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peds_electrolyte imbalances

Hyperkalemia ↑ GI smooth muscle activity; muscle dysfunction; weakness; cardiac arrhythmia Renal insufficiency primary cause; ↑ K intake r/t IV K overload; blood transfusion, crush injury, sickle cell anemia chemotherapy If mild K+ is restricted & loop/thiazide diuretics used; if more severe peritoneal dialysis, hemodialysis, Kayexalate or 70% sorbitol; IV sodium bicarbonate, IV insulin, glucose & calcium gluconate move K+ into cells
Hypocalcemia ↑ muscular excitability (tetany), twitching & cramping, tingling around the mouth or in fingers, carpal & pedal spasms; laryngospasms, seizures & cardiac arrhythmias; CHF; spontaneous fractures malnutrition, diet low in vitamin D & Ca+; lack of sun exposure; uremic syndrome; high phosphate intake; chronic iarrhea & steatorrhea; hypoparathyroidism hypomagnesemia; alkalosis; liver transplant patients; acute pancreatitis;; burns & wound drainage Oral or IV Ca+; Mg+ must be replenished first if caused by hypomagnesemia Cheese, chicken, egg yolks, figs, grains, legumes, milk, nuts, pudding, sardines, yogurt
Hypercalcemia Decreased neuromuscular excitabiliy; constipation anorexia, N/V; fatigue, skeletal muscle weakness; confusion, lethargy, decreased attention span, polyuria; cardiac arrhythmias & arrest; ↑ K+ & Na- excretion → polyuria/polydipsia Large amounts of chicken liver, megadoses of vitamin D & A, TPN, hyperparathyroidism, prolonged immobilization, leukemia, chemotherapy, thiazide diuretics Administration of fluids & Lasix, glucocorticoids, phosphate, dialysis
Hypomagnesemia ↑ muscular excitability (tetany), hyperactive reflexes, skeletal muscle cramps, twitching, tremors, cardiac arrhythmias; seizures Hypocalcemia, neonates of diabetic mothers; chronic diarrhea, short bowel syndrome, malabsorption syndromes, steatorrhea; transfusion of many units citrated blood Mg+ administaration Almonds, dark-green vegetables, egg yolk, peanut butter, soy, whole grain cereal
Hypermagnesemia ↓ muscle irritability, hypotension, bradycardia, drowsiness, lethargy, ↓ DTR; flaccid muscle paralysis, fatal respiratory depression, cardiac arrhythias & arrest if severe Impaired renal function; Mg+ containing enemas, laxatives, antacids & IV fluids; Epsom salt; Addison disease; MgSO4 given to mother before delivery → hypermagnesemia in newborn ↑ fluid intake, diuretics, dialysis
Hyponatremia ↓ LOC, nausea, vomiting, headache, respiratory distress, ↓ DTR, agitation, seizures (if rapid/severe) Diarrhea, vomiting, excessive sweating, diuretics; excessive IV D5W, CHF, excessive tap water enema Feeding proper formula, restricting water intake, IV hypertonic fluid Processed foods
Hypernatremia Na > 146mmol/L; decreased urine output; decreased LOC (confusion, lethargy, coma); seizures Diarrhea, vomiting, excessive sweating, high solute intake, IV hypertonic solutions IV hypotonic solutions; if dehydrated isotonic fluid administered first
Hypokalemia Decreased GI smooth muscle activity; weakness; respiratory muscles may be impaired; cardiac arrhythmias GI K+ loss Major Cause (vomiting, diarrhea); osmotic diuresis, hypomagnesemia, hypercalcemia, hyperaldosteronism, CHF, nephrotic syndrome, cirrhosis, ↑cortisol, black licorice, NPO sttus, anorexia nervosa, hyperalimentation Oral & IV K+ replacement Apricots, bananas, cantaloupe, cherries, dates, figs, molasses, orange juice, peaches, potatoes, prunes, raisins, strawberries, tomato juice