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What is Electrolyte Imbalance? ? ? It is the imbalance of certain ionized salts like Sodium, potassium, calcium, bicarbonate, magnesium, phosphate, potassium in the blood
Body Fluid Compartments
Electrolyte Imbalances 1) Hyponatremia/ hypernatremia 4) Hypocalcemia/ Hypercalcemia 2) Hypokalemia/ Hyperkalemia 5) Hypophosphatemia/ Hyperphosphatemia 3) Hypomagnesemia/ Hypermagnesemia 6) Hypochloremia/ Hyperchloremia
Sodium v. Major extracellular cation v. Attracts fluid and helps preserve fluid volume v. Combines with chloride and bicarbonate to help regulate acid-base balance v. Normal range of serum sodium 135 - 145 m. Eq/L
1) Hyponatremia üSerum Na+ level is less than 135 m. Eq/L. ü Causes: Prolonged diuretic therapy, Insufficient Na intake, excessive diaphoresis, excess water intake, alcoholism. üSymptoms: Headache, muscle twitching, seizures, coma, decreased BP, edema. üTreatment: Mild cases: Increase sodium intake, restrict fluid intake Severe cases: Infuse hypertonic Na. Cl solution (3% or 5% Na. Cl), Furosemide drug to remove excess fluid
2) Hypernatremia üExcess Na+ relative to body water ie. more than 145 m. Eq/L. üCauses: Excessive sodium intake, less fluid intake, diabetes insipidus. ü Symptoms: Think S-A-L-T • Skin flushed • Agitation • Low grade fever • Thirst üTreatment: Gradual fluid replacement.
Potassium v. Major intracellular cation v. Untreated changes in K+ levels can lead to serious neuromuscular and cardiac problems v. Normal range K+ levels = 3. 5 - 5 m. Eq/L
3) Hypokalemia üSerum K+ < 3. 5 m. Eq/L üCauses: Diarrhea, insufficient intake, non-K+ sparing diuretics (thiazide, furosemide). üSymptoms: numbness. Weakness, constipation, weak pulse, üTreatment: Increase dietary K+, oral KCl supplements, IV K+ replacement, change to K+-sparing diuretics, monitor ECG changes.
4) Hyperkalemia üSerum K+ > 5 m. Eq/L. üCauses: altered kidney function, increased intake of K+, blood transfusions, K+ sparing diuretics. üSymptoms: Irritability, muscle weakness (especially legs), irregular pulse, hypotension, nausea, abdominal cramps, diarrhea. üTreatment: Loop diuretics, 10% calcium gluconate in case of emergencies.
Magnesium v. Helps produce ATP v. Role in protein synthesis & carbohydrate metabolism v. Helps cardiovascular system function v. Regulates muscle contractions v. Normal serum magnesium levels – 1. 5 -2. 5 m. Eq/L
5) Hypomagnesemia üSerum Mg++ level < 1. 5 m. Eq/L üCauses: Poor dietary intake, poor GI absorption, excessive urinary losses, chronic alcoholism üSymptoms: Confusions, hallucinations, muscle weakness, leg cramps, hypertension, nausea, vomiting. üTreatment: Cardiac monitoring, magnesium sulfate infusions.
6) Hypermagnesemia üSerum Mg++ level > 2. 5 m. Eq/L üCauses: Renal failure. üSymptoms: Decreased neuromuscular activity, muscle weakness, nausea, vomiting. üTreatment: Increased fluids if renal function normal, hemodialysis.
Calcium v 99% in bones, 1% in serum and soft tissue. v. Works with phosphorus to form bones and teeth v. Role in cell membrane permeability v. Participates in blood clotting v. Normal calcium level: serum calcium- 8. 9 -10. 1 mg/dl ionized calcium- 4. 5 -5. 1 mg/dl
7) Hypocalcemia üSerum calcium < 8. 9 mg/dl üIonized calcium level < 4. 5 mg/dl üCauses: inadequate intake, malabsorption, pancreatitis, thyroid surgery. üSymptoms: Fracture, muscle twitching, muscle pain, anxiety. üTreatment: Calcium replacement
8) Hypercalcemia üSerum calcium > 10. 1 mg/dl üIonized calcium > 5. 1 mg/dl üCauses: Cancer üSymptoms: muscle weakness, coma, lethargy, cardiac arrest, Anorexia , nausea/vomiting, constipation, renal failure üTreatment: Hydrate the patient to encourage diuresis, loop diuretics, corticosteroids.
Phosphorus v. The primary anion in the intracellular fluid v. Crucial to cell membrane integrity, muscle function, neurologic function and metabolism of fats and proteins. v. Functions in ATP formation, phagocytosis, platelet function and formation of bones and teeth v. Normal level: 2. 5 -4. 5 mg/dl
9) Hypophosphatemia üSerum phosphorus < 2. 5 mg/dl üCan lead to organ system failure üCauses: more insulin release, malabsorption, diuretics, extensive burns üSymptoms: muscle weakness, respiratory muscle failure, confusion, anxiety, seizures, coma hypotension, easy bruising üTreatment: Oral supplements, IV replacement using potassium phosphate or sodium phosphate.
10) Hyperphosphatemia üSerum phosphorus > 4. 5 mg/dl üCauses: impaired kidney function, cell damage, respiratory acidosis, increased dietary intake üSymptoms: eating poorly, oliguria, muscle weakness. üTreatment: Low-phosphorus diet, IV saline for severe hyperphosphatemia in patients with good kidney function
Chloride v. Major extracellular anion v. Sodium and chloride maintain water balance v. Secreted in the stomach as hydrochloric acid v. Aids carbon dioxide transport in blood v. Normal level : 96 -106 m. Eq/l
11) Hypochloremia üSerum chloride < 96 m. Eq/L üCauses: decreased intake or decreased absorption, diuretics üSymptoms: Agitation, irritability, muscle cramps, slow respirations, coma üTreatment: Oral or IV replacement in a sodium chloride or potassium chloride solution
12) Hyperchloremia üSerum chloride > 106 m. Eq/L üCauses: dehydration, renal failure. üSymptoms: weakness, agitation, edema üTreatment: Restore fluid, electrolyte and acid-base balance