Electrolyte Homeostasis and Imbalances

• Insulin
• Epinephrine
• Alkalosis (H⁺ ions leave cells which drives K⁺ ions in)
• TPN (large amounts of carbohydrate and amino acid put into the blood, which causes release of insulin, which puts the K⁺ into the cells)
• Hypothermia (cold triggers the sympathetic nervous system to release epinephrine, which puts K⁺into cells.)

• Diarrhea
• Aldosterone (retains Na⁺ and H₂0, excretes K⁺)
• NG tube
• Glucocorticoid excess
• Diuretics
• Hypomagnesia
• Aldosterone excess (or black licorice)

• Hypokalemia: low K⁺ in the blood/plasma
• Hyperkalemia: high K⁺ in the blood/plasma

Measurements don't reflect how much is in the whole body because some is in the cells (might have enough, too much, or not enough in the cells.)

• Increased excretion
• Loss through abnormal routes
• Shift from plasma to cells
• Decreased intake

• Abdominal distention
• Decreased bowel sounds
• Constipation
• Paralytic ileus
• Polyuria
• Orthostatic hypotension
• Flaccid skeletal muscle weakness (bilateral)
• Flaccid paralysis
• Cardiac dysrhythmias

• Safe weight-loss diets
• Bowel management to prevent diarrhea with laxative use
• Increased Potassium intake to match abnormal loss
• Potassium-rich foods list.

• Acidosis due to mineral acids (e.g., caused by bicarbonate loss from diarrhea)
• Tissue injury or massive cell death (includes cytotoxic drugs)
• Insulin deficiency (untreated diabetes, diabetic ketoacidosis)
• Massive overdose of digitalis glycosides such as digoxin (Lanoxin) (beyond the scope of this course)
• Beta-adrenergic blockade and excessive strenuous exercise

• Intestinal cramping and diarrhea
• Flaccid skeletal muscle weakness
• Flaccid paralysis
• Cardiac dysrythmias
• Cardiac arrest

• Stop K⁺ containing preparation if urine output decreases
• Keep KCl away from children/grandchildren
• Reduce intake of potassium-rich foods

• Bound to plasma proteins
• Bound to small organic anions
• Free ionized (the only physiologically active form)

• It removes it from the bone and puts it in the blood.
• It regulates blood calcium levels.

• Burns: fluid loss in fluid seeping from burn wounds
• Rapid infusion of protinaceaous plamsa expanders: osmotically pulls fluid
• Steatorrhea: fat in stools binds calcium (from the diet and from the digestive secretions), which is excreted with the stool

Positive Chvostek sign means there is increased neurvous hyperexcitability, possibly from hypocalcemia or hypomagnesemia.

It is an abnormal reaction of the facial nerve to stimulation.

• Positive Chvostek sign, positive Trousseau sign
• Muscle twitching, cramping
• Grimacing
• Perioral and digital paresthesias
• Carpopedal spasm
• Tetany
• Laryngospasm
• Seizures
• Cardiac dysrrhythmias

• Anorexia
• Constipation
• Nausea and emesis
• Muscle weakness, fatigue
• Confusion, lethargy
• Personality and mood changes
• Polyuria

• Hypocalcemia
• Hypomagnesia

• Hypercalcemia
• Hypermagnesia

• Bound to plasma proteins
• Bound to small organic anions
• Free ionized (the only physiologically active form)

• Insomnia
• Hyperflexia
• Positive Trousseaus and Chvostek sign
• Skeletal muscle cramps, twitching, tremors, tetany
• Dysphagia
• Nystagmus
• Seizures
• Extreme confusion
• Cardiac dysrythmias

• Hypotension
• Feeling of warmth
• Bradycardia
• Drowsiness, lethargy
• Weak or absent deep tendon reflexes
• Flaccid muscle paralysis
• Respiratory depression
• Cardiac dysrhythmias
• Cardiac arrest