Professional Documents
Culture Documents
Hypokalemia Hyperkalemia
- Potassium, <3.5 mEq/L + Potassium, >5.0 mEq/L
Cation (+), Intracellular (98%) Cation (+), Intracellular (98%)
Cause: Lost in sweat, most diuretics, except those Cause: Less common than hypokalemia.
that work at last distal tubule (thiazide, loop Aldosterone is released, diuretics that work at last
diuretics), kidneys affect potassium levels. distal tubule (thiazide, loop diuretics), kidneys affect
Medications: corticosteroids, sodium penicillin, potassium levels.
amphotericin B, GI loss, common cause: S/S: Severe: Ventricular dysrhythimics, and cardiac
vomiting/GI suctioning. Seen in patients w/persistent arrest, muscle weakness, paralysis, r/t depolarization
insulin hypersecretion, alcoholism, anorexia. block in muscle. Effects primarily on peripheral
S/S: Severe: Death by cardiac/respiratory arrest, nervous system. Nausea, diarrhea, intestinal colic.
fatigue, N/V, muscle weakness, leg cramps, often Treatment: IV Calcium gluconate, beta2 antagonist,
asst/ w/metabolic alkalosis. DX: ECG
Treatment: Diet, cautious IV
Hypocakcemia Hypercakcemia
- Calcium, <8.6 mg/dL + Calcium, <10.2 mg/dL
Cation (+), Calcium plays major role in transmitting Cation (+), Calcium plays major role in transmitting
nerve impulses and helps regulate muscle nerve impulses and helps regulate muscle
contraction/relaxation, including cardiac muscles contraction/relaxation, including cardiac muscles
Cause: Third space shift occurs in these patients. Cause: Malignancies, hyperparathyroidism,
Regulated by parathyroid (PTH). Primary severe/multiple fractures, spinal cord injury, thiazide
hypoparathyroidism. diuretics.
S/S: Tetany (common), increases neural excitability, S/S: Life-threatening, 50% die if not treated
tingling sensation, painful spasms, “Trousseau's sign” promptly. Reduces neuromuscular excitability.
seizures, depression, delirium, ventricular tachycardia. Muscle weakness, in-coordination, constipation,
dyspnea (SOB), laryngospasm. Hyperactive bowel signs, N/V, confusion, impaired memory, slurred speech,
dry/brittle nails. Hyperphosphatremia lethargy, coma. Sever: Cardiac arrest.
Treatment: Diet, cautious IV (life threatening), Treatment: Flurosemide, IV phosphate, 0.9%
avoid too rapid = cardiac arrest preceded by NACL, Calcitonin, increase mobility & push fluids
bradycardia)
Hypomagnesemia Hypermagnesemia
- Magnesium, >1.3 mg/dL + Magnesium, >2.3 mg/dL
Cation (+), ICF Cation (+), ICF
Cause: Loop & thiazide diuretics. NG suctioning, Cause: Renal failure (most common), untreated diabetic
diarrhea/fistulas. Common in acutely & critical ketoacidosis, Addison's disease, hypothermia,
patients, often withdrawal from alcohol & adrenocortical insufficiency, excessive antacids/laxatives,
administration of ET feedings. Aminioglycosides, medications that decrease GI motility (opioids and
digitalis, amphotericin. Occurs in diabetic antichlinergics) excessive injury, necrosis (trauma, shock,
sepsis, cardiac arrest and severe burns.
ketoacidosis, pregnancy, lactation, sepsis, burns,
hypothermia and dysphagia. S/S: Diminishes excitability of muscle cells.
S/S: Increases irritability of muscle & contraction. Decrease BP, N/V, facial flushing, lethargy, difficulty
Neuromuscular junction excitability, Chrostek's & speaking, drowsiness, coma, cardiac arrest.
Trousseau's sign tetany. Treatment: Ventilatory support, IV Calcium
Treatment: Diet, oxide or gluconate form IV gluconate
magnesium sulfate.
Hypophosphatemia Hyperphosphatemia
- Phosphorus, <2.5 mg/dL + Phosphorus, >4.5 mg/dL
Anion (-), Intracellular Anion (-), Intracellular
Cause: Regulated by parathyroid (PTH). During Cause: Regulated by parathyroid (PTH). Renal
administration of calories to patients with severe failure (most common), excessive vitamin D,
protein-calorie malnutrition. Alcoholism. Heat- chemotherapy, hyperparathyroidism, acidosis,
stroke, hyperventilation, diabetic ketoaidosis, muscle necrosis.
respiratory alkalosis, major thermal burns, osmotic S/S: Few. Tetany (most important), anorexia,
diuresis, malignancies. Phosphorus crical component tingling, N/V, bone & joint pain, muscle weakness,
of body's tissues, muscle & RBCs. tachycardia, hyperreflexia, soft tissue calcification.
S/S: Most result from deficiency of ATP, irritability, Treatment: Treat underlying disorder. Surgery for
fatigue, apprehension, weakness, numbness, removal of large calcium & phosphorus deposits.
dysphagia, confusion, seizure, coma, muscle damage
may occur as ATP level drops. Rickets.
Treatment: Prevention! IV phosphorus only for
severe cases. Diet increase phosphorus
Hypochloremia Hyperchloremia
- Chloride, <97 mEq/L + Chloride, >107 mEq/L
Anion (-), ECF Anion (-), ECF
Cause: Lost in sweat. Found in interstitial and Cause: Found in interstitial and lymph fluid (more
lymph fluid (more than blood) gastric, pancreatic than blood) gastric, pancreatic juices, bile & saliva.
juices, bile & saliva. Assist in determining osmotic Assist in determining osmotic pressure. Almost
pressure. Lost in feces. GI tube drainage, GI suction, always because of introgenically induced
N/V, low sodium intake, metabolic alkalosis, hyperchloremic metabolic acidosis from excessive
massive blood transfusion, diuretics, burns & fever. 9.9% NACL, head trauma, increased perspiration,
Hyperkalemia. excessive adrenocortical hormone production,
S/S: Hyperexcitability of muscle, tetany, hypoactive decreased glomerular filtration.
DTRs, weakness, twitching, muscle cramps, avoid look, S/S: Tachypnea, weakness, lethargy, deep rapid
osmotic or thiazide diuretics. respirations, diminished cognitive ability, hypertension.
Treatment: Treat cause of hypochloremia, normal Treatment: Correct underlying cause, Lactated
saline & 0.45% replace chloride. Ammonium ringers, diuretics, IV sodium bicarbonate.
chloride, sometimes used (not for renal failure) diet.
Metabolic Acidosis Metabolic Alkalosis
(Base Bicarbonate -) (Base Bicarbonate +)
- pH, <7.35 - pH, >7.45
Cause: Gain of hydrogen or loss of bicarbonate. Cause: Gain of bicarbonate or loss of hydrogen.
Diarrhea, early renal insufficiency, excessive Vomiting, GI suction, diuretic therapy that potassium
administration of chloride, lactate. wasting (thiazide, furosemide), excessive
S/S: Headache, confusion, drowsiness, increased adrenocorticoid hormone.
respirations, rate/depth, N/V S/S: r/t calcium ionization, tingling finger/toes,
Treatment: Correct imbalance. dizziness, hypertonic muscles, decreased
respirations, tachycardia.
Treatment: Correct underlying cause. Give sodium
chloride fluids, potassium given