High Acuity > Electrolytes > Flashcards

Electrolytes Flashcards

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1
Q

Define electrolyte

A

Electrically charged micro-solutes required for enzyme activities, muscle contraction, and metabolism

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2
Q

Extracellular electrolytes

A
  • Sodium (Na+)
  • Chloride (Cl-)
  • Calcium (Ca++)
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3
Q

Intracellular electrolytes

A
  • Potassium (K)
  • Magnesium (Mg)
  • Phosphorus/Phosphate (PO4)
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4
Q

Sodium Range

A

135-145 mEq/L

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5
Q

Normal functions of sodium

A
  1. Water retention/excretion (blood pressure and volume)
  2. Nerve/skeletal muscle impulse transmission (Active Transport - Na/K pump)
  3. pH balance: combines with chloride or bicarb to increase/decrease pH
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6
Q

What causes hypernatremia?

A

Net loss of body water relative to sodium

  1. excessive intake
  2. dehydration/fluid loss
  3. diuretic management of HF
  4. SIADH
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7
Q

Signs and Symptoms of Hypernatremia

A

Big + Bloated (FRIED SSHALTTT)

Flushed skin
Restless
Increased BP/Fluid Retention/tachy
Edema
Decreased urine output

Seizure
Sick (N/V)
Hypertension
Agitation and Confusion
Low grade fever
Thirst
Twitching
Too much reflexes

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8
Q

What causes hyponatremia?

A

Hypovolemic: decreased sodium and water
- increased GI loss (n/v, diarrhea)
- increased skin loss
- increased renal loss
> signs and symptoms of dehydration

Hypervolemic: increased water compared to sodium
- dilution of sodium
- edema
- ascites
- renal diseases

Overall
- sweating
- diuretics
- lack of dietary intake
- heart failure`

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9
Q

Signs and symptoms of hyponatremia

A

Depressed and Deflated (SALTTT LOSS)

Stupor/Coma
Anorexia (N/V)
Lethargy (weakness/fatigue)
Tachy
Twitch
Tremor

Limp Muscles
Orthostatic hypotension
Seizures
Stomach cramping (hyperactive bowel)

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10
Q

Action against sodium imbalances

A
  1. Monitor for cerebral changes (cerebral edema with hyponatremia)
  2. Monitor for muscle weakness: decrease strength of resp muscles (hyponatremia)
  3. Avoid increasing levels too quickly as they can cause CNS irritation, pulmonary edema
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11
Q

Treatment of hyponatremia

A
  • Sodium in tube feeds
  • Hypertonic (2-3% NS) Solution
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12
Q

Treatment of hypernatremia

A

o Fluids to dilute
o Furosemide

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13
Q

Chloride normal value

A

95-105

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14
Q

Normal functions of chloride

A
  1. Works with sodium to regulate fluids and osmolarity of ECF
  2. Works with magnesium to maintain nerve transmission and muscle contraction
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15
Q

What causes hyperchloridemia?

A

Follows sodium, so relatively the same

  • gain of chloride
  • decreased excretion
  • fluid shifts (water loss exceeds na/cl loss)
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16
Q

Signs and symptoms of hyperchloridemia?

A

Similar to that of hypernatremia

  • hypertension
  • tachycardia
  • agitation/headache/LOC changes
  • nausea
  • weakness
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17
Q

What causes hypochloridemia?

A

Follows sodium so relatively the same

  • loss of chloride
  • inadequate intake/absorption
  • fluid shifts (loss)
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18
Q

Signs and symptoms of hypochloridemia

A

Similar to hyponatremia

  • hypotension
  • tachycardia
  • confusion/disorientation
  • muscle cramps
  • shallow resps/bradypnea
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19
Q

Chloride imbalance management

A
  1. imbalances never alone - look at other electrolyes
  2. treat underlying cause - usually fluid status
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20
Q

What drugs increase and decrease chloride?

A
  • Drugs that increase Cl: ammonium chloride/KCl, NaCl
  • Drugs that decrease Cl: RL, sodium bicarb
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21
Q

Normal calcium value

A

2.3-2.8

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22
Q

Normal Function of Calcium

A

the 3 B’s!!

Bone integrity
Blood clotting
Beats (heart/neuromuscular contraction)

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23
Q

What regulates calcium levels?

A

PTH, calcitonin, calcitril

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24
Q

What 3 systems maintain serum calcium levels?

A
  • kidneys (excretion)
  • GI tract (absorption)
  • Bones (mobilization from bone to blood)
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25
Calcium/Phosphorous relationships
Inverse
26
Calcium/Magnesium relationships
direct work together to build bone
27
Result of acute hypocalcemia
the rapid onset of acute life-threatening conditions such as seizures or respiratory distress because of neuromuscular irritability
28
Causes of hypercalcemia
- overactive PTH (stimulate osteoclast activity therefore increasing calcium release from bone) - increased absorption - increased available calcium
29
Signs and symptoms of hypercalcemia
Slow and Swollen - Moans, Groans, and Stones (BACK ME) Bone Pain + fractures (calcium leaving) Arrhythmias Constipation + Cog changes Kidney Stones Muscle Weakness/Decreased DTR Excess urination
30
Signs of hypocalcemia
Irritable and At Risk Trousseaus and Chvosteks Numbness/Tingling/cramps Fracture risk Bleed risk Dysrhythmias risk
31
Management of calcium imbalances
1. Assess chvostek and trousseaus signs 2. Mobilzation for hypo to enhance transfer from bone to blood 3. Treat cause (bone mets v nutrition) 4. Replace if low (IV calcium chloride) 5. Monitor ECG (pacemaker cells and contraction) 6. Dietary management
32
Normal potassium value
3.5-5
33
Normal function of potassium
Major intracellular cation Keeps HEART and MUSCLE CONTRACTED Additionally - nerve impulse - carb metabolism
34
Excess potassium is excreted by the
Kidneys Therefore if damaged can cause hyper
35
Effect of diuretics on potassium
Enhance excretion and stop reabsorption
36
Potassium levels of patient with renal damage
can not excrete and often have high levels
37
What occurs in metabolic acidosis to potassium levels
potassium shifts from intracellular compartments to the extracellular space in exchange for hydrogen in an effort to maintain acid-base balance.
38
Causes of hyperkalemia
1. increased intake/supplements 2. renal damage decreasing excretion 3. fluid shifts/losses
39
Signs and symptoms of hyperkalemia
TIGHT + CONTRACTED <3 - ST elevation - peak T wave - wide QRS - vfib/asystole - bradycardia/hypotension GI - diarrhea - hyperactive bowel - cramps Neuromuscular - paralysis - increased DTR - weakness
40
Signs and symptoms of hypokalemia
LOW + SLOW <3 - flat t wave - ST depression - U wave - irregular pulse - cardiac arrest GI - decreased motility (constipation/distention) - decreased bowel sounds - paralytic ileus Neuromuscular - decreased DTR - cramps - flaccidity - resp arrest
41
Causes of hypokalemia
1. decreased intake 2. GI loss 3. urinary excretion 4. fluid shifts
42
What can occur in the danger zone of potassium
Lethal arrhythmias and resp arrest
43
What medication must you monitor potassium with and why?
Digoxin Hypokalemia increases the cardiac muscles sensitivity to the drug- can result in dig toxicity.
44
Management of potassium imbalances
* Assessments- cardiac specifically * Treat causes * If LOW give IV KCL- high risk drug; avoid potassium in renal patients or Oral- Slow K Solution, or KCL elixer * If HIGH K * Kayexalate: promotes uptake of potassium into bowels and excretes through stool * Insulin: forces potassium back into cells * Furosemide: forces renal loss/enhances excretion * IV sodium bicarb: gives potassium something to bind to * ventolin neb: forces back into cells * Monitor diet – avoid foods with potassium in them
45
Normal magnesium levels
1.5-2.5
46
Normal function of magnesium
Maintains law and order in muscles, mainly heart, uterus, and neuromuscular Required for calcium and vitD absorption
47
Causes of hypermagnesia
1. excessive intake 2. increased absorption 3. renal retention
48
Signs and symptoms of hypermagnesia
Calm and Quiet! <3 - heart block - wide QRD/prolonged PR - decreased HR/BP - decreased DTR/weakness - depressed shallow resps - hypoactive bowels - decreased LOC
49
Cause of hypomagnesia
- losses - inadequate intake - impaired absorption - fluid shifts
50
Signs and symptoms of hypomagnesia
Buck wild!!! <3 - torsades de point - vfib - increased HR Hyperreflexes/irritability - trousseaus and chvosteks - nystagmus - anorexia/N/V
51
Hypomagnesia ECG
Torsades, PVC, Vtach, V fib, cardiac arrest
52
Hypermagnesia ECG
complete heart block, brady, arrest
53
Normal phosphorous value
1.7-2.6
54
Normal function of phosphate
bone and teeth calcium regulation energy and nutrition
55
What causes hyperphosphatemia
§ PO4 gain § Increased absorption or retention § Fluid shifts
56
What causes hypophosphatemia
§ PO4 loss § Inadequate intake § Impaired absorption § Increased excretion § Fluid shifts § Refeeding syndrome Closely tied to malnutrition
57
Signs of hyperphosphatemia
Signs and Symptoms of HYPOcalcemia Irritable and at risk Trousseaus and Chvosteks Numbness/Tingling/cramps Fracture risk Bleed risk Dysrhythmias risk muscle cramping, weakness, tachycardia, diarrhea, nausea, abdominal cramping.
58
Signs of hypophosphatemia
Signs of HYPERcalcemia Tied with malnourished Slow and Swollen - Moans, Groans, and Stones (BACK ME) Bone Pain + fractures (calcium leaving) Arrhythmias Constipation + Cog changes Kidney Stones Muscle Weakness/Decreased DTR Excess urination weakness, numbness, tingling, pathologic fractures, diminished myocardial function, N&V, anorexia, disorientation, irritability, seizure, coma. Severe myocardial, respiratory, and nervous system dysfunction if severe imbalance.
59
Treatment of hypophosphatemia
IV NaPO4 or K2PO4; po phosphate effervescent
60
Treatment of hyperphosphatemia
diuretics, oral antacids
61
What can be given to increase PO4 absorption
Vit D
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