HYPOKALEMIA I. Definition -Below 3.5 mEq/L (3.5mmol/L) serum potassium level. -Indicates an actual deficit in total potassium stores. II.

Etiology 1. GI loss of potassium 2. Medications a. Potassium-losing Diuretics b. Corticosteroids c. Sodium penicillin 3. Vomiting and gastric suction 4. Diarrhea 5. Prolonged intestinal suctioning 6. Recent ileostomy 7. Villous adenoma 8. Hyperaldosteronism 9. Insulin hypersecretion 10.Patients who are unable or unwilling to eat a normal diet for a prolonged period of time a. Debilitated elderly patients b. Alcoholic patients c. Patients with anorexia nervosa 11.Magnesium depletion III. Clinical Manifestations 1. Fatigue 2. Anorexia 3. Nausea 4. Vomiting 5. Muscle weakness 6. Leg cramps IV. Medical Management 7. Decreased bowel motility 8. Paresthesias 9. Dysrhythmias 10.Increased sensitivity to digitalis 11.For prolonged hypokalemia, dilute urine and excessive thirst 12.For severe hypokalemia, cardiac or respiratory arrest then death. d. Carbenicillin e. Amphotericin

Increase potassium intake in the daily diet.5. Prevention a. Careful monitoring of intake and output. it should be administered through a central IV catheter using an infusion pump. 3.3. (40mEq/L is lost for every 1L of urine) 3. Correcting Hypokalemia a. Administer as per policy standards. together with serum potassium levels after the IV administration. 3. Decreased renal excretion of potassium as in Renal Failure 3. Fresh and Frozen vegetables a. but the maximum concentration is 20mEq/100mL at rate no faster than 10-20 mEq/hr.c. V.2.1. Nursing Management 1. IV potassium supplements such as KCl. 2.b. 2.b. Monitor patient for signs and symptoms. If the hypokalemia is caused by abuse of laxatives or diuretics. or KPO4 or potassium acetate through an infusion pump.1. Check potassium requirements b. Definition Greater than 5mmol/L (5mEq/L ) serum potassium levels II. Fresh meats a. Pseudohyperkalemia . Oral supplements such as salt substitutes and Oral hydration solutions 3. c. provide patient education. Monitor ECG for changes and check ABG for elevated bicarbonate and pH levels.1 Ensure that adequate urine flow is established. Processed foods b. Encourage patient to eat foods rich in potassium (when the diet allows) a. Etiology 1. assess serum potassium concentration. HYPERKALEMIA I. c. Milk a.4.b. Iatrogenic causes 2.2. citrus fruits a. Monitor BUN and creatinine levels. melon. Administer IV potassium 3. For concentrations higher than 2omEq/100mL. Fruits – bananas.

3. Familial pseudohyperkalemia 4. Captopril 6. Heparin c. 5. Immediate and continuous ECG monitoring. Clinical Manifestations 1. Emergency Pharmacologic Therapy . Slow ventricular conduction 3. 2. Potassium –sparing diuretics d. III. Monitor serum potassium levels. Hemolysis of blood sample before analysis c. and diarrhea IV. At risk are patients with hypoaldosteronism or Addison’s disease. NSAIDs f. Medications as probable contributing factor a. 5. 4. lysis of malignant cells after chemotherapy. ACE inhibitors e. Use of a tight tourniquet around an exercising extremity while drawing a blood sample b. Skeletal muscle weakness and even paralysis R/T depolarization block in muscle 2. GI manifestations – Nausea. Occurrence of extensive tissue trauma such as burns. Thrombocytosis e. Drawing blood above a site where potassium is infusing f. restriction of dietary potassium and potassium-containing medications. Ascending muscular weakness leading to flaccid quadriplegia 4. Paralysis of respiratory and speech muscles 5.a. KCl b. intermittent intestinal colic. Marked leukocytosis d. crushing injuries or severe infections. In non-acute situations. Medical Management 1. Administration of Cation exchange resins (Kayexalate) for patients with renal impairment and if the patient does not have paralytic ileus.

II. Peritoneal dialysis. salt substitutes to patients with renal dysfunction.. Phospates . IV administration of sodium bicarbonate to alkalinize the plasma and cause temporary shift of potassium into the cells. 3. For dangerously elevated serum potassium levels. e. Definition -Lower than 8. Cisplatin e. Mithramycin g. c.6 mmol/L (8. HYPOCALCEMIA I. Loop diuretics increase water excretion by inhibiting reabsorption of K. Advise patients to take potassium-rich foods in moderation. c. Avoid prolonged use of a tourniquet while drawing the blood sample. Na and Cl. hemodialysis may be done. administer IV calcium gluconate to antagonize the action of hyperkalemia on the heart. Closely monitor for signs and symptoms those patients at risk for potassium excess eg. with renal failure. Serum potassium levels should be monitored periodically. Deliver the blood sample immediately to the laboratory as soon as possible. Corticosteroids f. 4. Prevention a. V. IV administration of regular insulin and a hypertonic dextrose solution.a. Caution patients to use salt substitutes sparingly if they are taking potassiumsparing diuretics d. potassium supplements. b. b. Do not administer potassium-sparing diuretics. To avoid false positive serum potassium values. For patients at risk.6mEq/L) total serum calcium level. c. a. Aminoglycosides c. Medications predisposing to hypocalcemia: a. encourage them to stick to prescribed potassium restriction b. Etiology 1. Advise patient not to exercise the extremity immediately before blood sample is obtained. Aluminum-containing antacids b. 2. If the hyperkalemic condition is not transient. Nursing Management 1. Caffeine d. d.

extended interphalangeal joints with fingers together. 3. b. Depression b. Trousseau’s sign – by inflating a BP cuff on the upper arm 20 mmHg above systolic pressure. Sensations of tingling in the tips of the fingers. Delirium e. Low serum albumin levels 9. Impaired memory c. Medullary thyroid carcinoma 8. flexed wrist and metacarpopharyngeal joints. Spasms of the muscles of face and extremities 2. Chronic hypocalcemia . Mental changes such as a.twitching of muscles supplied by the facial nerve when the nerve is tapped 2 cm anterior to the earlobe. Dyspnea b. within 2-5 mins. Tetany – entire symptom complex induced by increased neural excitability. Laryngospasm 7. Isoniazed i. Occurs and is common in patients with pancreatitis due to increased secretion of glucagon which results to increased secretion of calcitonin. Respiratory effects a. Magnesium deficiency 7. just below the zygomatc arch. Inadequate Vit D consumption 6. Confusion d. Clinical Manifestations 1. Elderly people with osteoporosis have an increased risk because bed rest increases bone resorption. Hyperphosphatemia 5. Alkalosis 10.Alcohol abuse III. An adducted thumb. 4. around the mouth and in the feet. Chvostek’s sign. Hallucinations 6. Seizures 5. a. 4. 3. Loop diuretics 2.h.

6. Observe patients at risk for signs and symptoms 2. and use of lithium Clinical Manifestations 1. Encourage patient to do weight-bearing exercises in decreasing bone loss. Aluminum hydroxide. Malignancies and Hyperparathyroidism 2. Nursing Management 1. Caution patients using laxatives and antacids that contain phosphorus because they decrease calcium absorption. Safety precautions are taken if the condition is severe 3. Vitamin A and Vitamin D intoxication. Abnormal clotting Medical Management 1. Bone mineral loss during immobilization causing elevated total calcium in the bloodstream.a. HYPERCALCEMIA Definition -excess of calcium in the plasma. Dry and brittle hair and nails c. Advise patient to consider calcium supplements but must be taken in divided doses with meals. Etiology 1. IV calcium administration (Calcium Chloride ) 2. Thiazide diuretics 4. is a dangerous imbalance when severe. 3. 7. calcium acetate or calcium carbonate may be given to decrease elevated phosphorous levels in patients with CRF. V. Muscle weakness . Hyperactive bowel sounds b. hypercalcemic cases has a mortality rate as high as 50% if not treated promptly. Vitamin D therapy 3. Emphasize that alcohol and caffeine inhibit calcium absorption and moderate cigarette smoking increases urinary calcium excretion. V. Take adequate dietary calcium 4. 5.

5. Biphosphonates Pamidronate (Aredia) and Etidronate (Didronel) inhibit osteoclast activity. 3. Coma IV. Excessive urination 8. Vomiting 6.2. Furosemide increases calcium excretion. Confusion d. Increase patient mobility and ambulation. 6. Monitor patients who are at risk. Abdominal cramps e. 7. Constipation 5.Medical Management 1. IV administration of 0. Slurred speech 10. IV administration of phosphate can cause reciprocal drop in serum calcium. Lethargy c. Encourage patient to drink fluids containing sodium unless contraindicated. Anorexia 4. Acute psychotic behavior 11. mobilize the patient.9% NaCl solution. lumphomas and leukemia. . 4. Hypercalcemic crisis – acute rise of serum calcium level to 17 mg/dL: a. and restricting dietary calcium intake. Peptic ulcer symptoms b. 3. Nursing Management 1. General measures include administering fluids to dilute serum calcium and promote its excretion by the kidneys. Incoordination 3. Excessive thirst secondary to polyuria 9. 2. Abdominal and bone pain 7. Corticosteroids may be used for patients with sarcoidosis. myeloma. Calcitonin to lower serum calcium level for patient with renal failure or heart disease. 2.

. Encourage patient to drink 3 to 4 quarts of fluid daily. 7.4. paroxysmal atrial tachycardia. heart block) for abnormalities. Provide patient safety as necessary when mental symptoms are present. Assess patient for signs and symptoms of digitalis toxicity. 8. 6. Adequate fiber should be provided in the diet. 5. Monitor ECG changes (premature ventricular contractions.