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Hypercalcemia info
- Causes: increased calcium from bone, decreased excretion of calcium
- Clinically: lethargy, coma, weakness/flaccidity, n/v, constipation, ARF (acute renal failure), EKG changes
- Treat: IVF fluids, phosphates, decrease calcium intake, increase mobility do calcium doesn’t get leached from bone
- ----Depresses the system
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Hypocalcemia
- Causes: diuretics, lack of vit D, sepsis (body wide infection), pancreatitis, liver disease
- Clinically: weakness, muscle spasms, ileus (paralyzation of the bowel), mental status changes, EKG changes, neuromuscular irritability, and shallow resp.
- Treat: calcium chloride, calcium gluconate
- ----Irritates the system
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Hypermagnesemia (rare) info
- Causes: renal failure, excessive mag intake (antacids - Tums)
- Clinically: bradycardia, decreased RR, drowsiness
- Treat: IV calcium gluconate, hemodialysis
- ----Things depressed
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Hypomagnesemia info (more common in acutely ill)
- Causes: CRF (chronic renal failure), pancreatitis, cirrhosis, ETOH (alcohol) abuse, GI losses
- Clinically: tetany, seizures, EKG changes
- Treat: IV or PO mag replacement
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Management of electrolyte imbalances
- ECG changes
- ----K
- ----Ca
- ----Mg
- Medical management is to look for cause and correct it
- ----We don’t correct electrolyte imbalances
- Remember vital signs!
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Common Causes of Imbalances
- Tissue injury
- ----Burns
- Surgery
- Trauma
- Diabetes mellitus
- ----DKA: diabetic ketoacidosis: increase production of keytones: part of break down of fat
- Malignant tumors
- ----Paraneoplastic syndromes
- --------Some tumors excrete peptides that directly alter electrolytes
- --------Can also be indirect
- ------------Chemo/radiation: cause fluid loss, nausea, vomiting
- Alcohol withdrawal
- Eating disorders
- ----If not eating not getting enough electrolytes
- Skin
- ----Poor skin turgor
- ----Temperature changes
- --------Cool pale too much fluid
- --------Not enough fluid: warm/red
- ----Edema
- Neuromuscular
- ----Muscle fatigue
- ----Twitching
- ----Cramping
- ----Tetany
- CNS
- ----Changes in DTR’s
- ----Convulsions
- ----Depression
- ----Memory impairment
- Vital Signs
- ----Tachycardia
- ----Postural hypotension
- ----Altered respirations
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Deep Tendon Reflexes hyperactive
- Hypocalcemia
- Hypomagnesemia
- Hypernatremia
- Hyperkalemia
- ----More commonly hyper active, sometimes hypo
- Alkalosis
- Dehydration
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Deep tendon reflexes Hypoactive
- Hypercalcemia
- ----Everything depressed
- Hypermagnesemia
- ----Everything depressed
- Hyponatremia
- Hyperkalemia
- ----More commonly hyper active, sometimes hypo
Acidosis
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Assessment of Imbalances
- Head and neck
- ----Edema versus dry mucous membranes
- Extremities
- ----Dependent edema versus muscle weakness, tingling, tetany
- Skin
- ----Warm, moist, cool versus dry with decreased turgor
- Circulation
- ----Hypertension versus hypotension
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Acid- Base Balance Mechanisms
- Buffer system- immediate, not long lasting, plasma proteins
- Respiratory- works over hours, regulates pCO2
- Metabolic- works over days, kidneys regulate bicarb (HCO3-)
- ----Main way
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Normal ABG (arterial blood gas)
- pH: 7.35-7.45 (a little alkalinic)
- pCO2: 35-45 mmHg
- PaO2: >60 mmHg
- HCO3-: 22-26
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Acidemia
Don’t know cause
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