Electrolytes are regulated by:Normal organ & gland function | Intake, output | Acid-base balance | Hormones | Cell integrity |
ElectrolytesSodium | 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 - HyponatremiaWater 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 - HypokalemiaCauses | 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
| | Organs & glands associated with F&E balanceLungs & 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 - HypernatremiaHypernatremia 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 | | | Diuretics | | | Sodium restriction | | | Seizure precautions | | | If severe - dialysis | Sodium must be reduced slowly to avoid swelling in the brain, causing seizures |
Potassium Imbalance - HyperkalemiaVery 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 |
RecapHyponatremia | 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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