Hyponatremia:

<135 mEq/L

      Assessment = nausea, muscle cramps, increased ICP, confusion- Increased ICP and confusion occur because of swelling of the cell, twitching, convulsions

    Causes = excessive water administration/intake/retention- Sodium too low, vomiting, diuretics, SSRI’s- Depression med side effects

Treatment = sodium rich foods, IV normal saline or LR, I&O, daily weight, possible water restriction, hypertonic fluids if severe (ICU only) 

Hypernatremia:

 >145 mEq/L

  Assessment = *thirst*, fever, dry tongue, weakness, disorientation, psychosis, seizures, hyperreflexia- overactive reflexes, tachycardia

    Cause = dehydration- No sodium loss, diarrhea-absorbing sodium losing water, water deprivation or inadequate intake, hypertonic tube feedings without water, hyperventilation, diabetes insipidus- Losing mass amounts of water, diaphoresis, burns, heatstroke, overuse of OTC drugs such as Alka-Seltzer, inhaling large amounts of salt water- near drowning in ocean

   Treatment = hypotonic IV fluid, regular fluid intake, decrease sodium in diet, daily weight 

Hypokalemia:

< 3.5 mEq/L

Assessment = anorexia, n/v, muscle weakness, paresthesias, dysrhythmias

    Causes= vomiting, gastric suction, diarrhea, *diuretics*, steroids, inadequate intake

      Treatment= oral potassium supplements, increase dietary intake, IV supplements, assess renal function

PO and IV administration with caution- Potassium is very caustic. PO can cause gastric lesions- Take with juice or food to protect. IV can cause phlebitis infuse slowly and dilute it a lot. 

Hyperkalemia:

>5.0 mEq/L

     Assessment = EKG changes, dysrhythmias, cardiac arrest, muscle weakness, paralysis, nausea, diarrhea

    Causes = renal failure, use of potassium supplements, burns, crushing injuries- potassium is going to leak out into ECF

Treatment = restrict potassium, Kayexalate to induce diarrhea, dialysis, diuretics, IV administration of calcium gluconate-Forces potassium into cells, sodium bicarbonate, regular insulin and dextrose-forcepotassium inside cells

Pseudohyperkalemia – False hyperkalemia on blood draws, if keep tourniquet on too long or if use wrong tube or too small of a needle 

Hypocalcemia:

·         Ionized serum < 4.5 mEq/L or Total serum <8.5 mEq/L

      Assessment = Low calcium more nervous system excitability, tetany-muscle spasms, seizures, confusion, paresthesia, irritability

·      

Causes = hypoparathyroidism- less parathyroid hormone= less calcium released, pancreatitis, renal failure, steroids, loop diuretics, inadequate intake, post-thyroid surgery

·         

Treatment = oral calcium gluconate or chloride, IV calcium gluconate, regular exercise-builds bone, phosphate binding antacids, vitamin D- required for calcium absorption, seizure precautions & safety precautions d/t confusion that is associated with it

·         IV administration caution – Monitor flow, administer slowly

Hypercalcemia:

Too much will slow down things

·    Ionized serum >5.1 mEq/L or Total serum >10.5 mEq/L

·   

 Assessment = sedative effects on nervous system, muscle weakness, constipation, confusion, depressed DTR’s, dysrhythmias, thirst, polyuria

·       

     Cause = cancer-specifically bone cancer, hyperparathyroidism-too much calcium from bone, excessive intake, immobility- not building new bone, excessive antacids

      Treatment = IV normal saline, encourage fluids- help get calcium out, mobilize the patient, IV phosphate, Lasix, IM Salmon Calcitonin- Helps to rebuild bone- help to use calcium and take it in, calcium restriction, surgery for hyperparathyroidism-too much parathyroid hormone

Hypermagnesemia:

>2.5 mEq/L

Assessment = depresses the CNS, depresses cardiac impulses, hypotension, absent DTR’s, shallow respiration

 Diagnosis = renal failure, excessive magnesium administration

Plan/Implementation = D/C supplements, support ventilation, IV calcium gluconate, dialysis, monitor reflexes, teach about OTC drugs with Mg, monitor cardiac rhythm