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electrolytes ch.41

electrolyte imbalances

QuestionAnswer
Hyponatremia/Signs and Symptoms pprehension, personality change, postural hypotension, postural dizziness, abdominal cramping, nausea and vomiting, diarrhea, tachycardia, dry mucous membranes, convulsions and coma
Hyponatremia/Causes GI losses: vomiting, diarrhea, NG suction;Renal loss: kidney disease resulting in salt wasting; diuretics; adrenal insufficiency;Skin loss: excessive perspiration; burns;Psychogenic polydipsia;Syndrome of inappropriate ADH (SIADH)
Hyponatremia/Laboratory findings serum sodium level below 135 mEq/L, serum osmolality 280 mOsm/kg, and urine specific gravity below 1.010 (if not caused by SIADH)
Hypernatremia/Causes Excess salt intake: ingestion of large amounts of concentrated salt solutions; iatrogenic administration of hypertonic saline solution parenterally;Excess aldosterone secretion;Diabetes insipidus;Increased sensible and insensible water loss;Water deprived
Hypernatremia/Signs and Symptoms extreme thirst, dry and flushed skin, dry and sticky tongue and mucous membranes, postural hypotension, fever, agitation, convulsions, restlessness, and irritability
Hypernatremia/Laboratory findings serum sodium levels above 145 mEq/L, serum osmolality 300 mOsm/kg, and urine specific gravity 1.030 (if not caused by diabetes insipidus)
Hypokalemia/causes Use of potassium-wasting diuretics;Diarrhea, vomiting, or other GI losses Alkalosis Excess aldosterone secretion Polyuria Extreme sweating;Excessive use of potassium-free intravenous (IV) solutions Treatment of diabetic ketoacidosis with in
Hypokalemia/ S&S weakness and fatigue, muscle weakness, nausea and vomiting, intestinal distention, decreased bowel sounds, decreased deep tendon reflexes, ventricular dysrhythmias, paresthesias and weak, irregular pulse
Hypokalemia/labs serum potassium level below 3.5 mEq/L and electrocardiogram (ECG) abnormalities: flattened T wave; ST segment depression; U wave; potentiated digoxin effects (e.g., ventricular dysrhythmias)*
Hyperkalemia/causes Renal failure;Fluid volume deficit;Massive cellular damage such as from burns and trauma;Iatrogenic administration of large amounts of potassium intravenously;Adrenal insufficiency;Acidosis, especially diabetic ketoacidosis;Rapid infusion of stored blood
Hyperkalemia/S&S anxiety, dysrhythmias, paresthesia, weakness, abdominal cramps, and diarrhea
Hyperkalemia/labs serum potassium level above 5.0 mEq/L and ECG abnormalities: peaked T wave and widened QRS complex (bradycardia, heart block, dysrhythmias); eventually QRS pattern widens and cardiac arrest occurs
Hypocalcemia/causes Rapid administration of blood transfusions containing citrate;Hypoalbuminemia Hypoparathyroidism Vitamin D deficiency Pancreatitis Alkalosis; Chronic renal failure;Chronic alcoholism
Hypocalcemia/S&S numbness and tingling of fingers and around mouth, hyperactive reflexes, positive Trousseau's sign (carpopedal spasm with hypoxia), positive Chvostek's sign (contraction of facial muscles when facial nerve is tapped), tetany, muscle cramps
Hypocalcemia/labs serum ionized calcium level below 4.5 mEq/L or total serum calcium below 8.5 mg/dL and ECG abnormalities: ventricular tachycardia
Hypercalcemia/causes Hyperparathyroidism;Osteometastasis Paget's disease Osteoporosis Prolonged immobilization Acidosis;Thiazide diuretics
Hypercalcemia/S&S anorexia, nausea and vomiting, weakness, hypoactive reflexes, lethargy, flank pain (from kidney stones), decreased level of consciousness, personality changes, and cardiac arrest
Hypercalcemia/labs serum ionized calcium level above 5.5 mEq/L or total serum calcium level above 10.5;elevated blood urea nitrogen (BUN) level 25 mg/100 mL and elevated creatinine level 1.5 mg/100 mL ; ECG abnormalities: heart block mg/dL;
Hypomagnesemia/causes Inadequate intake: malnutrition and alcoholism;Inadequate absorption or loss: diarrhea, vomiting, nasogastric drainage, fistulas, diseases of small intestine Excessive loss resulting from thiazide diuretics Aldosterone excess;Polyuria
Hypomagnesemia/S&S muscular tremors, hyperactive deep tendon reflexes, confusion and disorientation, tachycardia, hypertension, dysrhythmias, and positive Chvostek's sign and Trousseau's sign
Hypomagnesemia/labs serum magnesium level below 1.5 mEq/L
Hypermagnesemia/causes Renal failure;Excess oral or parenteral intake of magnesium
Hypermagnesemia/S&S acute elevations in magnesium levels: hypoactive deep tendon reflexes, decreased depth and rate of respirations, hypotension, and flushing
Hypermagnesemia/ labs serum magnesium level above 2.5 mEq/L; ECG abnormalities: prolonged QT interval, AV block
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