PCCN:CCRN- Electrolyte Review.pdf - 1 ELECTROLYTES CCRN...

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CCRN ELECTROLYTES 1 PCCN
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Potassium Normal serum level: 3.5 – 5 mEq/L Acquired in diet - NPO patient requires 40 mEq per day to maintain levels. - 200 mEq or more to replace lost stores Excreted in urine Must be replaced daily 2
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Potassium Functions Maintains osmotic pressure inside the cell Maintains electrical potential Maintains acid/base balance Participates in metabolism 3
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Hyperkalemia Hyperkalemia: common causes Renal failure — most common Over-replacement Cell damage/potassium shifts out of cell. - Acidosis - Hemolysis - Sepsis - Chemotherapy Spironolactone administration 4
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Hyperkalemia Manifestations Bradycardia Tremors, twitching Nausea/vomiting ECG changes (know this) 5
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Hyperkalemia ECG manifestations Increased K + suppresses SA node Peaked T-waves (all 12 leads) Flattened P-wave (all l12 leads) Long PR-interval Heart blocks PVCs, ventricular dysrhythmias 6
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Hyperkalemia Treatment Kayexelate Insulin/glucose (pushes K + back into cell) Dialysis Sodium bicarbonate Calcium Albuterol aerosol 7
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Hypokalemia Common causes Poor intake Renal loss - Diuretics, renal tubular acidosis, drugs GI loss - Diarrhea, vomiting Shift into the cell - Excessive insulin intake, alkalosis 8
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Hypokalemia Manifestations Tachycardia, hypotension, flaccid muscles ECG changes (know these) 9
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Hypokalemia ECG changes Flattened T-waves (all 12 leads) Long ST-segment U-wave Peaked P-waves (all 12 leads) Long PR-interval PVCs, ventricular dysrhythmias 10
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Hypokalemia Treatment Oral replacement is preferred (allows slower equilibration) in floor patient: in ICU usually IV replacement IV replacement: remember peripheral vs. central line replacement 11
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Potassium Things to remember: Potassium levels change inversely to serum pH. Low K can lead to digoxin toxicity. There is no fast fix…. 12
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Calcium Normal serum level 8.4 – 10.2 mg/dL Ionized (active fraction of calcium) Inactive fraction (bound to albumin) Adjusted calcium level - [(4-Albumin level) X 0.8] + calcium = adjusted calcium 13
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Calcium Essential for the functioning of: Neuromuscular activity Integrity of cell membranes Cardiac electrical conduction and muscle contraction Blood coagulation 14
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Hypercalcemia Etiology Hyperparathyroidism Paget’s disease Excessive vitamin D intake 15
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