The 

nursing diagnosis Risk for Electrolyte Imbalance is defined as at risk for

change in serum electrolyte levels that may compromise health.

Electrolytes regulate nerve and muscle function, hydrate the body,

balance blood acidity and pressure, and further rebuild damaged tissue. Sodium,
calcium, potassium, chloride, phosphate, and magnesium are all electrolytes.
When these substances become imbalanced, it can lead to either muscle
weakness or excessive contraction.

Electrolyte imbalance can occur due to several factors. Various disorders and
their corresponding treatments may put the patient at risk for imbalances in
serum electrolyte concentrations. Patients experiencing congestive heart
failure frequently end up as rebound hospitalizations due to irregular sodium
and potassium levels. Diabetes and hypertension may eventually place a patient
in a calcium or magnesium imbalance. Electrolyte losses may occur from
draining wounds and fistulas, particularly gastrointestinal fistulas. Irregularities
in sodium and chloride concentrations happen frequently in situations
associated with fluid imbalances, primarily gastrointestinal fluid losses such
as vomiting, diarrhea, or suctioning.

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Changes in the secretion of antidiuretic hormone and aldosterone can contribute

to sodium imbalances. Patients receiving diuretics may be at risk for potassium
imbalances. Thyroid and parathyroid problems place the patient at risk for
calcium imbalances. Magnesium imbalances often occur in the same situations
as calcium and potassium imbalances.

Electrolytes are vital for the normal functioning of the human body. A proper
understanding of these imbalances is essential for current management and
future prevention. This care plan and nurse study guide focus on sodium,
potassium, calcium, and magnesium imbalances.

 Risk Factors
 Goals and Outcomes
 Nursing Assessment for Risk for Electrolyte Imbalance
 Nursing Interventions for Risk for Electrolyte Imbalance
 References and Sources

Risk Factors
Here are some factors that may be related to the nursing diagnosis Risk for
Electrolyte Imbalance that you can use for your nursing care plan:

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 Renal dysfunction
 Endocrine dysfunction
 Vomiting
 Diarrhea
 Poor nutrition
 Severe dehydration
 Acid-base imbalance
 Fluid imbalance
 Congestive heart failure
 Cancer treatment
 Hypertension
 Diabetes
 Diuretics
 Bulimia
 Aging
 Fistulas
 Tissue trauma
 Wound drainage
 Significant burns
 Alcohol abuse

Goals and Outcomes

The following are the common goals and expected outcomes for Risk for
Electrolyte Imbalance nursing diagnosis:

 Patient will sustain normal serum electrolyte balance as evidenced

by: sodium level of 136 to 145 mEq/L; potassium level of 3.5 to 5.1
 mEq/L; chloride level of 98 to 107 mEq/L; total calcium level of 9 to 10.5
mg/dL; ionized calcium of 4.6 to 5.1 mg/dL; and magnesium level of 1,8
to 3 mg/dL.

Nursing Assessment for Risk for Electrolyte

Imbalance
The following are the subjective and objective data you need to assess for a
patient with a nursing diagnosis of Risk for Electrolyte Imbalance:

Assessment Rationale

The levels of electrolytes in the body can

become too low or too high. Early detection of
Monitor serum electrolyte levels. abnormality in serum electrolyte levels allows
prompt initiation of measures to prevent
further imbalances.

 Sodium 136 to 145 mEq/L

 Potassium 3.5 to 5.1 mEq/L

 Chloride 98 to 107 mEq/L

 Total calcium 9 to 10.5 mg/dL

 Ionized calcium 4.6 to 5.1 mg/dL

 Magnesium 1.8 to 3 mg/dL

 Phosphate 0.8 to 1.5 mEq/L


Identify any clinical conditions or situations
that may be a factor for an imbalance
in serum electrolytes.
 Dietary consumption
 Tissue trauma and wound
drainage
 Renal dysfunction
 Drug therapy
Assessing a patient for electrolyte imbalance
can give health care providers an insight into
the homeostasis of the body and can serve as
a marker for the presence of other illnesses.
Prevention of electrolyte irregularities begins
with the identification of situations that put
the patient at risk for imbalance.
The patient’s fluid and food intake have a
direct impact on the risk of electrolyte
imbalance. A serum sodium level below 135
mEq/L is considered hyponatremia. This state
can be due to low levels of sodium or to
excess water in connection to the amount of
sodium, referred to as dilutional
hyponatremia.
For bowel to skin fistulas, the body fluid levels
and electrolytes including levels of sodium,
potassium, calcium, and magnesium in the
blood will need to be monitored regularly and
corrected to replace any losses. Extensive
tissue injury may occur with trauma
or burns may cause hyperkalemia, initially.
Eventually, the patient may be at risk for
hypokalemia and hyponatremia.
In this case, electrolyte imbalance can be
caused by reduced renal excretion, excessive
intake or leakage of potassium from the
intracellular space. In addition to acute
and chronic renal failure, hypoaldosteronism,
and massive tissue breakdown as in
rhabdomyolysis are common conditions
influencing hyperkalemia.
Loop and thiazide diuretics increase
sodium delivery to the distal segment of the
distal tubule, this increases potassium loss
and potentially causing hypokalemia because
the increase in distal tubular sodium
concentration stimulates the aldosterone-

 Gastrointestinal fluid losses
 Endocrine dysfunction
 Cancer
sensitive sodium pump to increase sodium
reabsorption in exchange for potassium and
hydrogen ion, which are lost to the urine.
Thiazide diuretics also increase calcium
reabsorption at the distal tubule causing
hypercalcemia. Potassium-sparing diuretics
may cause hyperkalemia. Hypokalemia may
also be associated with prolonged use of
corticosteroids.
Gastrointestinal losses from diarrhea,
vomiting, or nasogastric suctioning also are
typical causes of hypokalemia. Vomiting leads
to hypokalemia via complex pathogenesis.
Gastric fluid holds little potassium, around 10
mEq/L. Nevertheless, vomiting produces
volume depletion and metabolic alkalosis,
which are accompanied by increased renal
potassium excretion.
Variations in the secretion of antidiuretic
hormone from the posterior pituitary gland
place the patient at risk for sodium
imbalances. Changes in the thyroid gland and
parathyroid gland increase the patient’s risk
for calcium imbalances. Disorders linked with
changes in cortisol and aldosterone secretion
from the adrenal cortex put the patient at risk
for imbalance in potassium and sodium.
The most dangerous forms of electrolyte
imbalance in cancer patients is hypercalcemia
or a disorder called tumor lysis syndrome that
results in electrolyte imbalance from the
killing of cancer cells. Both of these can be life-
threatening if not managed appropriately.

Nursing Interventions for Risk for Electrolyte

Imbalance
The following are the therapeutic nursing interventions you can use for your care
plan for Risk for Electrolyte Imbalance nursing diagnosis:
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Nursing Interventions Rationale

Lactated Ringer’s solution has an electrolyte concentration

Supply balanced electrolyte IV
solutions as directed.
similar to that of extracellular fluid. Isotonic saline (0.9%
sodium chloride) may contribute to hypernatremia if used in
a long period of time. Extreme use of sodium free IV
solutions (e.g., D5W) puts the patient at risk for
hyponatremia.

Oral or IV administration of electrolytes may be prescribed

Administer electrolyte
to keep electrolyte balance for patients at risk for
replacements as prescribed.
imbalances.

Hyperkalemia is common in patients with end-stage renal

Consider measures to reduce
excess electrolytes.
disease and may result in serious electrocardiographic
abnormalities. Dialysis is the definitive treatment of
hyperkalemia in these patients. Intravenous calcium is used
to stabilize the myocardium. Kayexalate may be indicated to
patients at risk for electrolyte excesses such as potassium.

Irrigation of nasogastric tubes with plain water produces

Irrigate nasogastric tubes with electrolyte losses. Plain water attracts electrolytes from
isotonic saline, as prescribed. mucosal tissue into the stomach, where they are eliminated
with suctioning.

Electrolytes are salts and minerals, like sodium, potassium,

calcium, magnesium, and chloride, in the body that maintain
fluid balance and blood pressure. A balanced diet provides
the patient with sources of electrolytes to prevent
Educate the patient about imbalances. Milk, yogurt, dark green, leafy vegetables, and
dietary sources of electrolytes. legumes are excellent sources of electrolyte calcium. Whole
grains, nuts, fruits, and vegetables are good sources for
magnesium and potassium. Bananas are known to be the
king of all potassium containing fruits and veggies. Vitamin D
is needed for the absorption of calcium from the intestines.

dill pickles
 Sodium tomato juices, sauces, and soups
table salt
 Potassium potatoes with skin

 Calcium
 Chloride
 Magnesium
Educate the patient about
dietary sources of sodium and making this switch may have benefits for the heart. But
the use of salt substitutes. these potassium-based salt substitutes are not for everyone:
Educate the patient using
potassium-wasting about
potassium replacements.
Educate the patient about
limiting the use of over-the-
counter antacids and laxatives. the blood, because of the reduced ability of the kidneys to
References and Sources
Additional references and further reading about Risk for Electrolyte Imbalance
nursing diagnosis:
plain yogurt
banana
yogurt
milk
ricotta
collard greens
spinach
kale
sardines
tomato juices, sauces, and soups
lettuce
olives
table salt
halibut
pumpkin seeds
spinach
Patients need to learn to read labels to identify all sources of
sodium in foods. Changing from table salt to a potassium-
based salt substitute is another way to shift your sodium-
potassium balance, and some preliminary study implies that
Excess potassium can be fatal for people who
have kidney disease or who are taking medications that can
increase potassium levels in the bloodstream.
To prevent hypokalemia, the patient needs to understand
the importance of potassium replacements that include
dietary sources and prescribed oral replacements such as
potassium chloride (KCl).
Excessive use of antacids that contain magnesium has a
laxative effect that may cause diarrhea, and in patients with
renal failure, they may cause increased magnesium levels in
eliminate magnesium from the body in the urine.
 Metheny, N. (2011). Fluid and electrolyte balance. Jones & Bartlett
Publishers. [Link]
 Carpenito-Moyet, L. J. (2006). Handbook of nursing diagnosis.
Lippincott Williams & Wilkins. [Link]
 Williams, L. S., & Hopper, P. D. (2015). Understanding medical surgical
nursing. FA Davis.