Sodium (135-145 mEq/L)

Primary ECF cation (over 90%)

Regulates osmotic forces
Functions:
Neuromuscular irritability, acid-base balance (sodium bicarbonate and sodium
phosphate), and cellular chemical reactions and membrane transport
Hyponatremia
Related to sodium loss, inadequate sodium intake, and dilution of the bodys sodium
level (dilutional hyponatremia)
Causes:
Vomiting and Diarrhea
Diuretic use
Inappropriate administration of hypotonic IVFs
SIADH (see hypotonic overhydration)
Clinical Manifestations (dependent on the cause of hyponatremia)
Neurologic symptoms: lethargy, confusion
If due to sodium loss: Hypovolemia signs and symptoms
If due to dilutional hyponatremia: watch for s/s of fluid overload
Treatment
Correct underlying condition
Salt tablets, hypertonic solutions
Free water restriction-<800mL/day
Hypernatremia
Related to sodium gain or net water loss
Causes:
Inappropriate administration of hypertonic IVFs
Cushing Disease/Syndrome
Diabetes Insipidus (see hypertonic dehydration)
Clinical Manifestations
Neurologic symptoms
If due to sodium gain: think of fluid overload
If due to net water loss: think of hypovolemia
Treatment
Treat underlying condition if possible
Sodium restriction in sodium gain
Volume repletion, generally with hypotonic solutions if due to hypovolemia
Potassium
Major intracellular cation
Normal: 3.5 - 5.0 mEq/L
Functions:
Essential for transmission and conduction of nerve impulses, normal cardiac rhythms,
and skeletal and smooth muscle contraction
Changes in pH affect K+ balance
Hydrogen ions accumulate in the ICF during states of acidosis. K+ shifts out to maintain a
balance of cations across the membrane.
Hypokalemia
Related to reduced intake of potassium, increased entry of potassium, increased loss of
potassium
Causes
Dietary deficiency, alcoholism, malnutrition
 Diuretics use, diarrhea, prolonged vomiting
Insulin administration
Cushing syndrome
Clinical Manifestations
Causes a decrease in neuromuscular excitability skeletal muscle weakness,
smooth muscle atony (decreased GI motility), parasthesias, glucose intolerance,
and cardiac dysrhythmias
Severe: shallow respirations, polyuria
Treatment
IV or oral potassium
Potentially change diuretic or supplement daily with potassium
Hyperkalemia
Related to increased intake, shift of K+ from ICF to ECF, decreased renal excretion,
insulin deficiency, or cell trauma
Causes
Traumatic injuries, burns
Renal failure
Hyperglycemia
Multiple blood transfusions
Metabolic acidosis
Various medications (digoxin, ACE inhibitors, potassium sparing diuretics)
Aldosterone deficit (Addison's disease)
Clinical Manifestations
Mild attacks: Increased neuromuscular irritability, tingling of lips and fingers,
restlessness, intestinal cramping, and diarrhea
Severe attacks: Muscle weakness, loss or muscle tone, and flaccid paralysis,
cardiac dysrhythmias, respiratory arrest
Treatments
D50 plus insulin (transient therapy for urgent hyperkalemia)
Sodium Bicarbonate-potassium moves into the cells (transient therapy for urgent
hyperkalemia)
IV Calcium
Kaexalate-causes potassium to be excreted in the stool, causes diarrhea as well.
Diuretics
Calcium

99% of calcium is located in the bone as hydroxyapatite with balance controlled by parathyroid
hormone and calcitonin
Important ECF cation
Plasma concentration 9 to 11 mg/dL or 3.5 to 4.5 mEq/L
Functions:
Necessary for structure of bones and teeth, blood clotting, hormone secretion, and cell
receptor function
Hypocalcemia
Causes
Inadequate ingestion or intestinal absorption
Low albumin
Hypoparathyroidism
Hypomagnesemia
Chronic kidney disease
Osteoblastic metastases
 Acute pancreatitis
Sepsis, severe burns
Clinical Manifestations:
Muscle cramps, hyperactive reflexes, hyperactive bowel sounds, paresthesias,
Chvostek and Trousseau Signs, delayed heart conduction
Remember increased neuromuscular excitability
Treatment
Various medications
Correct underlying conditions/deficiencies
Magnesium

1.5-2.5 mEq/L
Phosphate

2.5-4.5 mg/dL
Chloride

96-106 mEq/L