Electrolyte imbalances

• less than 3.5 mEq/L (3.5 mmol/L)
• Anorexia, nausea, and vomiting
• Muscle weakness, paresthesias
• Dysrhythmias, increased sensitivity to digitalis

• Potassium—main intracellular ion; involved in cardiac rhythm, nerve transmission
• Normal level—3.5–5.0 mEq/L (3.5-5 mmol/L)
• Causes—vomiting, gastric suction, diarrhea, diuretics and steroids, inadequate intake

• Administration of oral potassium supplements—dilute in juice to avoid gastric irritation
• Increase dietary intake—raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery
• IV supplements—40 mEq/L usual concentration; cannot give concentration greater than 40 mEq/L into peripheral IV or without cardiac monitor
• Increases risk of digoxin toxicity
• Protect from injury
• Assess renal function prior to administration

• greater than 5.0 mEq/L (5 mmol/L)
• EKG changes, dysrhythmias, cardiac arrest
• Muscle weakness
• Paralysis
• Nausea
• Diarrhea

Causes—renal failure, use of potassium supplements, burns, crushing injuries

• Restrict dietary potassium and potassium-containing medications
• Sodium polystyrene sulfonate—cation exchange resin (causes diarrhea)
• Orally—dilute to make more palatable
• Rectally—give in conjunction with sorbitol to avoid fecal impaction
• In emergency situation, calcium gluconate given IV, sodium bicarbonate given IV, regular insulin and dextrose
• IV administration of regular insulin and dextrose shifts potassium into the cells
• Peritoneal or hemodialysis
• Diuretics

• Less than 135 mEq/L (135 mmol/L)
• Nausea
• Muscle cramps
• Increased intracranial pressure, confusion, muscular twitching, convulsions

• Sodium—main extracellular ion; responsible for water balance
• Normal—135–145 mEq/L (135–145 mmol/L)
• Causes—vomiting, diuretics, excessive administration of dextrose and water IVs, prolonged low-sodium diet, excessive water intake

• Oral administration of sodium-rich foods—beef broth, tomato juice
• IV lactated Ringer’s or 0.9% NaCl
• Water restriction (safer method)
• I and O
• Daily weight

• greater than 145 mEq/L (145 mmol/L)
• Elevated temperature
• Weakness
• Disorientation
• Delusion and hallucinations
• Thirst, dry swollen tongue, sticky mucous membranes
• Postural hypotension with decreased ECF
• Hypertension with normal or increased ECF
• Tachycardia

Causes—hypertonic tube feedings without water supplements, diarrhea, hyperventilation, diabetes insipidus, ingestion of OTC drugs such as Alka-Seltzer, inhaling large amounts of salt water (near-drowning), inadequate water ingestion

• IV administration of hypotonic solution—0.3%
• NaCl or 0.45% NaCl; 5% dextrose in water
• Offer fluids at regular intervals
• Decrease sodium in diet
• Daily weight

• Ionized serum calcium less than 4.5 mg/dL or total serum calcium less than 8.6 mg/dL (2.2 mmol/L) (total serum calcium levels used)
• Nervous system becomes increasingly excitable
• Tetany
• Trousseau’s sign—inflate BP cuff on upper arm to 20 mm Hg above systolic pressure; carpal spasms within 2–5 minutes indicate tetany
• Chvostek’s sign—tap facial nerve 2 cm anterior to the earlobe just below the zygomatic arch; twitching of facial muscles indicates tetany
• Seizures
• Confusion
• Paresthesia
• Irritability

• Calcium—needed for blood clotting, skeletal muscle contraction
• Ionized serum calcium less than 4.5 mg/dL or total serum calcium less than 8.6 mg/dL (2.2 mmol/L)
• Regulated by parathyroid hormone and vitamin D, which facilitates reabsorption of calcium from bone and enhances absorption from the GI tract
• Causes—hypoparathyroidism, pancreatitis, renal failure, steroids and loop diuretics, inadequate intake, post-thyroid surgery

• Orally—calcium gluconate (less concentrated) or calcium chloride; administer with orange juice to maximize absorption
• Parenterally—calcium gluconate--Effect is transitory and additional doses may be necessary
• Use caution with digitalized clients because both are cardiac depressants
• Calcium may cause vessel irritation and should be administered through a long, stable intravenous line
• Avoid infiltration since tissue can become necrotic and slough
• Administer at a slow rate to avoid high serum concentrations and cardiac depression
• Seizure precautions
• Maintain airway because laryngeal stridor can occur
• Maintain safety needs since confusion is often present
• Increase dietary intake of calcium, calcium
• supplements
• Regular exercise
• Administer phosphate-binding antacids, calcitriol, vitamin D

• Ionized serum calcium greater than 5.1 mg/L or total serum calcium greater than 10.2 mg/dL (2.5 mmol/L)(total serum calcium levels used)
• Sedative effect on central and peripheral nervous system
• Muscle weakness, lack of coordination, constipation, abdominal pain, and distension
• Confusion
• Depressed or absent tendon reflexes
• Dysrhythmias

Causes—malignant neoplastic diseases, hyperparathyroidism, excessive intake, immobility, excessive intake of calcium carbonate antacids

• IV administration of 0.45% NaCl or 0.9% NaCl
• Encourage fluids
• furosemide
• Calcitonin—decreases calcium level
• Mobilize the client
• Restrict dietary calcium
• Prevent development of renal calculi
• Increase fluid intake
• Maintain acidic urine
• Prevent UTI
• Surgical intervention may be indicated in hyperparathyroidism
• Injury prevention
• Limit intake of calcium carbonate antacids

• less than 1.3 mEq/L (0.53 mmol/L)
• Magnesium acts as a depressant
• Increased neuromuscular irritability
• Tremors, tetany, seizures
• Dysrhythmias
• Depression, confusion
• Dysphagia

• Normal—1.3–2.3 mEq/L (0.53-0.95 mmol/L)
• Causes—alcoholism, GI suction, diarrhea, intestinal fistulas, abuse of diuretics or laxatives
• Usually seen with other electrolyte deficits

• Increased intake of dietary Mg—green vegetables, nuts, bananas, oranges, peanut butter, chocolate
• Parenteral administration of supplements magnesium sulfate
• Monitor cardiac rhythm and reflexes to detect depressive effects of magnesium Keep self-inflating breathing bag, Monitor respiratory status airway and oxygen at bedside, in case of respiratory emergency
• Calcium preparations may be given to counteract the potential danger of myocardial dysfunction that may result from magnesium intoxication secondary to rapid infusions
• Oral—long-term maintenance with oral magnesium
• IV administration—assess renal function
• Monitor for digitalis toxicity
• Maintain seizure precautions
• Provide safety measures because confusion is often present
• Test ability to swallow before PO fluids/ food because of dysphagia

• greater than 2.3 mEq/L (0.95 mmol/L)
• Depresses the CNS
• Depresses cardiac impulse transmission
• Hypotension
• Facial flushing, muscle weakness
• Absent deep tendon reflexes, paralysis
• Shallow respirations

• Causes—renal failure, excessive magnesium
• administration (antacids, cathartics)

• Discontinue oral and IV Mg
• Emergency
• Support ventilation
• IV calcium gluconate
• Hemodialysis
• Monitor reflexes
• Teach about OTC drugs containing Mg
• Monitor cardiac rhythm; have calcium preparations available to antagonize cardiac depression