Electrolytes are regulated by:
Normal organ & gland function |
Intake, output |
Acid-base balance |
Hormones |
Cell integrity |
Electrolytes
Sodium |
Major extracellular electrolyte |
Controls & regulates water balance |
Where sodium goes, water follows |
Potassium |
Major intracellular electrolyte |
Helps maintain intracellular water balance |
Transmit nerve impulses to muscles and contract skeletal and smooth muscles (e.g., cardiac) |
Sodium Imbalance - Hyponatremia
Water excess or loss of sodium |
Causes |
Dilution |
Polydipsia |
Freshwater drowning |
ADH |
CHF (Excess Na+ loss) |
Excretion |
Sweating |
Diuretics |
GI wound drainage |
Renal disease (Excess Na+ loss) |
Intake |
Low salt diet |
Severe vomiting/diarrhea (inadequate Na+ intake to balance loss) |
Signs & Symptoms |
S tupor/coma |
A norexia, nausea & vomiting |
L ethargy |
T endon reflexes decreased |
L imp muscles (weakness) |
O rthostatic hypertension |
S eizures/headaches |
S tomach cramping |
What can you do? |
3% normal saline |
If caused by fluid excess, will need fluid restriction |
Usually can't be fixed by adding sodium to the diet |
Don't forget! Sodium must be replaced slowly! |
Potassium Imbalance - Hypokalemia
Causes |
Vomiting |
NG suction |
Diarrhea |
Medications (diuretics, laxatives, insulin) |
Signs & symptoms |
Dysrhythmias |
Weakness |
Low BP |
Weak pulse |
Muscle weakness and paralysis |
Diuresis |
What can you do? |
Cardiac monitor |
Foods high in potassium |
Potassium IV (only if good urine output) |
Keep patient safe from falls |
Basic Metabolic Panel/Urea &Electrolytes example
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Organs & glands associated with F&E balance
Lungs & Liver |
Water & Sodium balance |
Heart |
Excretes sodium via excretion of atrial natriuretic peptide |
Sweat glands |
Excrete Na+, K+, Cl-, water |
GI Tract |
Absorbs fluids & electrolytes |
Kidneys |
Water, electrolytes; K+, Na+, Urea, and H+ ions |
Sodium Imbalance - Hypernatremia
Hypernatremia is too much sodium |
Causes |
Excess Na+ intake |
Inadequate water intake |
Excess water loss |
Hypernatremia relsults in fluid shift from ICF to ECF (water follows sodium) |
Signs & symptoms |
F = Fever (low grade, flushed skin) |
R - Restless (irritable) |
I - Increased fluid retention and increased BP |
E - Edema (peripheral & pitting) |
D - Decreased urine output, dry mouth |
What can you do? |
Treat the underlying cause |
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Diuretics |
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Sodium restriction |
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Seizure precautions |
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If severe - dialysis |
Sodium must be reduced slowly to avoid swelling in the brain, causing seizures |
Potassium Imbalance - Hyperkalemia
Very dangerous |
Causes |
Kidney failure (most common) |
Use of salt or potassium supplements, recieving old blood (not very common anymore) |
Cell destruction, Acidosis, hypoxia |
Exercise, catabolic state |
Use of potassium-sparing diuretics |
Can get false high results if specimen not handled properly |
Symptoms |
M uscle weakness |
U rine, oliguria, anuria |
R espiratory distress |
D ecreased cardiac contractability |
E CG changes |
R eflexes - hyperflexia, or areflexia |
What can you do? |
Cardiac monitor |
Lasix if kidneys are functioning |
Stop potassium in IV fluids |
Have patient avoid foods high in potassium |
Dialysis if severe |
Recap
Hyponatremia |
Not enough salt/increased secretion/dilution |
Confusion, headaches, ado cramps |
Hypernatremia |
Eating too much Na+/water loss/kidney failure |
Fluid retention, edema |
Hypokalaemia |
Vomiting/diarrhea/diuretics |
Dysrhythmias, weakness |
Hyperkalaemia |
Kidney failure/ingesting too much K+/acidosis |
Stops cardiac function/ECG changes |
Magic 4 of electrolyte lab values
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