Electrolyte Imbalances
Hi New Friend! In this guide you’ll find brevity in only some of the highest yield “mustknow” content for your exams for electrolyte imbalances. This one is solely focused on basics of acid base. For even more content or to be able to remember all of these facts (and more) simply visit our website at www.picmonic.com or click on one of the direct topic links below. Good Luck Studying! Wm. Kendall Wyatt RN, EMTP Content Director Picmonic, Inc Twitter: @PicmonicKendall Youtube: @PicmonicVideo
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Electrolyte Imbalances Electrolyte Imbalances ● Electrolyte Imbalances
■ Potassium ●
Normal Range 3.55 mg/dL
● Hypokalemia (Click to Learn Picmonic) ○
Decreases often caused by diuretics (especially loop diuretics like furosemide), excess diuresis,
○ Symptoms: ○ ○
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Muscle weakness ECG: Flattened T Waves, U Wave ■ Think DECREASED Potassium=DECREASED Height of T Waves Decreased Deep Tendon Reflexes (DTRs) Constipation
○ Treatment: ○
Stop Offending Agent, REPLACE ■ Give oral potassium (its slow, takes days) ■ Give IV potassium ● Administer SLOWLY 510 meq/hr maximum in a peripheral IV. This is why IV potassium comes in 1020 mEq premixed bags in the hospital… it’s for safety.
● Hyperkalemia (Click to Learn Picmonic) ○
Increases often caused by renal failure, too much intake, etc
○ Symptoms: ○ ○
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Muscle Cramps/ Twitching ECG: Tall, PEAKED, T waves ■ Think INCREASED Potassium = INCREASED Height of T Waves Diarrhea
○ Treatment: ○
REMOVE/ PUSH INTO CELLS
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Electrolyte Imbalances ■
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Push Potassium into cells by administering Insulin ● Insulin works by causing glucose to enter the cells and takes potassium with it. Decreasing extracellular potassium levels. ● Administer with Glucose to prevent hypoglycemia Give Sodium Polystyrene (Kayexelate) ● Often rectally (but can be oral) ● Binds to potassium that is created by gut bacteria to prevent further absorption
Potassium Notes: ○ Think ECG first! ○ Potassium is often the first electrolyte to be imbalanced. ○ Medications can alter potassium: It’s so delicate! ■ Diuretics (especially Loop Diuretics) can cause loss of electrolytes: especially potassium ■ Potassium sparing diuretics (Spironolactone) obviously can cause hyperkalemia!
■ Sodium ●
Normal Range 135145 meq/L
● Hyponatremia (Click to Learn Picmonic) ○ ○ ○ ○
Confusion Lethargy Seizures! Treatment: ■ Dilutional Hyponatremia (Fluid Overload) ● Mannitol: Osmotic Diuretic ● Fluid Restriction ■ Fluid Deficit Hyponatremia (Dehydration) ● Hypertonic Solution: 3 or 5% NaCl ■ **Low Sodium levels must be corrected slowly because of the risk of Central Nervous System Damage ■ A patient who is actively seizing due to a low sodium level is the only scenario where it is safe to choose a high sodium 3%NaCl Solution.
● Hypernatremia (Click to Learn Picmonic) ○ ○ ○ ○ ○
Confusion Warm, Dry Flushed Skin Orthostatic Hypotension Seizures! Treatment: ■ Preventing dehydration is best ■ Hydration with ISOTONIC solutions is always the best answer (0.9% NaCL) ■ Hydration & Diuretics
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Electrolyte Imbalances ■
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Hypotonic Solutions (¼ or ½ normal saline 0.225% NaCL or 0.45% NaCl) often for seizing patients due to the risk of hugh fluid shifts and damage to cells. Restrict Oral Sodium Intake
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Sodium Notes: ■ Think neuronal cellular firing! Neurons are sensitive to sodium imbalances causing changes in LOC and increased risk for seizures!
■ Magnesium ■
Normal Range 1.5 .2.5 mg/dL
■ Hypomagnesemia (Click to Learn Picmonic) ■
(Angry, Angry Hippo Magazine!) ● Everything is UP & Irritated! ● Confusion ● Insomnia ● Increased DTR’s ● Tachycardia ● Muscle Cramps ● Seizures! ● Treatment: REPLACEMENT! ○ Magnesium Sulfate ○ Supplement diet: green veggies (spinach, broccoli), avocados, nuts, bananas, meats and TUNA
■ Hypermagnesemia (Click to Learn Picmonic) ●
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Everything is DOWN and RELAXED ○ When I’m around someone who is hyper and talks a lot I think to myself how much magnesium I would need to give them just to relax those jaw muscles enough so they would stop. Just stop. Lethargy Muscle Weakness Decreased DTR’s Bradycardia Decreased Respiration Hypotension Treatment: ○ Dietary Restriction
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Electrolyte Imbalances ○ ○
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Diuretics Calcium Gluconate ■ If you are giving an OB patient magnesium sulfate to decrease contractions. You can remember to assess DTR’s to monitor toxicity. This also means that the antidote to Mag is Calcium Gluconate! Wow, we make this look easy, huh? ○ Calcium Chloride Notes on Magnesium: ■ Magnesium relaxes muscles! Too much and you are weak, Too little and you have ants in your pants! ■ A patient with a low potassium level that doesn’t improve after giving potassium may also have a low magnesium level. Magnesium levels need to be corrected at the same time as potassium. In an emergent scenario the answer will not be to assess magnesium levels though!
■ Calcium ●
Normal Range 8.510.5 mg/dL
■ Hypocalcemia (Click to Learn Picmonic) ●
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Many causes but often caused by: Low Vitamin D Levels, Decreased Intake Symptoms: Muscle Spasms Tetany Chvostek's Sign ○ Tapping facial nerve on the cheek causes a muscle twitch Trousseau’s Sign ○ BP cuff placed on arm causes a carpopedal spasm (drawing in of fingers) ○ Have you ever seen anyone hyperventilate (anxiety attack) and their hands draw in? This because hyperventilation causes respiratory alkalosis (blowing off all CO2) leading to transient decreased in ionized calcium and this sign! (trousseau's, muscle spasms, tetany) ECG: Prolonged QT Interval Treatment: ○ Give Calcium replacement
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Electrolyte Imbalances ○ ○
Oral (Calcium Carbonate: Like Antacids) IV: Calcium Gluconate
■ Hypercalcemia (Click to Learn Picmonic) ●
■
Pathologic Fractures ○ Due to osteoclasts breaking down bone into the bloodstream ● Constipation ● Kidney Stones ● ECG: Shortened QT Interval ● Treatment: ○ Restrict Oral Calcium Intake ○ Calcitonin (I remember this as: calciTONEDOWN) ○ Hydration and Loop Diuretics ■ Loops LOSE Calcium ■ **NOT Thiazide diuretics though because they cause hypercalcemia! Notes on Calcium: ● Often patients with hypocalcemia have concurrent hypomagnesemia that must be corrected before the calcium can be corrected. (They have a direct relationship) ● Calcium is bound to albumin in the body… Patients with low albumin levels must have a corrected calcium level.
■ Phosphorus ●
Normal Range 2.54.5 mEq/L
○ Hypophosphatemia ■ ■ ■ ■ ■
Muscle Weakness Respiratory Failure Change in LOC Paresthesias Treatment: ● Oral Phosphate supplementation
○ Hyperphosphatemia ■ ■ ■
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Muscle Spasms Tetany Treatment: ● Dialysis
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Electrolyte Imbalances ○
● Aluminum Hydroxide (binder) Notes on Phosphorus: ■ Phosphorus is excreted by the kidneys and BUILDS UP IN RENAL FAILURE ■ Phosphorus values typically go OPPOSITE of Calcium (High Phosphorus= Decreased Calcium)
■ Chloride ●
95105 mEq/L
● Hypochloremia ○
The most important thing here to remember is that patients with excess vomiting (or less commonly diarrhea) lose all of their chloride. This leads to a hypochloremic metabolic alkalosis.
● Hyperchloremia ○
I don’t recommend spending time on this.
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Electrolyte Imbalances
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