Electrolytes are minerals which are present in body, which does various activities throughout the body.
They also manage of water balance in the body.
e.g. : Sodium, Potassium. Phosphorus, Calcium, etc.
Take an example of ABG , Ever thought why ABG IS prescribed when patient is sick.
Yes, It checks how much O2 AND CO2 is present in the blood, but apart from this , it also shows the level of various electrolytes in the body. It gives a fast review of the deficiency and excess of electrolytes in the body . This helps to correct them so that harmful events can be avoided in advance.
A detailed class related to this topic is present on my Youtube Channel.
1. Sodium (Na+)
Ø Normal Value of sodium is 135-145 mEq/L
Ø Food
Sources are Processed
food, Snack
foods,
Ø Table
salt
Ø Hyponatremia : < 135
·
Less
Sodium Intake, NPO
·
Increased
Excretion – VPPS
·
SIADH
·
Decreased
Sec. Of Aldosterone
· Always Watch
for Lithium Toxicity (Less Sodium : Lese Lithium Excretion)
·
Intervention
:
Increased Intake, Correctional Medicines
Ø Hypernatremia
- >145 mEq/L
- Increased Intake
- Decreased Excretion
v Corticosteroids
v Cushing’s syndrome
v Kidney disease
v Hyperaldosteronism
- Increased Water Loss : Fever,
Metabolism, Diaphoresis
- Intervention
:
Correctional Medications
2. Potassium
Ø Normal
Value : 3.5
to 5.0 mEq/ L
Ø Food
Sources :
Fruits(Avocado, Banana, Orange),
Ø Vegetables(Spinach)
Ø Hypokalemia-
·
<3.5 mEq/L
·
Diuretics, Corticosteroids
·
Increased secretion of aldosterone (Cushing’s
syndrome)
·
VPPS
·
Decreased Resorption from Kidney
- NPO, Hyperinsulinism, Alkalosis
- Intervention
: -
Oral Potassium Or Potassium Infusion
Potassium
is never administered by IV push, IM or SC routes. IV potassium is always
diluted and administered using an infusion device!
Ø Hyperkalemia>5.0 mEq/L
- Causes :
- Excessive K intake (Incrteased intake of potassium chloride, Rapid infusion of potassium-containing IV solution, foods rich in K)
- Decreased K excretion ( K Sparing Diuretics e.g. Spironolactone, Kidney disease, Addison’s ds, Tissue damage, Acidosis)
- MONITOR
FOR CARDIAC CHANGES
- Interventions :
- K Excreting diuretics (Renal
function - administer sodium
polystyrene sulfonate (oral or rectal route), a cation-exchange resin
that promotes GI Na+ absorption and K+ excretion )
Dialysis can be done in excess potasium level, D25 along with HIR can be given to shift potassium from blood to cell, Fresh Blood Transfusion should be done because old blood can cause hyperkalemia.
3.Calcium
Normal
Value : 9.0 to 10.5 mg/dL
Food
Sources : Cheese, Milk, soy milk, Tofu, Yogurt
Hypocalcemia :
- < 9
mg/Dl
- Causes :
Less
intake of calcium, in Lactose intolerance, in celiac, sprue or Crohn’s ds
Inadequate intake of vitamin D
End-stage
kidney disease
Inc.
Excretion – in kidney diseases, in Polyurea, in Diarrhea, in Steatorrhea, in condition of GI Wound Drainage
Hyperproteinemia,
Alkalosis,Ca chelaters,
Phosphate, Parathyroid –
these
conditions decrease
ionized fraction of calcium.
ASSESSMENT FINDINGS :
Decreased
heart rate
Hyperactive
deep tendon reflexes
Positive
Trousseau’s and Chvostek’s signs
Increased
gastric motility; hyperactive bowel sounds
Nursing Considerations : Seizure Precautions
Calcium Supplement – Orally /
Intravenously
Vitamin D helps in the absorption of
calcium from the intestinal tract.
Incresased Oral Intake of Foods Rich in Calcium
- Hypercalcemia >10.5 mg/dL·
- causes
Increased Intake
Excessive oral intake of calcium, vitamin D
Increased bone
resorption of calcium
Increased bone resorption of calcium
. Hyperparathyroidism
b. Hyperthyroidism
c. Malignancy (bone destruction from metastatis)
d. Immobility
Hemoconcentration
a. Dehydration
b. Use of lithium
c. Adrenal insufficiency
Decreased Excretion : in Kidney
disease , thiazide diuretics use
- NURSING CONSIDERATION : APPLY CARDIAC MONITOR
- INTERVENTION : CORRECT THE
CAUSE OF HYPERCALCEMIA
- ADMIN. phosphorus,
calcitonin, bisphosphonates,
and
prostaglandin synthesis inhibitors (acetylsalicylic
acid,
nonsteroidal antiinflammatory
medications).
4. Magnesium Normal Range : 1.3 to 2.1 mEq/Lt
Hypomagnesemia <1.3 mEq/L
Causes
:
- Less
Mg intake :
• Malnutrition
and starvation.
• Vomiting
or diarrhea
• Malabsorption
syndrome
• Celiac
disease
• Crohn’s disease
2.
Mg Excretion : Diuretics, Chronic alcoholism
3.
Intracellular movement of Mg : Hyperglycemia, Insulin administration, Sepsis
Restore
normal serum calcium levels [dec. Mg = dec. ca]
Avoid
Oral Mg : may cause diarrhea and increase magnesium loss.
Admin
IV Mg [IM Admin may cause pain] : initiate seizures precautions
Increase
intake of Mg rich foods
Ø Hypermagnesemia > 2.1 mEq/L
Causes
:
1.
Increased magnesium intake
a.
Magnesium-containing antacids and laxatives
b.
Excessive admin. Of Mg IV
2.
Decreased renal excretion of magnesium : renal insufficiency
INTERVENTION
:
- Diuretics
- Intravenously
administered calcium gluconate may be prescribed to reverse the effects of
magnesium on cardiac muscle.
- Restrict
intake of foods rich in Mg
Calcium gluconate is antidote for
magnesium overdose
5.Phosphate :
Normal
Value : 3.0 – 4.5 mg/dL
Hypophosphatemia <3.0 mg/dL [is
accompanied by an increase in the serum calcium level.]
Causes
:
1.
Less intake: Malnutrition, starvation
2.
Increased excretion: Hyperparathyroidism,
Malignancy, Use of magnesium-based
/ aluminumhydroxide–based antacids
3.
Intracellular shift :
a.
Hyperglycemia
b.
Respiratory alkalosis
• NSG.
CONSID. :
1. Decreased
contractility and cardiac output ,Decreased deep tendon reflexes
2. Seizures
3. A decrease in the phosphate is caused by an increase in the calcium level, and an increase in the phosphate is caused by a decrease in the calcium level. This is known as reciprocal relationship.
Interventions :
Stop medications that cause hypophosphatemia
Administer phosphorus orally along with a vitamin D supplement [Slow IV]
Decreasing the intake of any calcium-containing foods
Ø Hyperphosphatemia
>4.5 mg/dL
An increase in the phosphorus level is caused by a decrease in the calcium level
Causes
1. Decreased renal excretion
2. Tumor lysis syndrome
3. Increased intake of phosphorus, including
dietary intake or overuse of phosphate-containing laxatives or enemas
4. Hypoparathyroidism
Intervention :
Management of hypocalcemia.
Administer
phosphate-binding medications
Avoid phosphate-containing medications,
including laxatives and enemas