Client who is hyponatremic may manifest muscle cramps, weakness, fatigue,anorexia, vomiting, diarrhea, nausea, abdominal cramping (early signs at 125 meq/L);cerebral edema symptoms, headache, depression, personality changes, constipation,lethargy, muscle twitching tremors, further progress to convulsions and coma inseverely low levels of sodium(later signs at <120 meq/L).
condition wherein serum potassium levels are below than 3.5 ± 5.0 meq/L.Decrease in potassium (hypokalemia) can profoundly affect the nervous system andincreases the chance of irregular heartbeats (arrhythmias), which, when extreme, canbe fatal.Hypokalemia, or decreased potassium, can arise due to kidney diseases; excessiveloss due to heavy sweating, vomiting, or diarrhea, eating disorders, certain medications,or other causes.Client with low levels of serum potassium may manifest lethal ventricular arrhythmias (flattened T wave, prominent U wave), anorexia, vomiting, constipation,abdominal distention, paralytic ileus, muscle weakness, paralysis, shallow respiration,fatigue, lethargy, decrease tendon reflexes, confusion, depression, polyuria, decraseserum osmolality, and nocturia.
Because hydrogen is abundant in the upper part of the system (Black andHawks, 2008; Medical-Surgical Nursing, Clinical Management for Positive Outcomes,8
edition) thus, excessive vomiting may cause excessive loss of hydrogen thus, resultsto metabolic alkalosis which is defined as the primary increase in HCO
with or withoutcompensatory increase in Pco
; pH may be high or nearly normal. Renal impairment of HCO
excretion must be present to sustain alkalosis. Symptoms and signs in severecases include headache, lethargy, and tetany. Diagnosis is clinical and with
BG andserum electrolyte measurement. The underlying cause is treated; oral or IVacetazolamide or HCl is sometimes indicated.Metabolic alkalosis involving loss or excess secretion of Cl is termed Cl-responsive, because it typically corrects with IV administration of NaCl-containing fluid.Cl±unresponsive metabolic alkalosis does not, and it typically involves severe Mg or Kdeficiency or mineralocorticoid excess. The 2 forms can coexist, eg, in patients withvolume overload made hypokalemic from high-dose diuretics.Symptoms and signs of mild alkalemia are usually related to the underlyingdisorder. More severe alkalemia increases protein binding of ionized Ca
, leading tohypocalcemia and subsequent headache, lethargy, and neuromuscular excitability,sometimes with delirium, tetany, and seizures.
lkalemia also lowers threshold for anginal symptoms and arrhythmias. Concomitant hypokalemia may cause weakness.Diagnosis
BG and serum electrolytes
Diagnosis of cause usually clinical
Sometimes, measurement of urinary Cl