F&E values and critical S/S of imbalances
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| Hypernatremia | cell membrane irritability and severe cellular dehydration results in altered cerebral function, muscle twitching/weakness/contractions (irregular), reduced deep tendon reflexes, decreased contractility
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| Hypernatremia Causes | high aldosterone, corticosteroids, kidney failure, excessive intake (oral or IV), near drowning in saltwater, NPO, increased rate of metabolism, watery diarrhea, fever/infection, excessive diaphoresis, hyperventilation
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| Hyponatremia | reduced excitable membrane depolarization and cellular swelling results in acute or increased confusion (esp. elderly), general muscle weakness, increased G.I. motility (N/D, abd. cramping, hyper sounds), seizures, coma, death; requires K+ monitoring
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| Hyponatremia Causes | low aldosterone, diuretics, wound drainage (esp. G.I.), kidney disease/failure, hyperlipidemia, NPO, low-salt diet, hyperglycemia, heart failure, excessive intake or irrigation with hypotonic fluids (ex: BPH patients), SIADH
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| Hypokalemia | reduced cell excitability & diminished tissue response results in resp. weakness/shallow resp.,dysrhythmias,thready/weak pulse,ECG changes(flat T wave),skeletal muscle weakness, flaccid paralysis,confusion/irritability,lethargy/coma,N/V/C, paralytic ileus
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| Hypokalemia Causes | inappropriate use of diuretics/digitalis/corticosteroids, high aldosterone, NPO, wound drainage (esp. G.I.), vomiting, diarrhea, prolonged NG suction, TPN, kidney disease, alkalosis, water intoxication, hyperinsulinism
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| Hyperkalemia | increased cell excitability (potential spontaneous discharge) & interference w/electrical conduction results in brady, low BP, ECG changes (peaked T, wide QRS), dysrhythmias/heart block/v-fib, muscle twitching, tingling/burning/paresthesias, diarrhea
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| Hyperkalemia Causes | excessive intake of salt substitutes, kidney failure, adrenal insufficiency, uncontrolled DM, acidosis, tissue damage (burns), hyperuricemia, transfusions of whole blood or packed cells, K+ sparing diuretics, ACE inhibitors,
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| Hypomagnesemia | increased membrane excitability(esp.nerve)& Ca++/K+imbalances results in increased nerve impulse transmission(+Chvostek&Trousseaus w/hypocalc.)hyper.deep tendon reflexes,numbness/tingling,painful muscle contractions,tetany, seizures, A/N/C,paralytic ileus
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| Hypomagnesemia Causes | malnutrition, starvation, chronic alcoholism, diarrhea, steatorrhea, Celiac disease, Crohn's disease
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| Hypermagnesemia | S/S after >4mEq/L; reduced membrane excitability results in cardiac arrest risk, brady, low BP, prolonged PR/widened QRS, reduced/absent deep tendon reflexes, weak/absent skeletal muscle contractions, lethargy, coma, resp. insufficiency/failure
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| Hypermagnesemia Causes | decreased kidney excretion (kidney disease)
increased intake via antacids, laxatives, IV replacement
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| Hyperphosphatemia | well tolerated by most body systems; problems arise d/t resulting hypocalcemia (increased membrane excitability); treated by managing hypocalcemia
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| Hyperphosphatemia Causes | kidney disease (decreased excretion), hypoparathyroidism, increased intake of phosphorus, tumor lysis syndrome
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| Hypophosphatemia | impact w/chronic low lvls;reduced energy metabolism,raised Ca++ lvls results in weak contractility,decreased SV/CO,reversible cardiac damage,weak sk.muscles->rhabdomyolosis, resp. failure,(decreased bone density)bone fractures,irritability->seizures->coma
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| Hypophosphatemia Causes | malnutrition, starvation, kidney failure, hypercalcemia, malignancy, hyperparathyroidism (excess PTH), hyperglycemia, alcohol abuse, uncontrolled DM, resp. alkalosis, use of aluminum-hydroxide/magnesium-based antacids, hyperalimentation (overfeeding)
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| Hypercalcemia | decreased sensitivity of excitable tissues results in increased HR/BP (severe: decreased HR), dysrhythmias, shortened QT, blood clots, severe muscle weakness, decreased deep tendon reflexes w/o paresthesias, confusion/lethargy, N/V/A/C,abd pain/distention
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| Hypercalcemia Causes | kidney failure, immobility, malignancy, use of thiazide diuretics, excessive oral intake of Ca++/Vit D, hyperthyroidism, hyperparathyroidism, use of glucocorticoids, dehydration
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| Hypocalcemia | increased membrane excitability results in paresthesias in hands/feet,muscle twitching/painful cramps or spasms,tetany, +Trousseaus/Chvostek signs,weak/thready pulse,prolonged ST/QT,increased peristalsis,D,loss of bone density, bone pain, change in height
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| Hypocalcemia Causes | end stage kidney disease, immobility, wound drainage(esp.GI), diarrhea, steatorrhea, lactose intolerance, acute pancreatitis, alkalosis, hyperphosphatemia, hyperproteinemia, removal/destruction of PT glands, excess Ca++ binders,Celiac sprue,Crohns disease
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| Sodium (Na+) Normal Level | 136-145 mEq/L
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| Potassium (K+) Normal Level | 3.5-5.0 mEq/L
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| Calcium (Ca++) Normal Level | 9.0-10.5 mg/dL or mg %
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| Magnesium (Mg++) Normal Level | 1.3-2.1 mEq/L
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| Phosphorus (P) Normal Level | 3.0-4.5 mg/dL
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| Chloride (Cl-) Normal Level | 98-106 mEq/L
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