Electrolyte Imbalances: Causes, Symptoms, and Management

Major Anion - INTRACELLULAR

85% bone, 15% intracellular

Hyperaldosteronism

A condition that can lead to increased Mg+ levels

Hyperparathyroidism

A condition that can lead to increased Mg+ levels

hypovolemic shock

A condition that can occur with Mg+ imbalance

What Magnesium Does

Activates enzymes, important part of carbohydrate/protein metabolism.

Hypercalcemia

Acute crisis has a high mortality rate.

VFD with decreased renal profusion

Alcoholism, GI losses (NG suction, diarrhea, fistula), malnutrition, renal loss, SIADH, DKA, chemotherapy

Sodium Bicarbonate

Alkaline agent/protects heart.

FOODS LOW IN Mg+

Almonds, avocados, pumpkin seeds, banana, nuts, spinach, black beans, whole grains, milk, peanut butter, legumes

Ca+ & Mg+ relationship

Are inversely related to phosphate

Hypomagnesemia

Associated with hypokalemia and hypocalcemia.

kidneys regulate phosphate

Based on overflow mechanism

NSAIDs

Blocks kidney function.

Signs/Symptoms of Hypercalcemia

Bone pain, arrhythmias, cardiac arrest, kidney stones, muscle weakness, excess urine, lethargy, decreased reflexes, polyuria, anorexia, confusion/stupor, peptic ulcers, heart attack, nausea.

Calcium and Phosphate Relationship

Calcium and phosphate are inversely related.

Rapid admin of citrated blood

Can lead to increased Mg+ levels

HYPOphosphatemia

Can occur when total body stores are normal

HYPERphosphatemia

Can occur with too much intake, decreased excretion, and intracellular shift to extracellular spaces

Signs/Symptoms of Hyperkalemia

Cardiac changes, muscle weakness, anxiety, paresthesias, GI manifestations.

Mg+ in the cardiovascular system

Causes vasodilation & decreased peripheral resistance

HYPOnatremia

Cells swell; intracellular fluid excess

Monitor ECG

Check for elevated bicarb and pH levels.

Hypoaldosteronism

Condition characterized by insufficient aldosterone.

irritable symptoms of Mg+ imbalance

Confusion, Trousseau's sign, Chvostek's sign, ataxia, insomnia, depressed mood, neuromuscular irritability

CATS GONUMB

Convulsions/seizures, arrhythmia, tetany, spasms/stridor, numbness.

Signs/Symptoms: High phosphate

Decreased PTH, BUN and creatinine levels - assess these for renal function

IV K+ Administration

Diluted with at least 100 ml of normal saline, max infusion rate 10 mEq/hour.

excess Mg+

Diminishes excitability of muscle cells (sedative)

Furosemide

Diuresis and Ca+ excretion.

Too much Mg+ in blood

Due to supplements, laxative, DKA, soft tissue injury - crushing

Med Management for Hyperkalemia

Eliminate K+ foods, stop K+ sparing diuretics.

Magnesium and Protein/DNA Synthesis

Essential to protein and DNA synthesis.

Causes of Hypercalcemia

Excess Ca+, thyroid disorder, cancer, immobility, hyperphosphatemia, hyperparathyroidism, kidney injuries, corticoid steroid therapy, malabsorption, osteoporosis, pancreatitis, alkalosis, transfusion of citrated blood, inadequate vitamin D intake, aluminum-containing antacids, diuretics, drainage diarrhea.

Intake

Excessive consumption.

Cation Resins

Exchange Na+ for K+ in intestines.

Med Management for Hypercalcemia

Fluid increase with diuretics, oral Ca+ & vitamin D, IV replacement with Ca+ gluconate or calcium chloride, administer IV fluids, avoid laxatives, smoking, caffeine.

Foods Low in K+

Fruit juices, citrus fruits, apples, berries.

Causes of HYPOkalemia

GI losses - diarrhea, vomiting, gastric suction, corticosteroid administration, hyperaldosteronism, tumor of intestine, diuretic wasting - K+(loop), insulin - promotes K+ into cells, poor diet, alteration of A-B balance, Cushing's disease (excess aldosterone and cortisol)

Signs/Symptoms: HIGH EVERYTHING

High DTR, high HR, BP, shallow breath, muscle twitch, tetany, seizure

MED MANAGEMENT for Mg+ excess

IV - calcium gluconate/calcium chloride - act at the neuromuscular junction to nullify action of Mg+

Excretion

Impaired elimination of waste.

Nephrons

Impaired functional units of the kidney.

Biophosphates

Inhibit osteoclast activity.

Sodium & K+ Relationship

Inversely related.

Keyexalate

K+ binder, excretes via feces.

How K+ works

K+ transforms carbs into energy & glucose into glycogen (maintaining insulin levels)

Med Management for HYPOnatremia

LR or Isotonic saline, restrict H2O intake, monitor fluid intake, I&O daily weight, CNS changes

6 L's

Lethargy, leg cramps, limp muscles, low shallow respirations, lethal cardiac dysrhythmias, lots of urine.

Magnesium in Blood

Little found in blood.

Signs/Symptoms: LOW EVERYTHING

Low BP, coma, confusion, DTRs, heart rate, RR, hypoactive bowel sounds, heart attack

WHAT IT DOES: Phosphate

Major role in metabolic processes - carbohydrates, lipids, proteins

Acidosis

Metabolic & respiratory condition.

Hypocalcemia

Mild - no signs/symptoms, moderate - well tolerated.

Foods High in Calcium

Milk, green leafy veggies, canned salmon, sardines, fresh oysters, broccoli, oranges, and dairy products.

FOODS HIGH IN PHOSPHATE

Milk, organ meats, beans, nuts, fish, poultry, lentils, dairy

Causes of Hypomagnesemia

Most common cause is kidney injury.

MURDER

Muscle weakness, urine (oliguria, anuria), respiratory distress, decreased cardiac contractility, ECG changes, reflexes hyperreflexia.

deficit Mg+

Neuromuscular irritability/contractility

Foods Low in Calcium

None specified.

Foods High in K+

Oranges, bananas, prunes, squash, raisins, dried beans, potatoes, sweet potatoes.

Phosphates Effect on Calcium

Phosphates cause Ca+ to drop.

Calcitonin

Produced and released by thyroid, decreases serum levels by opposing bone absorption.

Hypermagnesemia

Rare, because kidneys effectively excrete Mg+.

Calcitonin in Treatment

Reduces bone reabsorption and increases deposition.

Parathyroid Hormone (PTH)

Released as Ca+ decreases from parathyroid glands; increases absorption in the GI tract, renal tubule, and releases Ca+ from the bone.

MED MANAGEMENT for Mg+ deficit

Replacement Mg+ IV/PO; encourage fluids, hemodialysis, administer loop diuretics, sodium chloride, Lactated Ringer's

Signs/Symptoms of Acidosis

Respiratory distress, renal failure, abdominal cramps, diarrhea.

MED MANAGEMENT for high phosphate

Restrict foods with high phosphate, give Ca+ or phosphate binding antacids, loop diuretics

Aldosterone

Retains H2O/Na+ & kicks out K+.

Foods low in Na+

Salty foods!

Administer Glucose with Insulin

Shifts K+ out of serum into cells.

Signs/Symptoms: Low phosphate

Soft tissue calcification, associated symptoms of hypocalcemia - tetany & severe muscle cramping

Calcium Gluconate

Stops effects on the heart.

Abundant Cation of ICF

Stored in muscle tissue and bone.

Magnesium and Electrical Conduction

Vital role in electrical conduction of nerves and cardiac tissue.

Med Management for HYPERnatremia

admin hypotonic solution (.45% NaCl or .3% NaCl), do it slow - too rapid of shift = cerebral edema, diuretics, monitor CNS changes

Causes of HYPOnatremia

adrenocorticoid insufficiency - insufficient aldosterone, excess fluid intake, oral or parenteral, SIADH - continued secretion of ADH despite low serum osmolality & expanded ECF, psychogenic polydipsia, excessive admin of 5% Dextrose in H2O

HYPERnatremia

cells shrink; Na+ pulls H20 outta cells

Signs/Symptoms of HYPERnatremia

extreme thirst, flushed skin, restless anxious (neurochanges), increased BP/pulse & fluid retention, edema, decreased urine output, skin dry, agitation, low grade fever, thirst (dry mucus membranes)

Loss of fluids

fever/burns, decreased fluid intake, diabetes insipidus (decreased water, increase Na+), DIAPHORESIS, DIARRHEA, drains, diuretics, SIADH

Causes of HYPERkalemia

impaired renal function, rapid K+ administration, movement of K+ from ICF to ECF, hypoaldosteronism/Addison's disease, crushing injuries, acidosis, medications (60% of hyperK+ episodes are brought on by KCl, heparin, ACE inhibitors, and NSAIDs)

Major Cation of ICF

in all body cells

K+ transforms AAs into proteins

maintains normal resting membrane potential in neuromuscular tissue - skeletal cardiac, smooth muscle

HYPERkalemia

may occur with normal blood serum levels; heart attack!

HYPOkalemia

may occur with normal blood serum levels; heart attack!

Movement of K+

movement of K+ is due to Na+/K+ pump

Major cation on ECF

responsible for osmotic pressure of EFC

Signs/Symptoms of HYPOnatremia

stupor/coma, anorexia, lethargy, tachycardia, limp muscles, orthostatic hypertension, seizure/headache, stomach cramps (hyperactive bowels), elevated temp, swollen dry tongue, decreased DTRs

Causes of HYPERnatremia

too much salt intake, loss of H20, admin of IV fluid with Na+( hypertonic saline, Na+bicarb, isotonic saline), drinking saltwater, diabetes Insipidus, heat stroke, can't respond to thirst, hyperventilation