NUR 3980 Electrolytes Practice Material

Sodium (Na+)
 135 – 145
 ECF
 Maintains BP

Hypernatremia
 ALWAYS dehydration
 ↑ Concentration
 ↑ Thirst (think increased ADH)
 NEURO (SALT)
o Seizures/Stupor
o Attitude changes (Irritable)
o Lethargy
o Trouble concentrating
 If ↓ Fluid → Hydrate
 If ↑ Salt → D5W
 Seizure/Fall precautions!!!
 Pt will be on low sodium/renal diet

Hyponatremia
 ↓ in concentration
o Diabetes insipidus
o Insensible loss (Vomiting, Diarrhea (with ↑fluid), wound drainage
o ↓ Osmolality
 NEURO (SALT)
o Seizures/Stupor
o Attitude changes (Irritable)
o Lethargy
o Trouble concentrating
 If ↑ Fluid → Diuretics/Fluid restriction
 If ↓ Salt → Increase oral intake
 Hyponatremia WITH hypovolemia = HYPERtonic fluid
o Cerebral edema in the ICU

Potassium (K+)
 3.5 – 5.5
 ICF
 Heart/Rhythm

****Hyperkalemia
 Impaired renal function (↓ excretion)
 Cell death
 ACE inhibitor
 EKG changes (↑ T-waves, ↓ QT intervals)
 Muscle cramps → Muscle arrest (Charlie horse)
 Diarrhea
 Diuretics/Kayexilate
 Insulin cocktail
 Renal diet (NO POT or Green leafy)

Hypokalemia

,  Diuretic use (↑ Excretion by kidneys)
 Diarrhea/laxative use (↓ absorption)
 Hypovolemia = Aldosterone (saves Na) = ↓ potassium
 GI suction
 EKG changes (U-waves, ↑QT)
 Muscle cramps (Charlie horse)
 KCl (Slow-use pump - diluted with NaCl)
 Check magnesium levels
 Furosemide is a potassium WASTING diuretic

Calcium
 8.5 – 10.5
 ECF
 Bone, Beats & Blood
 Phosphate is opposite

Hypercalcemia
 ALWAYS dehydration
 Hyperparathyroidism
 Immobility (↑ release of calcium by muscles)
 *Malignancy (Tumor lysis/Bone destruction)
 Fatigue/cardiac Dysrhythmias (Sedation)
 Renal stones – Flank pain!!!
 ↑ Risk of fractures = FALL risk
 ↑ Fluid (3-4L/day)
 Avoid calcium rich food (Sardines, seeds, beans, nuts, green leafy, rhubarb)

Hypocalcemia
 Hypoparathyroidism
 Vitamin D deficiency
 Multiple blood transfusions (citranate in stored blood)
 Trousseau’s/Chvostek’s sign
 Dysrhythmias
 Tingling – Parastesia
 Supplements

Magnesium
 1.8 – 2.1
 ICF
 Muscles
 “Relax”

Hypermagnesemia
 Increased intake
 Renal failure
 ↓ DTR
 ↓ Muscle strength
 Lethargy
 ↓ BP
 Flushing
 Avoid food with magnesium (nuts, spinach, dark chocolate, TUMS)
 Diuretics