Electrolyte balance

• normal blood level is 3.5-5 
• potassium moves into cells: insulin(key brings sugar and K) , alkalosis(low K level) , anabolism(building cells) 
• mostly in cells don't want too much in blood

• =high blood K levels 
• extreme exercise(cell damage) 
• acidosis 
• trauma to cells

• inadequate intake 
• increased utilization 
• increased losses-diarrhea
• alkalosis 
• renal disorders

• lowers the resting membrane potential 
• which you need more stimuli to reach threshold(weak and fatigued)

• weakness"lazy muscles"
• speech changes-slurred
• flaccid paralysis-floopy.droopy
• shallow respirations, tachycardia
• decreased intestinal motility 
• anorexia 
• polyuria/nocuturia --kidneys can't concentrate and blood vessels relax..

• due to the electrical effect K has on heart
• arrythmias(depends on how sensitive the person is) 
• hypotension 
• arrest 

main intervention is EKG

• K replacement( squash,peaches, bananas, potatoes) orangy foods..used for long term
• oral meds(KCl) (powder and orange juice tang) -hard on stomach
• IV replacement: not undiluted, beware of infiltration(burn), EKG,
• toxicity(kidney disease decrease excretion,
• digoxin(inotropic agent-heart beats stronger and slower)/lasix-diruetic ..k wasting.. loose too much k and makes digoxin toxic 
• never give pure K always dilute 
• add it to iv bag(its irritating to the vein )

• potassium retention=renal failure, decreased aldosterone production(saving K) 
• excessive release from cells=burns, trauma, infection, acidosis 
• excessive k iv (med error)

raises the rmp...lots of firing its easy to excite

• intestinal colic
• diarrhea
• muscle twitching progressing to flaccid paralysis 
• arrythmias

• increase excretion =kayexalate enema(exchanges na for K ) -can also give orally 
• redistribution (glucose plus insulin)-near death=short term 
• NaHC03- correct acidosis 
• diuretics-lasix
• correct ph(can be causing the problem..
• dialysis if renal prob

• serum calcium range 9-11 
• parathyroid hormone increase=takes ca out of bone and into blood 
• calcitonin(thyroid) decreases=ca back into blood 
• vitamin D (in order to absorb ca..fat soluable) 
• ca and phosphorous inverse relationship

• low pth production(females) 
• acute pancreatitis(dump alkaline juice) 
• multiple blood transfusion(citrate-lacatace =base) 
• poor diet 
• pregnancy(need to increase ca by 50% baby takes 10% of bone mass) 
• alkalosis 

Presence of alkaline binds to ca; when ca is bounded it doesn't count therefore its low ( or precipitate when in iv causing it to be chunky )

• lowers threshold ..overall distance decreased 
• needs little stimulation

• tingling 
• muscle spam(trousseau's sign-inflate bp cuff and pinky and ring finger twitch easily ) 
• facial grimace( chvostek's sign-touch face-involuntary muscle spasm ) 
• laryngeospasm 
• convulsions
• tetany 
• ekg changes 
• phosphorous level =high

• oral replacement 
• if tetany: calcium gluconate SLOWLy , watch for hypotension and bradycardia...never give IM 
• watch for digoxin toxicity(enchanced by ca)-in presnece of low ca and K 
• ca isn't well absorbed in presence of base 
• citrical-acid with ca(ionized acid)
• wouldn't give tums because it is ca with antiacid

• hyperparathyroidism 
• immobility= goes out of bones 
• neoplasm-increase in cancer 
• decreased renal excretion 
• excess vitamin d =absorbed too much 
• antacid overdose(contains ca) 
• acidosis= ionized calcium 
• come out of binding once its free it causes electrical activity

raises threshold...causing a larger stimulus to occur

calcium deposits (flank pain, kidney stones, renal failure

• consitpation 
• peptic ulcer
• anorexia
• nausea 

use tums to relief ulcer but you just got another dose of calcium

• lethargy 
• exhaustion 
• confusion 
• coma

• bone pain 
• osteoporois (holes in bones..decrease bone density) 
• osteomalacia(weakness in bones) 
• pathologic fractures(any stress breaks bones)

• increase excretion (diuretics) 
• hydration with saline(increases excretion) 
• mobilization - walking brings ca back into bones
• synthetic calcitonin(tones down ca) 
• -beware of allergic response : antihistamine, epinephrine, and oxygen