ELECTROLYTES Flashcards

Hyperkalemia
Terms Definitions
HCO3Bicarb
22-26
pH
7.35-7.45
PaCo2carbon dioxide
35-45
Hypermagnesia
greater than 2.5
CATS (hypocalcemia ss)
convulsions
arrhythmia
tetany
spasms
Calcium (Ca)
9-11 mg/dl
Mnemonic for hypocalcemia SS?
CATS
Ca Low
Acute pancreatitis, hypoparathyroidism, liver disease, malabsorption syndrome, renal failure, Vitamin D deficiency
interstitial fluid
surrounds the cells
intracellular electrolytes
K+/Phosphate/Mg+ most abundant
MACHINE (hyperkalemia cm)
Meds-ACE inhibitors, NSAIDs
Acidosis
Cell destrux.
Hypoaldo
Intake excess
Nephron failure
Excretion impaired
Hypomagnesia
Mg lvls less than 1.5
Hypernatremia can be labeled __________
twitchy
Hypokalemia ________ smooth muscle excitability
decreases
Cl High
Corticosteroid therapy, metabolic acidosis, respiratory alkalosis, uremia
Na High
Corticosteroid therapy, dehydration, impaired renal function, primary aldosteronism
hypermagnesia ___ DTR's, hypomagnesia ______ DTR's
decreases; increases
Both hypo and hyperkalemia cause ______-tension
hypo
PTH
pulls Ca+ from bone alongside calcitriol
hypokalemia is _______ while hyperkalemia is _______
floppy; twitchy
What is hypernatremia associated with?
Possible FVD/dehydration
hypokalemia ______ smooth muscle excitability while hyperkalemia ________ it
decrease; increase
Cl Low
Addison's disease, diarrhea, metabolic alkalosis, respiratory acidosis, vomiting
who is at risk for dehydration
infants
Name the three major electrolyteregulatory systems
chemical buffersrespiratorykidneys
What intake creates hypermagnesia?
antacids, TPN and laxatives
K+ and Na+ have a(n) _______ relationship
inverse
hypokalemia is present during _______ while hyperkalemia is present during _________
alkalosis; acidosis
Mg affects ____ and ____ movement
K+; Na+
What overdoses contribute to hypercalcemia? (3)
vit A
vit D
antacids
What is hypernatremia?
greater than 145 serum Na+
Hypocalcemia is present alongside
alkalosis, low mg+ lvl's
isotonic solution
same solute concentration as another solution
hypokalemia causes _____ in the GI, while hyperkalemia causes _______
constipation, diarrhea
K+ imbalances causes both ___ and ______
hypotension; paresthesias
RENAL (hypermagnesia ss)
Reflexes decreased + paralysis and weakness
EKG changes (bradycardia and hypotension)
N/V
Appearance flushed
Lethargy and drowsiness (poss. coma)
S/S mnemonic for hypokalemia
SUCTION by the 6 Lesbians
s/s of dehydration
irratabilty / confusion / dizzyness /weakness / poor skin turgor / tenting.
acid-base balance
most H+ ions interactw/ electr to establish balance
What is a mnemonic for hypomangnesia?
STARVED by the 3T's
What contributes to hypermagnesia?
Impaired excretion secondary to age, DKA, and Addison's.
Excessive intake secondary to antacids, TPN and laxatives
What do you check for hypocalcemia?
chvostek's and trousseau's signs
What foods contain muck K+?
salt substitutes, bananas, oranges, avocados, cod, potato, and spinach
What are the clinical manifestations r/t neuromuscular of hyponatremia?
headache, confusion, lethargy, fatigue, decreased DTR, decreased muscles to the point of cardiac arrest, decreased LOC, seizures and comas
hypovolemia...teach?
stand / or raise slowly from bed to reduce risk of orthostatic hypotension....change positions slowly
How do you treat hypocalcemia?
correct Ca+ imbalance
Monitor VS, IO, LOC, RR, and heart
Be ready to intubate
Ask about neck surgery (injury of p.thyroid?)
What are the clinical manifestation r/t VS of hypernatremia?
hyperthermia and flushed skin, tachycardia, orthostatic hypotension
FRIED SALT (hypernatremia ss)
Fever (low grade) and flushed skin,
Restlessness and irritability,
Increased fluid retention and BP,
Edema peripheral and pitting, D
Decreased urine and dry mouth
Skin flushed,
Agitation,
Low grade fever,
Thirst and tachycardia
What are the clinical manifestations r.t GI of hyponatremia?
increased motility, increased BT, nausea, anorexia and abd cramping
foods high in sodium
cheese / ketschup / seafood / processed meats / canned soups and vegatables
What is the treatment for hyponatremia?
Restrict fluids, encourage high Na+ foods, adm hypertonic solutions, diuretics, monitor VS, IO, LOC, heart and breathing
What are the causes of hypocalcemia?
Impaired intake secondary to poor diet, insufficient vit D
Impaired absorption secondary to increased motility, laxatives diarrhea, and high phosporus
Excessive Ca+ loss from diuretics, renal disease, low serum albumin, and burns, infx.
Decrease of PTH from thyroidectomy, hypoparathyroidism
What are the CM of hypocalcemia?
Ca effects muscle and nerve impulses, heart fx/
N: anxiety, confusion, irritability
NM: paresthesia, twitching, muscle cramps, tremors, tetany (Chvostek's and Trousseau's), spasms that affect RR, hyper DTR
other: bone fractures, brittle nails, dry skin,
GI: abd cramps, increase BT's, /D/,
heart: angina, arrhythmia, hypotension, heart failure
What risk factors in the GI lead to hyponatremia?
V/D, NG suction and TWE
What does a low mg do to K+?
Decreases movement of K+ into cells, increases urine loss of K+
What are the main differences between hypo and hyper natremias?
One involves FVE and other FVD; one increases blood thickness, one decreases it; one increases cell excitability and the other decreases
What risk factors in the skin lead to hyponatremia?
burns, wound drainage, edema and ascites
What happens to K+ during alkalosis?
K+ moves into ICF to balance out the high pH, and H+ is excreted
What are the causes of hyponatremia?
Net gain of H2O or net loss of Na+
CLchloride
95-105
Cacalcium
4.5-5.5
K+ normal range
3.5-5
Hypercalcemia
Greater than 10.5
Hypocalcemia
less than 8.5
Potassium (K)
3.5-5.0 mEq/L
Mnemonic for hypermagnesia s/s
RENAL
hypokalemia
Less than 3.5 mEq/L
Ca High
Acute osteoporosis, hyperparathyroidism, multiple myeloma, Vitamin D intoxication
anioncation
negative charged electrolytepositive charged electrolyte
Calcium imbalances creates ________
bone fractures
Mnemonic to remember S/S hyperkalemia
MURDER
What foods are K+ low?
apples
Hypernatremia __________ cell excitability while hyponatremia ___________
increases; decreases
Mg High
Addison's disease, hypothyroidism, renal failure
renin
causes vasoconstriction=> bp or increase in bp
Hypercalcemia is a common ________ issue
metabolic
Hypomagnesia is _______ common than hypermagnesia
less
K Low
Cushing syndrome, severe diarrhea, diuretic therapy, GI fistula, pyloric obstruction, starvation, vomiting
s/s of dehydrationin the elderly
confusionsubnormal temperaturetachycardiapinched facial expression
normal sodium level
135 to 145 mEq/L
Name the major Electrolyte Anions.
Cl-, HCO3-
Ca+ affects ____ muscles
skeletal, smooth and cardiac
hypomagnesia causes ____-cardia and ______-tension; hypermagnesia causes _______-cardia and ______-tension
tachycardia, hypertension; bradycardia, hypotension
K+ affect what organ the most?
the heart
What is Na+ a good indicator of?
hydration
PTH _______ Ca+ lvls; Calcitonin ______ Ca+ lvls
increase; decrease
hypokalemia has an insulin ________, hyperkalemia has an insulin __________
excess; deficit
K imbalances causes ______
hypotension, paresthesias, skeletal muscle weakness, heart irregularities
albumin
lrg protein molecule, acts like a magnet to attract water and hold itinside blood vessel
electrolytes are measure where?
only in the bloodstream
K+ imbalances change what on the EKG?
U wave
Hyperkalemia is present during
acidosis, insulin deficiency and trauma
What foods are rich in Na+?
processed foods, ketchup,
Na is important in _______ fluids
ECF balance of
intracellular fluidextracellular fluid
fluid inside the cellsfluid outside the cells
What factor is unique to K+ excretion?
Tubular Secretion
What toxicity must you watch out for with hypomagnesia?
digoxin toxicity
What must you consider alongside Ca+ lvls?
serum albumin lvls
What do you never adm to a hypokalemic pt?
laxatives
How do you treat hyperkalemia?
Decrease K+ intake
Increase K+ excretion via loop diuretic
Promote K+ movement from ECF to ICF with NAHCO3, insulin, and dextrose
What is hyponatremia?
Less than 135 Na+ in the serum
SUCTION (hypokalemia ss)
Skeletal muscle weakness (lead to RR weakness)
U wave change (EKG)-bradycardia
Constipation
Toxic DIgoxin
Irreg., weak P
Orthostatic Hypotension
Numbness/paresthesias
What is a mnemonic to help remember S/S of hypernatremia?
FRIED SALT
hypovolemia ...s/s
high serum sodium > 145 mEq/Lelevated BUNincrease urine specific gravity
What can cause excessive K+ output?
prolonged gastric suction, diuretics, laxatives, loss of GI fluids and Cushing's
What other disease can contribute to hypokalemia?
hypovolemia, hyperaldosteronism, acute leukemia, alcoholism and hepatic disease
What are the CM of hypercalcemia?
excess Ca+=decrease of cell excitability
N: fatigue, confusion, depression, lethargy and coma
M: muscle weakness, hyporeflexia, decrease of tone
heart: arrhythmia, cardiac arrest
GI: N/V/C/abd pain, hypoBT
kidney: stones, polyuria, dehydration
bone pain and fractures
filtration occurs wherre?
in the nephron. its the process of removing particles from a solution by allowing the liquid portion to pass through membrane.
What 2 factors effect ALL Electrolytes excretion?
Glomerular Filtration, Tubular Reabsorption
What foods are low in Na+?
baked potato and and baked chicken
How do you treat hypokalemia?
Restore K+ balance via IV or oral
Prevent other serious complications by monitoring VS, IO, RR, and Heart
Treat underlying cause
Make sure no hypomagnesia=makes K+ replacement ineffective
How do you treat hypernatremia?
Increase oral fluids and decrease Na+ intake, Adm diuretics that target Na+, Adm fluids slowly to prevent cerebral edema, Monitor VS, IO, LOC, heart and breathing
What are the CM of hypermagnesia?
NM: decrease in muscle and nerve activity, decreased DTR, paresthesias and weakness (to the point of decreased RR), drowsy and lethargy
GI: N/V,
Heart: heart block, bradycardia, vasodilation (decreases BP and flushed skin)
What are the risk factors r/t hyperkalemia?
Injury of cells (trauma and burns),
impaired kidney excretion secondary to drugs,
increased intake secondary to salt substitutes, receiving donated blood and k+ supplements,
hypoaldosteronism secondary to NSAIDS, heparin, angio-tensin enzymes
What do you check if K+ replacement is ineffective?
magnesium levels; hypomagnesia renders K+ replacement ineffective
PaO2oxygen
80-100
Kpotassium
3.5-5.0
Ca+ ref range
8.5-10.5
Magnesium reference values
1.5-2.5
Sodium (Na)
135-145 mEq/L
Magnesium (Mg)
1.5-2.5 mEq/L
KIND (hyperkalemia tx.)
Kayexalate
Insulin R
NAHCO3
Diuretics
RF mnemonic for hyperkalemia
MACHINE
Mg Low
Chronic alcoholism, hyperparathyroidism, hyperthyroidism, hypoparathyroidism, severe malabsorption
hypomagnesia is more_________ than hypermagnesia
twitchy
Mnemonic to remember Tx. hyperkalemia
KIND
Hyponatremia can be labeled __________
floppy
When is hypercalcemia present?
acidosis, hypophosphatemia
Na Low
Addison's disease, diabetic ketoacidosis, diuretic therapy, excessive loss from GI tract, excessive perspiration, water intoxication
transcellular
CSF, pleural cavity, lymph systemjoints and eyes.
SALT LOSS (hyponatremia ss)
Stupor/coma,
Anorexia N/V/
Lethargy
Tendon reflexes decreased
Limp Muscles
Orthostatic hypotension
seizures/HA
stomach cramping
Calcitonin
inhibits Ca+ pulling from bone, decreases Ca+ absorption and increases its excretion
MURDER (hyperkalemia ss)
Muscle weakness
Urine little (oliguria, anuria)
Resp distress
Decreased heart CONT
EKG changes (irregular, arrhythmatic)
Reflexes hyper or arreflexic
What contributes to hypercalcemia?
hyperparathyroidism, prolonged immobilization and cancer (invades bone and releases PTH-like hormone)
Na+ and _________ are a couple
H2O
Hyperkalemia occurs _____ than hypokalemia, but is more __________
less; lethal
hyperkalemia
serum level greater than 5 mEq/L
K High
Addison's disease, diabetic ketosis, massive tissue destruction, renal failure
active transport
energy from molecule adenosine triphosphate moves solutes fromlower to higher concentration
hyponatremia....s/s
abdominal crampsaltered LOC , lethargy & confusionH/A , muscle twitching, nausea
ADH antidiuretic hormone
reduces diuresisincreases urine retentionrestores blood volume
name the major Electrolyte Cations.
Na+, K+,
6 L's (lesbians) (hypokalemia ss)
Leg cramps
Limp muscles
Lethargy
Lethal Arrhythmias
Low, shallow respirations
Lots of urine
What causes hypokalemia?
Insufficient intake and excessive output
Is Na+ in the ECF or ICF?
ECF
What can be overwhelmed by hypercalcemia?
the kidneys
factors effecting electro balance
fluid I/Oacid-base balancehormone secretionnormal cell function
Heart CM hyperkalemia
decreased HR, irreg P, hypotension, and cardiac arrest/arrhythmia
When is hypokalemia present?
during alkalosis and excessive insulin
Mnemonic for hypercalcemia ss
bones, moans, stones, and groans
With sodium imbalances, what's a major issue?
cerebral edema
What fluid imbalances are associated with hyponatremia?
FVE and overhydration
Hypokalemia causes ___, ____, ____, and ____ in the GI
N/V/C and anorexia
treat hypovolemia
fast infusion of normal saline / lactated ringer's solution followed by plasma proteins like albumin
What electrolytes are affected by low serum lvls?
Mg and Ca
NM CM hyperkalemia
skeletal muscle weakness that can lead to flaccid paralysis (affect RR), decrease of DTR's, smooth muscle hyperactivity (N/D/abd cramping)
Mg+ lvls are heavily tied to _______ lvls
serum albumin
normal specific gravity / urine
1.010 to 1.025 sp. gr.
cause of hypovolemia
laxative use / overuse of diurectic therapy / fever / hemorrhage / vomiting and diarrhea
Bones, moans, stones and groans (hypercalcemia s/s)
bones: pain and fractures
moans: pain
stones: renal caliculi
groans: psychological stuff, confusion and depression
What are the main hyperkalemia CM's?
neuromuscular and heart function, paresthesia and irritability
s/s of hypervolemia
distended neck veins / in hands and neck and crackles upon auscultation / S3 heart sounds when ventricles are overloaded
Activated form of vitamin D does what?
promotes Ca absorption through GI
calcium pulling from bone
kidney reabsorption of Ca+
All increasing serum Ca+ levels
Eating lots of antacids can do what to mg?
Increase its levels
What is the tx. for hypercalcemia?
Stop Ca+ intake
Increase excretion via hydration and diuretics
Adm corticosteroids (decrease levels)
Monitor VS, IO, LOC, heart, neuro, and RR
What tx. do you provide to the patient?
Oral/IV mg supplements
Asses Renal fx
Assess VS, IO, LOC, heart, and RR
hypocalcemia causes ____, ____, ___ in the GI; hypercalcemia causes ___, ___, ___
abd cramp, /D/, increased BT; abd pain, /C/, decreased BT
What happens to the cells in hyponatremia?
cells swell r/t fluid movement from ECF to ICF
Imbalances of Na+ either way leads to what?
Increased GI motility, hyper BT, /N/, abd cramping, tachycardia, seizures and comas
What does hyponatremia do to nerves and muscles?
lack of Na+ decreases nerve and muscle excitability
What contributes to poor mg intake/absorption and excess loss?
GI issues, excess Ca+ or P- in the GI tract, NG sux., aldosteronism, parathyroid imbalance, SIADH
/ 171
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