient with hyperkalemia. A thorough head-to-toe nursing assessment is critical for patients diagnosed with hyperkalemia to determine any physiological changes in function and to alert the nurse to subtle changes that may indicate a rise in the serum potassium level Focus on the cardiac, neuromuscular, GI, and urinary systems, as these are the ones most affected by a potassium imbalance. ECG for flattened T waves, depressed ST segments, U waves, and dysrhythmia diminished or absent deep tendon reflexes and myalgias monitor intake and output. Nursing Consideration/ Interventions 2 Hypermagnesemia Nausea, vomiting, neurological impairment, abnormally low blood pressure (hypotension), flushing, headache. Clinical - above 2.5 mg/dL Hypomagnesaemia twitches, particularly in the facial muscles, weakness and exhaustion, nausea and vomiting, personality changes. (AMS), tremors, very pronounced reflexes, constipation. Clinical - less than 1.5 mg/dL It's most likely to occur in patients with renal failure or renal insufficiency who have a glomerular filtration rate (GFR) of less than 30 mL/minute/1.73 m2. Other causes include excessive use of magnesium-containing laxatives or antacids, Addison disease (adrenal insufficiency), and overcorrection of hypomagnesemia hypomagnesemia is most often associated with conditions that limit dietary magnesium intake (for example, malnutrition), impair intestinal absorption of magnesium (for example, diarrhea), or increase renal losses of magnesium Chronic alcohol abuse Electrolyte Signs and Symptoms Causes If renal function is impaired, however, the patient may require peritoneal dialysis or hemodialysis. To treat severe symptoms, the healthcare provider may prescribe I.V. calcium, which acts as a magnesium antagonist Preventing hypermagnesemia is the first line of defense. Avoid giving magnesium-containing medications to patients with renal failure, and carefully monitor patients receiving I.V. magnesium for any reason treated with oral magnesium supplements. Encourage the patient to consume magnesium-rich food sources, such as green vegetables, nuts, legumes, bananas, and oranges. The underlying cause of hypomagnesemia needs to be identified and appropriately treated, along with any other accompanying electrolyte imbalances serious signs and symptoms such as ventricular dysrhythmias may require I.V. magnesium sulfate given slowly with careful monitoring Treatment Instruct the patient/family to call for assistance before the patient gets up to ambulate from a lying or sitting position. Before discharge, educate the patient regarding the proper use of laxatives and antacids containing magnesium magnesium administration can cause a prolonged PR interval and widening of the QRS complex Nursing Consideration/ 3 Imbalance Hypercalcemia Interventions Loss of appetite, Nausea and vomiting, Constipation and abdominal pain, Increased thirst and frequent urination, Fatigue, weakness, and muscle pain, Confusion, disorientation, and difficulty thinking, Headaches, Depression. Clinical >10.0 mg/dL “The body is too WEAK” Weakness of muscles (profound) EKG changes shortened QT interval (most common) and prolonged PR interval Hypocalcemia numbness and/or tingling of the hands, feet, or lips, muscle cramps, muscle spasms, seizures, facial twitching, muscle weakness, lightheadedness, and slow heartbeat. Clinical - <8.6 mg/dL Decreases Contractility (ionotropic) Electrolyte Imbalance Signs and Symptoms Increased intake of calcium Hyperparathyroidism Glucocorticoids usage Hyperthyroidism Lithium usage (Bipolar) Absent reflexes, absent minded (disorientated), abdominal distention from constipation Kidney Stone formation Low parathyroid hormone Oral intake inadequate Wound drainage Celiac’s & Crohn’s Disease Acute Pancreatitis Low Vitamin D levels Chronic kidney issues Causes Administer calcium reabsorption inhibitors: Calcitonin, Bisphosphonates, prostaglandin synthesis inhibitors (ASA, NSAIDS) Keep patient hydrated (decrease chance of renal stone formation) Keep patient safe from falls or injury Monitor cardiac, GI, renal, neuro status Assess for complaints of flank or abdominal pain & strain urine to look for stone formation Decrease calcium rich foods and intake of calcium-preserving drugs like thiazides, supplements, Vitamin D Administer IV calcium as ordered If phosphorus level is high (remember phosphorus and calcium do the opposite) the doctor may order aluminum hydroxide antacids (tums) Safety (prevent falls because patient is at risk for bone fractures, seizures precautions, and watch for laryngeal spasms) Treatment Nursing Consideration/ Interventions 4 Hyperphosphatemia numbness and/or tingling of the hands, feet, or lips, muscle cramps, muscle spasms, seizures, facial twitching, muscle weakness, lightheadedness, and slow heartbeat. Clinical - >4.5 mg/dL phosphate containing laxatives or enemas Hypoparathyroidism Overuse of Vitamin D Syndrome of Tumor Lysis rHabdomyolysis Crush Injuries Restrict foods high is phosphate ***eat, poultry, fish, dairy, nuts, sodas, oatmeal Prepare patient for dialysis if patient in renal failure **Administer phosphate-binding drugs (PhosLo) which works on the GI system and causes phosphorus to be excreted through the stool. *** NCLEX: Give with a meals or right after eating meal Hypophosphatemia Muscle dysfunction and weakness – This occurs in major muscles, but also may manifest as: diplopia, low cardiac output, dysphagia, and respiratory depression due to respiratory muscle weakness. White blood cell dysfunction, causing worsening of infections. instability of cell membranes due to low adenosine triphosphate (ATP) levels aluminum hydroxidebased or magnesiumbased antacids cause Hyperparathyroidism Oncogenic osteomalacia Syndrome of Refeeding Pulmonary issues such as respiratory alkalosis Thermal Burns Electrolyte imbalances: if phosphate levels less than 1mg/dL, the doctor may order IV phosphorous which affects calcium levels causing hypocalcemia or increase phosphate levels Administer oral phosphorus with Vitamin-D supplement (remember vitamin-d helps with absorbing phosphate) Ensure patient safety due to risk of bone fractures If patient is receiving TPN watch for patient complaints of muscle pain or weakness Clinical - < 2.5 mg/dL 5