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Potassium - cation that is more prevalent inside - used to transmit and conduct neurological impulses and to maintain cardiac

rhythms - used to contract skeletal and smooth muscles. - regulates intracellular osmolality and promotes cell growth - normal serum potassium is between 3.5 to 5.3 (mEq/L). - Caution: Serum potassium less than 2.5 mEq/L or greater than 7.0 mEq/L can cause the patient to have a cardiac arrest. - Dse such as kidney disease can cause potassium to become imbalanced. - Caution: This deficit cannot be corrected rapidly. The infusion should not exceed 10 to 20 mEq per hour or the patient may experience hyperkalemia and can experience cardiac arrest. - Be alert that infusions containing potassium may cause pain at the IV insertion site. - If urine output is <30 mL/hour notify doc . - Infusions should not contain >60 mEq/L KCl 40 mEq/L is the preferred amount to add to 1000 mL of IV - Warning: NEVER give potassium as an IV push or intravenous bolus. This will cause immediate cardiac arrest which is not reversible with cardiopulmonary resuscitation. Potassium must be diluted in IV fluids as stated above. Don’t give potassium if the patient suffers from renal insufficiency, renal failure, or Addison’s disease. Do not give potassium if the patient has hyperkalemia, severe dehydration, acidosis, or takes potassium-sparing diuretics. Use with caution with patients who have cardiac disorders or burns.

Hyperkalemia - serum potassium level greater than 5.3 mEq/L. Factors: • Impaired renal excretion (most common) • Massive intake of potassium. • Medications such as potassium-sparing diuretics Aldactone and Dyrenium, angiotensin-converting enzyme (ACE) inhibitors Vasotec and Prinivil, which reduce the kidney’s ability to secrete potassium.

signs and symptoms: • Nausea. • Cold skin; grayish pallor. • Hypotension. • Mental confusion and irritability. • Abdominal cramps. • Oliguria (decreased urine output). • Tachycardia (fast pulse) and later bradycardia (slow pulse). • Muscle weakness to flaccid paralysis. • Numbness or tingling in the extremities. • Peaked T waves on the EKG.

Interventions: risk for seizures, injury related to muscle weakness, and cardiac arrhythmias. • Restrict intake of potassium rich foods. • Administer diuretics and ionexchange resins such as Kayexalate (retention enema) as directed to increase the elimination of potassium. • Dialysis therapy may be ordered in critical cases to remove potassium. • Administer insulin and glucose parenterally to force potassium back inside cells. • Administer sodium bicarbonate intravenously to correct the acidosis (elevate pH). • Administer calcium gluconate intravenously to decrease the irritability of the heart; it does not promote potassium loss.

Hypokalemia - serum potassium level of less than 3.5 mEq/L Factors • Diarrhea. • Vomiting. • Fistulas. • Nasogastric suctionings. • Diuretics. • Hyperaldosteronism. • Magnesium depletion. • Diaphoresis. • Dialysis. • Increased insulin. • Alkalosis. • Stress (increases epinephrine). • Starvation. • Low potassium in diet.

signs and symptoms : • Leg cramps. • Muscle weakness. • Vomiting. • Fatigue. • Decreased reflexes. • Polyuria. • Irregular pulse. • Bradycardia. The patient may also exhibit an abnormal EKG that shows: • Depressed ST segment. • Flattened T wave. • Presence of U wave. • Premature ventricular contractions.

Interventions: risk for injury related to muscle weakness and cardiac arrhythmias. • Increase dietary intake of potassium. • Teach the patient how to prevent hypokalemia by maintaining an adq. dietary intake. These include fruits, fruit juices, vegetables, or potassium supplements. Bananas and dried fruits are higher in potassium than oranges and fruit juices. • Administer potassium chloride supplements orally (may take 30 minutes for onset) or IV. Use a central IV line for rapid infusion in critical conditions. Take with at least a half a glass of fluid (juice or water) because potassium is extremely irritating to the gastric and intestinal mucosa. • Teach patients the signs and symptoms of hypokalemia and to call the healthcare provider if any of these are experienced.

• The result of major trauma or after surgery (sodium loss) • Excessive ingestion of water (water gain) • Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH).patient losses sodium while the water volume remains normal .patient has increased the volume of water while the sodium concentration remains normal . Most excess sodium is excreted in urine although sodium also leaves the patient as perspiration and in feces. • Administering hypertonic saline solution IV such as Dextrose 5% in saline to restore the serum sodium level.Hypernatremia caused by: • Inadequate water intake. . depolarization (contraction) occurs. • Ingestion of excessive amounts of sodium such as seawater. Monitor: • Vital signs • Fluid intake and output • Serum sodium levels • Dietary sodium intake • Breath sounds and signs of respiratory distress.combines readily in the body with chloride (Cl) or bicarbonate (HCO3) to promote acid-base balance (pH). .When it shifts into the cell.reasons: . • Inability of the pituitary gland to release ADH. which is the ratio of sodium to water. a patient whose consciousness is impaired or who cannot swallow. .serum sodium level. • Inappropriate use of sodium-containing drugs. • Inability of the kidneys to respond to ADH. • Lowering the serum sodium level slowly to avoid the risk of cerebral edema (brain swelling). • Seizures.serum sodium is less than 135 mEq/L. . Hyponatremia . Reasons: .normal range of serum sodium is from 135 mEq/L to 145 mEq/L.A patient’s serum sodium level moves out of the normal range when the patient is retaining too much or too little water. Interventions: • Treating the underlying cause.sodium concentration has increased while the volume of water remains unchanged . . which is a higher-than-normal concentration of sodium.important role in the regeneration and transmission of nerve impulses and affects water distribution inside and outside cells . • Assessing extremities for edema (swelling).kidneys regulate the sodium balance by retaining urine when the sodium concentration is low and excreting urine when the sodium concentration is high.major cation in extracellular fluid found in tissue spaces and vessels. • Headache. • Nausea. • Excess sodium (such as from a hypertonic IV sol’n). when it shifts out of the cell.Regardless of what happened. Hypernatremia . which causes abnormal water retention (sodium loss) or Addison’s Disease • Loss of sodium from the GI tract as a result of diarrhea and vomiting (sodium loss) • The use of potent diuretics (lose water and salt together).serum sodium is greater than 145 mEq/L. . . • Replacing fluid loss with commercially available electrolytic fluids. • Burns and wound drainage (sodium loss) • Intake of too much water caused by polydipsia (excessive thirst) symptoms of hyponatremia: • Fatigue.part of the sodium/potassium pump that causes cellular activity . is the indicator of the sodium level in a patient’s body. • Monitoring breath sounds and respiratory effort for signs of heart failure. is at risk for hypernatremia. such as a frail elderly patient. However. • Monitoring patient’s weight. • Restricting sodium intake. .water volume has decreased while the sodium concentration remains unchanged. the patient experiences hyperosmolality. • Coma. • Muscle cramps. otassium goes back into the cell and repolarization (relaxation) occurs.Sodium .Hyponatremia is caused by: • Profuse sweating on a hot day or after running a marathon • Inappropriate administration of a hypotonic IV solution (sodium loss). This causes water to shift out of cells and into extracellular space resulting in cellular dehydration. . • Inability of the hypothalamus gland to synthesize anti-diuretic hormone (ADH) (which the kidneys require to regulate sodium). .A patient who is alert and can drink water to quench a thirst is at less risk for hypernatremia. signs and symptoms : • Agitation • Restlessness • Weakness • Seizures • Twitching • Coma • Intense thirst • Dry swollen tongue • Edematous (swollen) extremities Interventions: • Replacing water using an IV of 5% dextrose in water or a hypotonic saline solution as ordered. . or a combination of both. has a high or low concentrations of sodium.

• Administer synthetic calcitonin to lower serum calcium concentration • Administer plicamycin (Mithracin) to increase absorption of calcium in bone. and other disorders). as serum calcium decreases.5 mg/dL. Fractures (broken bones) may occur if a calcium deficit persists because of calcium loss from the bones (demineralization). Conversely. which binds primarily with albumin. • Depressed reflexes. 1. • Fractures (occur when calcium leaves the bone due to cancer. • Vomiting. PTH moves calcium out of bone and into the serum. • Hypertension. • Cancer. amikacin.serum calcium level is lower than 8. Tums. • Decreased memory. increases reabsorption of calcium in the kidneys.plays a critical role in transmission of nerve impulses. Half of the patient’s total calcium is in the free ionized form. blood clotting.normal serum calcium ranges between 8. serum phosphorus increases.5 mg/dL. • Numbness and tingling in the face. Too little calcium intake causes calcium to leave the bone to maintain a normal calcium level. Complex form. Protein bound. • Increase dietary calcium to 1500 mg/day by eating . • Hallucinations.The level of calcium is regulated by the PTH. and vitamin D. 3. • Ventricular tachycardia. 2. Meds That Increases Serum Calcium Calcium salts Vitamin D IV lipids Kayexalate androgens Diuretics (Thiazides. • Kidney stones. • Prolonged diarrhea. This usually produces a high serum phosphorus level. • Polyuria (frequent urination). • Muscular weakness. tobramycin) Phosphate preparations: oral. prednisone) Loop diuretics (furosemide [Lasix]) symptoms: • Depression. It reverses action of PTH by increasing the absorption of calcium by bone. Chlorthalidone. Free ionized form. • Anorexia. This reflects the calcium level for all three forms of calcium.equal proportion in intracellular fluid and extracellular fluid. If given IV. . Megacal) 650–1500 mg tablets Calcium gluconate (Kalcinate) 500–1000 mg tablets Calcium lactate 325–650 mg tablets Calcium citrate 950 mg tablet • Take safety precautions because the patient is at risk for tetany and seizures. Caution: tissue infiltration leads to necrosis and sloughing. • Constipation. .combined with phosphate in bone and with protein (albumin) in the serum. capsule. • Excess intake of calcium supplements (such as in Tums and other medications to prevent and treat osteoporosis). Do not mix with a saline solution because sodium encourages the loss of calcium. which is where calcium is combined with phosphate. • Administer parenteral calcium.5 mg/dL . • Excessive use of diuretics. . potassium phosphate) Corticosteroids (cortisone. serum phosphorus decreases. • Personality changes or mood swings. Hypocalcemia . • Confusion. decreases calcium absorption in Hypercalcemia .Calcium . Hygroten) signs and symptoms: • Patients with mild hypercalcemia may have no signs and symptoms • Nausea. and the formation of teeth and bone .There is a balance between calcium and phosphorus. or powder form or IV.produces a low serum phosphorus level. Calcium increases the action of digoxin and can result in cardiac arrest. Hemodialysis is the most effective method to lower calcium levels in severe cases when kidney function is not normal. and IV (sodium phosphate. Calcium preparations can be given PO in tablet. • Ingestion of phosphates. Hypomagnesium caused by alcoholism. • Cardiac arrhythmias. • Tell the patient to refrain from alcohol and caffeine because they inhibit calcium absorption. around the mouth. Caltrate. enema. • Confusion. calcitonin. and in the hands and feet. which is the biologically active form. Administer furosemide  (Lasix) or ethcrynic acid (Edecrin) loop diuretics after adequate fluid intake is established. • Bone pain. • Muscle spasms in the face. • Inadequate intake of dietary calcium and/or Vitamin D. • Immobility. Calcitonin is produced by the thyroid gland. • Hyperparathyroidism. Hypocalcemia is caused by: • Hypoparathyroidism. • Administer the following medication intravenously if ordered: Calcium chloride IV 10mL Calcium gluceptate 5 mL Calcium gluconate 10 mL • Administer the following medication PO if ordered: Calcium carbonate (Oscal. increases the absorption of calcium from the GI tract. As serum calcium increases. • If kidney function is adequate:  dminister isotonic saline IV A to hydrate the patient. • Polydipsia (extreme thirst). • Hyperreflexia. • Abdominal pain. Production is increased when there is a high serum calcium level. around the mouth.serum calcium level is higher than 10. • Memory loss. . • Coma. Meds that Decreases Serum Calcium Magnesium sulfate Propylthiouracil (propacil) Colchicines Pliamythin Neomycin Acetazolamide Aspirin Anticonvulsants Glutethimide Estrogens Aminoglycosides (gentamicin. ionized calcium (iC) levels are sometimes reported separately (4–5 mg/dL). • Thyroid or neck surgery where the parathyroid gland is removed or injured. Hypercalcemia can be caused by: • Renal failure. Low serum calcium causes an increase in the production of PTH. • Make sure the patient performs weight-bearing activities. then mix with 5% dextrose in water. and in the hands and feet. muscle contraction.three forms of calcium in serum that can fluctuate among forms depending on changes to the serum pH and/or serum protein (albumin) levels. Make sure the patient drinks 3000 to 4000 ml of fluid to excrete the calcium in urine. • Overuse of antacids for GI disturbances. citrate. • Take safety measure to protect the patient who experiences neuromuscular effects. • Provide a low-calcium diet. . osteoporosis. Don’t add calcium to bicarbonate or hosphorus because precipitates form. However.5 mg/dL to 10. or carbonate.

serum magnesium level is less than 1. Hypermagnesemia . calcium. • Monitoring signs of magnesium toxicity such as hot flushed skin. bananas. . . . and hypertension green leafy vegetables and fresh oysters and milk products. The patient acquires magnesium by ingesting magnesium-rich food. where it is absorbed in the GI tract and then excreted in urine. . and potassium together. Typically. . laxatives.Diuretics. lethargy. whole grains. certain antibiotics.Magnesium is the coenzyme that metabolizes carbohydrates and proteins and is involved in metabolizing nucleic acids within the cell. and steroids are drug groups that promote magnesium loss. Patients who take lithium (antipsychotic medication) are also at risk for hypermagnesemia. • Hypotension. . • Drowsiness. and DiGel can also cause hypermagnesemia. and calcium.Px with hypomagnesemia may exhibit no signs and symptoms until the serum level approaches 1. and oranges. Treatment includes: • Administering intravenous magnesium sulfate in solution slowly. Keep calcium gluconate available for emergency reversal of hypermagnesemia as a result of overcorrecting hypomagnesemia. . Use an infusion pump to prevent rapid infusion that might result in cardiac arrest. hypotension and laryngeal stridor. • Paralysis.5 mEq/L. and magnesium citrate. Administer vitamin D. • Weakness. • Cardiac (ventricular) arrhythmias.sister cation to potassium and is higher in intracellular fluid (ICF). you’ll assess serum magnesium. Mylanta. • Taking safety precautions for patients who are at risk for seizures and mental confusion. spinach. • Increasing the dietary sources of magnesium including nuts. • Loss of deep tendon reflexes.0 mEq/L. • Monitoring EKG and pulse. which regulates calcium. Hypomagnesemia also enhances the action of digitalis and can cause digitalis toxicity. nxiety. If there is a loss of potassium there is also a loss of magnesium.5 mEq/L and 2.normal serum magnesium level is between 1. Signs of severe hypomagnesemia include tetany-like symptoms caused by hyperexcitability (tremors.serum magnesium level is greater than 2.5 mEq/L. and causes an increase in urine to excrete calcium. Magnesium also has a key role in neuromuscular excitability.5 mEq/L.This can be caused by longterm administration of saline infusions which can result in the loss of magnesium and calcium. signs and symptoms: • Lethargy. Antacids such as Maalox. . milk of magnesia. ventricular tachycardia that leads to ventricular fibrillation. Hypomagnesemia . Magnesium . • Heart block. also influences the magnesium balance. cornmeal. potassium.PTH.the GI tract. twitching of the face).There is a close relationship between magnesium. .Major cause: excessive intake of magnesium salts in laxatives such as magnesium sulfate.

• Vomiting.5 mg/dL. serum calcium decreases. . proteins. The rest of it is stored in tissues throughout the body.serum phosphate is greater than 4. Phosphorus is acquired by eating phosphorus-rich foods. . . • Administering sevelamer (Renagel).primary anion inside the cell and plays a key role in the function of red blood cells. . • Assessing vital signs. • Nausea.5 mg/dL and 4. • Institute seizure precautions.Both phosphate and calcium levels are regulated by parathyroid hormone (PTH). • Chemotherapy for neoplastic disease. • Administering calcium supplements. • Hypocalcemia. . • Diuresis. • Anorexia. • Increased phosphate levels during the last trimester of pregnancy. It is converted to phosphate in the body. Intervention: • Administering phosphate supplements such as Neutra-Phos PO. • Excessive ingestion of phosphate-containing laxatives. • Dialysis. • Muscle weakness. muscles. • Excessive drinking of milk. and the nervous system. the concentration of serum phosphorus decreases and conversely as serum phosphorus increases. Phosphorus is absorbed in the GI tract and excreted in urine and a small amount in feces. • Coma.Most of the body’s phosphate (about 85%) is found in bones. signs and symptoms: • Muscle problems. Both levels are usually measured at the same time.5 mg/dL: • Kidney disease.normal range of serum phosphorus is between 2. Hyperphosphatemia .Phosphorus . signs and symptoms: • Bone and muscle pain.serum phosphate is less than 2.caused by: • Inadequate intake. • Monitor blood levels. • Administering sodium phosphate IV. . • Administering potassium phosphate IV. Abnormally high levels of serum phosphate are usually caused by kidney malfunction. • Underactive parathyroid glands.5 mg/dL . Treatment includes: • Restricting foods and drinks (carbonated soda) high in phosphate. • Institute seizure precautions. • Treating the underlying cause. • Certain bone diseases. Hypophosphatemia . • Assessing changes in metal status. • Rhabdomyolysis. • Hyperreflexia. • Decrease in magnesium levels as in alcoholism. • Healing fractures. • Rhabdomyolysis. • Tetany. • Soft tissue calcification. and fats. • Overuse of phosphatebinding antacids.kidneys regulate the amount of phosphate in the blood. • Tachycardia. As the serum calcium concentration increases. The amount of phosphate in the blood effects the level of calcium in the blood. • Osteomalacia. • Alcoholism. • Acromegaly. • Excessive intake of vitamin D. • Untreated diabetic ketoacidosis. • Confusion. • Steroids.also involved the acid–base buffering and is involved with metabolizing carbohydrates.