Fluids and Electrolyte disturbances

Fluids and Electrolyte Fluids and Electrolyte

S.Y. 2009 – 2010S.Y. 2009 – 2010

San Juan de Dios Educational San Juan de Dios Educational Foundation Inc. Foundation Inc.

Third- SpacingThird- Spacing Is the accumulation and sequestration of trapped Is the accumulation and sequestration of trapped

intracellular fluid in an actual or potential body intracellular fluid in an actual or potential body space as a result of disease or injury.space as a result of disease or injury.

Trapped fluids represent a volume loss and is Trapped fluids represent a volume loss and is unavailable for normal physiological process. unavailable for normal physiological process.

Fluid may be trapped in body space such as the Fluid may be trapped in body space such as the pericardial, pleural, peritoneal, or joint cavities, pericardial, pleural, peritoneal, or joint cavities, the bowel, or the abdomen, or within soft tissues the bowel, or the abdomen, or within soft tissues after trauma or burns.after trauma or burns.

Assessing the intravascular fluid loss caused by Assessing the intravascular fluid loss caused by third-spacing is difficult. The loss may not be third-spacing is difficult. The loss may not be reflected in weight changes or intake and output reflected in weight changes or intake and output records and may not become apparent until after records and may not become apparent until after organ malfunction occurs. organ malfunction occurs.

Body Fluids ExcretionBody Fluids Excretion

SkinSkin Water is lost through skin in the amount Water is lost through skin in the amount

f about 400ml/dayf about 400ml/day Water lost by perspiration varies Water lost by perspiration varies

according to the temperature of the according to the temperature of the environment and of the body, but the environment and of the body, but the average amount of loss by perspiration average amount of loss by perspiration alone is 100ml/day.alone is 100ml/day.

Water lost through the skin is called Water lost through the skin is called insensible lossinsensible loss


LungsLungs Water is lost from the lungs through Water is lost from the lungs through

expired air that s saturated with water expired air that s saturated with water vapor.vapor.

The amount of water lost from the lungs The amount of water lost from the lungs varies with the rate and the depth of varies with the rate and the depth of respiration.respiration.

The average amount of water lost from The average amount of water lost from the lungs is about 350 ml/daythe lungs is about 350 ml/day


Gastrointestinal TractGastrointestinal Tract Large quantities of water are secreted Large quantities of water are secreted

into the gastrointestinal tract, but almost into the gastrointestinal tract, but almost all this fluid is reabsorbed.all this fluid is reabsorbed.

A large volume of electrolyte containing A large volume of electrolyte containing liquids moves into the gastrointestinal liquids moves into the gastrointestinal tract and then returns again into the tract and then returns again into the extracellular fluids.extracellular fluids.

150 ml/ day – feces, equal to the amount 150 ml/ day – feces, equal to the amount of water gained through oxidation of of water gained through oxidation of foods.foods.


KidneysKidneys Play major role in regulating fluids and Play major role in regulating fluids and

electrolyte balance.electrolyte balance. Normal kidneys can adjust the amount of Normal kidneys can adjust the amount of

water and electrolytes leaving the body. water and electrolytes leaving the body. The quantity of fluids excreted by the The quantity of fluids excreted by the

kidneys is determined by the amount of kidneys is determined by the amount of waste and solutes excreted.waste and solutes excreted.

Urine output – 1500ml/dayUrine output – 1500ml/day

Electrolyte Balance Electrolyte Balance Ions – electrically charged particles Ions – electrically charged particles

Two kinds of IonsTwo kinds of Ions(+) Cation (+) Cation

CalciumCalcium MagnesiumMagnesium PotassiumPotassium Sodium Sodium

(-) Anions(-) Anions BicarbonateBicarbonate ChlorideChloride Phosphorus Phosphorus

Neural electrical charge called Neural electrical charge called electroneutralityelectroneutrality

Calcium (Ca)Calcium (Ca) A major cationA major cation Found in teeth and bones and unfairly equal Found in teeth and bones and unfairly equal

concentrations in intracellular fluid (ICF) and concentrations in intracellular fluid (ICF) and extra cellular fluids (ECF)extra cellular fluids (ECF)

Also found in cell membranes, where it help cells Also found in cell membranes, where it help cells adhere to one another and maintain their shapes.adhere to one another and maintain their shapes.

Acts as an enzyme activator within cells (muscle Acts as an enzyme activator within cells (muscle must have Ca to contract)must have Ca to contract)

Aids coagulationAids coagulation Affects cell membrane permeability and firing Affects cell membrane permeability and firing

level level

Magnesium (Mg)Magnesium (Mg)

A leading ICF cationA leading ICF cation Contributes to many enzymatic and Contributes to many enzymatic and

metabolic processes, particularly metabolic processes, particularly protein synthesis.protein synthesis.

Modifies nerve impulse transmission Modifies nerve impulse transmission and skeletal muscle response and skeletal muscle response (unbalanced Mg concentration (unbalanced Mg concentration dramatically affect neuromuscular dramatically affect neuromuscular process) process)

Potassium (K)Potassium (K)

Main ICF cationMain ICF cation Regulates cell excitabilityRegulates cell excitability Permeates cell membranes, thereby Permeates cell membranes, thereby

affecting the cell’s electrical statusaffecting the cell’s electrical status Helps to control ICF osmolality and Helps to control ICF osmolality and

consequently, ICF osmotic pressure. consequently, ICF osmotic pressure.

Sodium (Na)Sodium (Na)

Main ECF cationMain ECF cation Helps govern normal ECF osmolality Helps govern normal ECF osmolality

(a shift in Na concentration triggers a (a shift in Na concentration triggers a fuild volume change to restore fuild volume change to restore normal solute and water ration)normal solute and water ration)

Helps maintain acid-base balanceHelps maintain acid-base balance Influences water distribution (with Influences water distribution (with

chloride)chloride)

Chloride (Cl)Chloride (Cl)

Main ECF anionMain ECF anion Helps maintain normal ECF osmolalityHelps maintain normal ECF osmolality Affects body pHAffects body pH Plays a vital role in maintaining acid-Plays a vital role in maintaining acid-

base balance; combines with base balance; combines with hydrogen ions to produce hydrochloric hydrogen ions to produce hydrochloric acid.acid.

Bicarbonate (HCOBicarbonate (HCO33-)-)

Present in ECFPresent in ECF Regulates acid – base balanceRegulates acid – base balance

Phosphorus (P)Phosphorus (P)

Main ICF anionMain ICF anion Promotes energy storage and Promotes energy storage and

carbohydrate, protein, and fat carbohydrate, protein, and fat metabolism.metabolism.

Acts as a hydrogen bufferActs as a hydrogen buffer

P K Ca

Ca Mg

Ca

Ca

Na

HCO3 -Cl

Measurement of electrolyteMeasurement of electrolyte

Milli equivalents (meq) per liter) a measure of chemical activity being equivalent to the

electrochemical activity of 1mg of hydrogen

in a solution, cations and anions are equal in msq /L

Approximate Major Electrolyte Content in Body Fluid

ELECTROLYTES MEQ/LExtracellular Fluid (Plasma)CationsSodium (NA) 142Potassium (K) 5Calcium (CA++) 5Magnesium (MG++) 2Total cations 154

AnionsChloride(CI-) 103Bicarbonate(HCO 3-) 26Phospate (HPO4--) 2Sulfate (SO4--) 1Organic Acids 5Proteinate 17Total anions 154

Intracellular FluidCationsPotassium (K+) 150Magnesium (MG++) 40Sodium (Na+) 10Total cations 200

Interpreting serum electrolyte Interpreting serum electrolyte test resulttest result

ElectrolytElectrolytee

ResultResult ImplicationsImplications Common Common CausesCauses

CalciumCalcium 8.9 to 10.1 8.9 to 10.1 mg/dlmg/dl

NormalNormal

< 8.9 mg/dl< 8.9 mg/dl

>10.1 >10.1 md/dlmd/dl

HypocalcemiHypocalcemiaa

HypercalcemiHypercalcemiaa

Acute Acute pancreatitpancreatitisis

HyperparaHyperparathyroidismthyroidism

ElectrolyElectrolytete


Calcium, Calcium, ionizedionized

4.5 to 4.5 to 5.1 5.1 mg/dlmg/dl

NormalNormal

< 4.5 < 4.5 mg/dlmg/dl

> 5.1 > 5.1 mg/dlmg/dl

HypochloremiHypochloremiaa

HyperchloreHyperchloremiamia

Prolonged Prolonged vomitingvomiting

HypernatreHypernatremiamia



ChlorideChloride 96 to 96 to 106 106 mEq/LmEq/L

NormalNormal

< 96 < 96 mEq/LmEq/L

> 106 > 106 mEq/LmEq/L

HypochloremHypochloremiaia

HyperchloreHyperchloremiamia

Prolonged Prolonged vomitingvomiting

HypernatreHypernatremiamia


ResulResultt

ImplicationsImplications Common Common CausesCauses

MagnesiuMagnesiumm

1.5 to 1.5 to 2.5 2.5 mEq/mEq/LL

NormalNormal

< 1.5 < 1.5 mEq/mEq/LL

> 2.5 > 2.5 mEq/mEq/LL

HypomagnesHypomagnesemiaemia

HypermagneHypermagnesemiasemia

MalnutritioMalnutritionn

Renal Renal FailureFailure


ResultResult ImplicatioImplicationsns

Common Common CausesCauses

MagnesiuMagnesiumm

2.5 to 2.5 to 4.5 4.5 mg/dl1.8 mg/dl1.8 to 2.6 to 2.6 mEq/LmEq/L

NormalNormal

< 2.5 < 2.5 mg/dl or mg/dl or 1.8 1.8 mEq/LmEq/L

> 4.5 > 4.5 mg/dl mg/dl 2.6 2.6 mEq/LmEq/L

HypophosHypophosphatemiaphatemia

HyperHyper

Diabetic Diabetic KetoacidosiKetoacidosiss

Renal Renal insufficiencinsufficiencyy

Maintaining Fluids and Maintaining Fluids and Electrolytes BalanceElectrolytes Balance

Concentration and composition of Concentration and composition of fluids must nearly constant.fluids must nearly constant.

Substance deficient either fluids or Substance deficient either fluids or electrolytes must be replaced.electrolytes must be replaced.

Excess of fluids or electrolytes, Excess of fluids or electrolytes, therapy is directed towards assisting therapy is directed towards assisting the body to eliminate the excess.the body to eliminate the excess.

Maintaining Fluids and Maintaining Fluids and Electrolytes BalanceElectrolytes Balance

The kidney plays a major role in controlling The kidney plays a major role in controlling all types of balance in fluids and electrolytes. all types of balance in fluids and electrolytes.

Adrenal gland, through excretion of Adrenal gland, through excretion of aldosterone, also aid in controlling aldosterone, also aid in controlling extracellular fluids volume by regulating the extracellular fluids volume by regulating the amount of sodium reabsorbed by the amount of sodium reabsorbed by the kidneys.kidneys.

Antidiuretic hormone from the pituitary gland Antidiuretic hormone from the pituitary gland regulates the osmotic pressure of regulates the osmotic pressure of extracellular fluids by regulating the amount extracellular fluids by regulating the amount of water reabsorbed by the kidney. of water reabsorbed by the kidney.

Types of Fluid Volume Types of Fluid Volume DeficitDeficit

Isotonic Dehydration Isotonic Dehydration Water and dissolved electrolytes are lost Water and dissolved electrolytes are lost

in equal proportions.in equal proportions. Known as hypovolemia, isotonic Known as hypovolemia, isotonic

dehydration is the most common type of dehydration is the most common type of dehydration. dehydration.

Isotonic dehydration results in Isotonic dehydration results in decreased circulating blood volume and decreased circulating blood volume and inadequate tissue perfusioninadequate tissue perfusion


Hypertonic dehydration Hypertonic dehydration Water loss exceeds electrolyte loss.Water loss exceeds electrolyte loss. Fluids moves from the intracellular Fluids moves from the intracellular

compartment into the plasma and compartment into the plasma and interstitial fluid spaces, causing cellular interstitial fluid spaces, causing cellular dehydration and shrinkage. dehydration and shrinkage.


Hypotonic DehydrationHypotonic Dehydration Electrolyte loss exceeds water loss.Electrolyte loss exceeds water loss. The clinical problems that occurs result The clinical problems that occurs result

from fluids shifts between compartments, from fluids shifts between compartments, causing a decrease in plasma volume.causing a decrease in plasma volume.

Fluid moves from the plasma and Fluid moves from the plasma and interstitial fluids spaces into the cells, interstitial fluids spaces into the cells, causing a plasma volume deficit and causing a plasma volume deficit and causing the cells to swell.causing the cells to swell.

Causes of Fluids volumes Causes of Fluids volumes deficitsdeficits

Isotonic Dehydration Isotonic Dehydration Inadequate intake of fluids and solutesInadequate intake of fluids and solutes Fluids shifts between compartmentFluids shifts between compartment Excessive losses of isotonic body fluidsExcessive losses of isotonic body fluids

Hypertonic DehydrationHypertonic Dehydration excessive perspiration, excessive perspiration,

hyperventilation, ketoacidosis, hyperventilation, ketoacidosis, prolonged fevers, diarrhea, early-stage prolonged fevers, diarrhea, early-stage renal failures, and diabetes insipidusrenal failures, and diabetes insipidus


Hypotonic DehydrationHypotonic Dehydration Chronic IllnessChronic Illness Excessive fluid replacementExcessive fluid replacement Renal FailureRenal Failure Chronic Malnutrition Chronic Malnutrition

AssessmentAssessment

CardiovascularCardiovascular Thready, increased pulse rateThready, increased pulse rate Decreased blood pressure and Decreased blood pressure and

orthostatic hypotensionorthostatic hypotension Flats neck and hand veins in dependent Flats neck and hand veins in dependent

positionspositions Diminished peripheral pulses.Diminished peripheral pulses.

RespiratoryRespiratory Increased rate and depth of respirationsIncreased rate and depth of respirations


NeuromuscularNeuromuscular Decreased CNS activity, from lethargy to comaDecreased CNS activity, from lethargy to coma FeverFever

RenalRenal Decreased urinary output Decreased urinary output Increased urinary specific gravity Increased urinary specific gravity

IntegumentaryIntegumentary Dry skinDry skin Poor turgorPoor turgor Dry mouthDry mouth


Gastrointestinal Gastrointestinal Decreased motility and diminished bowel Decreased motility and diminished bowel

soundssounds ConstipationConstipation ThirstThirst Decreased body weightDecreased body weight

Hypotonic dehydration: skeletal muscle Hypotonic dehydration: skeletal muscle weaknessweakness

Hypertonic dehydration: Hyperactive deep Hypertonic dehydration: Hyperactive deep tendon reflexes and pitting edema.tendon reflexes and pitting edema.

Laboratory FindingsLaboratory Findings

Increased serum osmolalityIncreased serum osmolality Increased hematocritIncreased hematocrit Increased blood urea nitrogen (BUN) Increased blood urea nitrogen (BUN)

levellevel Increased serum sodium level.Increased serum sodium level.

GoalGoal

Restore fluids volume, replace Restore fluids volume, replace electrolytes as needed, and eliminate electrolytes as needed, and eliminate the cause of the fluids volume deficit. the cause of the fluids volume deficit.

Intervention Intervention MonitorMonitor Prevent further fluids losses and increase Prevent further fluids losses and increase

fluids compartment volume to normal fluids compartment volume to normal ranges.ranges.

Provide oral rehydration therapy if Provide oral rehydration therapy if possible and IVF if the dehydration severepossible and IVF if the dehydration severe

Monitor intake and out putMonitor intake and out put Isotonic = isotonic, hypotonic = hyperonic, Isotonic = isotonic, hypotonic = hyperonic,

hypertonic = hypotoninchypertonic = hypotoninc Administered medication and oxygen as Administered medication and oxygen as

prescribed.prescribed. Monitor electrolyte valuesMonitor electrolyte values

Nursing diagnosis: fluid volume deficit due to insufficient Nursing diagnosis: fluid volume deficit due to insufficient fluid intake, vomiting, diarrhea, hemorrhage or third fluid intake, vomiting, diarrhea, hemorrhage or third space fluid loss (ascites, burns)space fluid loss (ascites, burns)

Planning: client's fluid balance will be restored as evidenced Planning: client's fluid balance will be restored as evidenced by vital signs within normal range, return to baseline by vital signs within normal range, return to baseline body weight, equal intake and output, urine output of body weight, equal intake and output, urine output of greater than 600ml/ day, dim turgos at 2 seconds, or greater than 600ml/ day, dim turgos at 2 seconds, or less and moist mucous membranesless and moist mucous membranes

Implementation: Implementation: a.a. vital sign assessed every 2 to 4 hours and compared vital sign assessed every 2 to 4 hours and compared

with baseline vital signswith baseline vital signsb.b. positional blood pressure should be assessed to positional blood pressure should be assessed to

determine degree of ostotrasis,determine degree of ostotrasis,

c.c. Urine output be assesses hourly if success per shift in mild Urine output be assesses hourly if success per shift in mild cases and per day should be compared with intake for the cases and per day should be compared with intake for the same time frame absence of urine output in 8 to 12 hours same time frame absence of urine output in 8 to 12 hours may indicate renal insufficiency because of decrease renal may indicate renal insufficiency because of decrease renal perfusion.perfusion.

d.d. Daily weight monitoring, a loss of 1kg is equivalent to 1 Daily weight monitoring, a loss of 1kg is equivalent to 1 liters, a 3.6 kg. weight loss equals approximately 3.L liters liters, a 3.6 kg. weight loss equals approximately 3.L liters which is indicates of a moderate fluid volume deficitwhich is indicates of a moderate fluid volume deficit

e.e. The nurse should apply lotion to the gleim to pressure them The nurse should apply lotion to the gleim to pressure them integrity. The client’s position should be changed way 2 integrity. The client’s position should be changed way 2 hours, oral care should be given every 2 hours with a hours, oral care should be given every 2 hours with a nonalcoholic-based solution. Lips should be moistened nonalcoholic-based solution. Lips should be moistened frequently.frequently.

f.f. Serum sodium, BUN, glucose and hematocrit levels should Serum sodium, BUN, glucose and hematocrit levels should be closely monitored to determine the serum osmolality.be closely monitored to determine the serum osmolality.

g.g. g) Clinical manifestation of fluid overload include dyspnea, g) Clinical manifestation of fluid overload include dyspnea, crackles and jugular vein engorgement.crackles and jugular vein engorgement.

Types Types

Isotonic overhydrationIsotonic overhydration Know as hypervolemia: excessive fluids Know as hypervolemia: excessive fluids

in the extracellular fluid compartments.in the extracellular fluid compartments. ECF is expanded, and fluids doesn’t shift ECF is expanded, and fluids doesn’t shift

between the extracellular and between the extracellular and intracellular compartment. intracellular compartment.

Cause circulatory overload and Cause circulatory overload and interstitial edema. Severe: congestive interstitial edema. Severe: congestive heart failure and pulmonary edema.heart failure and pulmonary edema.

TypesTypes

Hypertonic overhydrationHypertonic overhydration Occurrence is rare: caused by excessive Occurrence is rare: caused by excessive

sodium intake.sodium intake. Fluids is drawn from the intracellular Fluids is drawn from the intracellular

fluid compartment; the extracellular fluid compartment; the extracellular fluids volume expands, and the fluids volume expands, and the intracellular fluids volume contract. intracellular fluids volume contract.

TypesTypes

Hypotonic overhydrationHypotonic overhydration Know as water intoxicationKnow as water intoxication Excessive fluids moves into the Excessive fluids moves into the

intracellular space, and all body fluids intracellular space, and all body fluids compartments expands.compartments expands.

Electrolyte imbalance occur as a result Electrolyte imbalance occur as a result of dilutionof dilution

CausesCauses

Isotonic overhydrationIsotonic overhydration Inadequately controlled IV therapyInadequately controlled IV therapy Renal failureRenal failure Long-term corticosteroid therapyLong-term corticosteroid therapy

Hypertonic overhydrationHypertonic overhydration Excessive ingestion of sodiumExcessive ingestion of sodium Rapid infusion of hypertonic salineRapid infusion of hypertonic saline Excessive sodium bicarbonate therapy.Excessive sodium bicarbonate therapy.

CausesCauses Hypotonic overhydrationHypotonic overhydration

Early renal failureEarly renal failure Congestive heart failureCongestive heart failure Syndrome of inappropriate antidiuretic Syndrome of inappropriate antidiuretic

hormone secretion hormone secretion Inadequately control of IVInadequately control of IV Replacement of isotonic fluid loss with Replacement of isotonic fluid loss with

hypotonic fluidshypotonic fluids Irrigation of wounds and body cavities Irrigation of wounds and body cavities

with hypotonic fluids. with hypotonic fluids.

Pathophysiology

with fluid volume excess (fluid overload) the fluid pressure is even greater than usual at arterial end of the capillary. Fluid is pushed into the tissue spaces with greater force because venous pressure exceeds oncotic pressure. Peripheral and pulmonary edema may result.

When fluid overload result from renal Disorder there is in sodium and water retentions fluid volume rises and heart must compensate for the increasing pressure heart failure can result.

Clients with cerihosis of the liver sodium protein and albumin levels are decreased the oncotic pressure is decreased in the vascular fluids

which results in less fluid reabsorption from the tissue spaces peripheral edema and ascites result


CardiovascularCardiovascular Bounding, increase pulse rateBounding, increase pulse rate Elevated blood pressureElevated blood pressure Distended neck and hand veinsDistended neck and hand veins Elevated central venous pressureElevated central venous pressure

RespiratoryRespiratory Increased respiratory rate (shallow respiration)Increased respiratory rate (shallow respiration) DyspneaDyspnea Moist crackles on auscultation Moist crackles on auscultation

AssessmentAssessment NeuromuscularNeuromuscular

Altered level of consciousnessAltered level of consciousness HeadacheHeadache Visual disturbanceVisual disturbance Skeletal muscle weaknessSkeletal muscle weakness ParesthesiasParesthesias

IntegumentaryIntegumentary Pitting edema in dependent areaPitting edema in dependent area Skin pale and cool to touch Skin pale and cool to touch

Increase motility in the gastrointestinal Increase motility in the gastrointestinal tracttract


Isotonic overhydration results in liver Isotonic overhydration results in liver enlargement and ascites.enlargement and ascites.

Hypotonic overhydrationHypotonic overhydration PolyuriaPolyuria DiarrheaDiarrhea Nonpitting edemaNonpitting edema DysrhythmiasDysrhythmias Projectile vomitingProjectile vomiting

Laboratory FindingsLaboratory Findings

Decreased serum osmolalityDecreased serum osmolality Decreased hematocritDecreased hematocrit Decreased BUN levelDecreased BUN level Decreased serum sodium levelDecreased serum sodium level Decreased urine specific gravity Decreased urine specific gravity

InterventionIntervention MonitorMonitor Prevent fluid excessPrevent fluid excess Administer diuretics, osmotic diuretics Administer diuretics, osmotic diuretics

typically are prescribed first to typically are prescribed first to prevent severe electrolyte imbalance.prevent severe electrolyte imbalance.

Restrict fluids and sodium intakeRestrict fluids and sodium intake Monitor I & O, weightMonitor I & O, weight Monitor electrolytes valuesMonitor electrolytes values

Regulating sodium and Regulating sodium and waterwater

Serum osmolality falls less Than 280 mOsm/Kg

Thirst diminishes, leading toWater intake

Antidiuretic hormone (ADH)Release is suppressed

Renal water excretionincreases

Serum sodium level (water excess)

Renal water excretiondiminishes

ADH release increase

Thirst increase, leading toWater intake

Serum osmolality falls more Than 300 mOsm/Kg

Serum Sodium level(water deficit)

Serum osmolality normalizes

HyponatremiaHyponatremia

Serum sodium level lower than 135 Serum sodium level lower than 135 mEq/LmEq/L

Sodium imbalances usually are Sodium imbalances usually are associated with fluid volume associated with fluid volume imbalances.imbalances.

CausesCauses Increase sodium excretion Increase sodium excretion

Excessive diaphoresisExcessive diaphoresis DiureticsDiuretics VomitingVomiting DiarrheaDiarrhea Wound drainage, especially gastrointestinalWound drainage, especially gastrointestinal Renal diseaseRenal disease Decreased secretion of aldosteroneDecreased secretion of aldosterone

Inadequate sodium intake Inadequate sodium intake Nothing by mouthNothing by mouth Low salt dietLow salt diet

CausesCauses

Dilution of serum sodiumDilution of serum sodium Excessive ingestion of hypotonic fluids Excessive ingestion of hypotonic fluids

or irrigation with hypotonic fluidsor irrigation with hypotonic fluids Renal failureRenal failure Freshwater drowningFreshwater drowning Syndrome of inappropriate antidiuretic Syndrome of inappropriate antidiuretic

hormone secretionhormone secretion HyperglycemiaHyperglycemia Congestive heart failureCongestive heart failure

Classification Classification Hypovolemic hyponatremiaHypovolemic hyponatremia

Both sodium and water levels decreased in the Both sodium and water levels decreased in the extracelluar area but sodium loss is greater extracelluar area but sodium loss is greater than water loss. than water loss.

Causes may be nonrenal or renal.Causes may be nonrenal or renal. Nonrenal Nonrenal

VomitingVomiting DiarrheaDiarrhea FistulasFistulas Gastric suctioningGastric suctioning Excessive sweatingExcessive sweating Cystic fibrosisCystic fibrosis Burns Burns Wound drainage.Wound drainage.

ClassificationClassification

RenalRenal Osmotic diuresisOsmotic diuresis Salt losing nephritisSalt losing nephritis Adrenal insufficiencyAdrenal insufficiency DiureticsDiuretics

Causes sodium loss and volume depletion from Causes sodium loss and volume depletion from the blood vessels, causing the patient feel thirsty the blood vessels, causing the patient feel thirsty and his kidneys to retain water. Drinking large and his kidneys to retain water. Drinking large quantities of water can worsen hyponatremia. quantities of water can worsen hyponatremia.


Hypervolemic hyponatremiaHypervolemic hyponatremia Both water and sodium levels increase Both water and sodium levels increase

in the extracellular area, but the water in the extracellular area, but the water gain is more noticeable and has a gain is more noticeable and has a greater impact on the patient. greater impact on the patient.

Serum sodium level are diluted, and Serum sodium level are diluted, and edema occurs causes include heart edema occurs causes include heart failure, live failure, nephrotic syndrome, failure, live failure, nephrotic syndrome, excessive administration of hypotonic excessive administration of hypotonic I.V fluids and hyperaldosreroism. I.V fluids and hyperaldosreroism.


Isovolumic hyponatremiaIsovolumic hyponatremia Sodium levels may appear low because Sodium levels may appear low because

there’s too much fluids in the body. there’s too much fluids in the body. However the patient has no physical However the patient has no physical signs of fluids volume excess and total signs of fluids volume excess and total body sodium remain stable. body sodium remain stable.

Causes include glucocorticoid Causes include glucocorticoid deficiency, hypothyroidism and renal deficiency, hypothyroidism and renal failure. failure.

AssessmentAssessment CardiovascularCardiovascular

Symptoms vary with changes in vascular Symptoms vary with changes in vascular volumevolume

Normavolemic: rapid pulse rate; normal Normavolemic: rapid pulse rate; normal blood pressureblood pressure

Hypovolemic: thready, weak rapid pulse Hypovolemic: thready, weak rapid pulse rate; hypotension; flat neck veins, normal rate; hypotension; flat neck veins, normal or low central venous pressureor low central venous pressure

Hypervolemic: rapid, bounding pulse; Hypervolemic: rapid, bounding pulse; blood pressure normal or elevated; normal blood pressure normal or elevated; normal or elevated central venous pressure. or elevated central venous pressure.

AssessmentAssessment Respiratory: shallow, ineffective respiratory Respiratory: shallow, ineffective respiratory

movements as a late manifestation related to movements as a late manifestation related to skeletal muscle weakness. skeletal muscle weakness.

NeuromuscularNeuromuscular Generalized skeletal muscle weakness that is worse in Generalized skeletal muscle weakness that is worse in

the extremitiesthe extremities Diminished deep tendon reflexesDiminished deep tendon reflexes

Cerebral functionCerebral function HeadacheHeadache Personality changesPersonality changes ConfusionConfusion SeizuresSeizures comacoma


GastrointestinalGastrointestinal Increased motility and hyperactive Increased motility and hyperactive

bowel soundsbowel sounds NauseaNausea Abdominal cramping and diarrheaAbdominal cramping and diarrhea

RenalRenal Decreased urinary specific gravityDecreased urinary specific gravity Increased urinary outputIncreased urinary output

InterventionIntervention1.1. Monitor cardiovascular, respiratory, nueromuscular, Monitor cardiovascular, respiratory, nueromuscular,

cerebral, renal and gastrointestinal status.cerebral, renal and gastrointestinal status.2.2. If hyponatremia is accompanied by a fluid deficit, IV If hyponatremia is accompanied by a fluid deficit, IV

sodium chloride infusions are administered.sodium chloride infusions are administered.3.3. If hyponatremia is accomapnied by fluids excess, If hyponatremia is accomapnied by fluids excess,

osmotic diuretics are administered.osmotic diuretics are administered.4.4. If the cause is inappropriate or excessive secretions If the cause is inappropriate or excessive secretions

of antidiuretic hormone, such as lithium and of antidiuretic hormone, such as lithium and demeclocycline (Declomycin), may be administred. demeclocycline (Declomycin), may be administred.

5.5. Instruct client to increase oral sodium intake and Instruct client to increase oral sodium intake and inform the client about the foods to include in the inform the client about the foods to include in the diet.diet.

6.6. If the client is taking lithium, monitor the lithium If the client is taking lithium, monitor the lithium level, because hyponatremia can cause diminished level, because hyponatremia can cause diminished lithium excretion, resulting in toxicity. lithium excretion, resulting in toxicity.

HYPERNATREMIAHYPERNATREMIA

Is a serum sodium level that exceeds Is a serum sodium level that exceeds 145 mEq/L145 mEq/L

Causes Causes Decrease sodium excretionDecrease sodium excretion

CorticosteroidsCorticosteroids Cushing’s syndromeCushing’s syndrome Renal failureRenal failure HyperaldosteroismHyperaldosteroism

Causes Causes Increased sodium intake: excessive Increased sodium intake: excessive

oral sodium ingestion or excessive oral sodium ingestion or excessive administration of sodium containing IV administration of sodium containing IV fluids.fluids.

Decreased water intake: nothing by Decreased water intake: nothing by mouthmouth

Increased water loss; increased rate of Increased water loss; increased rate of metabolism, fever, hyperventilation, metabolism, fever, hyperventilation, infection, excessive diaphoresis, infection, excessive diaphoresis, watery diarrhea, diabetes insipidus. watery diarrhea, diabetes insipidus.

AssessmentAssessment Cardiovascular: heart rate and blood Cardiovascular: heart rate and blood

pressure that respond to vascular pressure that respond to vascular volume status.volume status.

Respiratory: Pulmonary edema if Respiratory: Pulmonary edema if hypervolemia is present.hypervolemia is present.

NeuromuscularNeuromuscular Early: spontaneous muscle twitches; Early: spontaneous muscle twitches;

irregular muscle contractionirregular muscle contraction Late: skeletal muscle weakness; deep Late: skeletal muscle weakness; deep

tendon reflexes diminished or absent.tendon reflexes diminished or absent.

AssessmentAssessment Central nervous systemCentral nervous system

Altered cerebral functions is the most common Altered cerebral functions is the most common manifestation of hypenatremia. manifestation of hypenatremia.

Normovolemia or hypovolemia: agitation, Normovolemia or hypovolemia: agitation, confusion, seizuresconfusion, seizures

Hypervolemia: lethargy, stupor, comaHypervolemia: lethargy, stupor, coma RenalRenal

Increased urinary specific gravityIncreased urinary specific gravity Decreased urinary outputDecreased urinary output

IntegumentaryIntegumentary Dry skinDry skin Presence or absence of edema, depending on Presence or absence of edema, depending on

fluid volume changes.fluid volume changes.

InterventionIntervention

Monitor cardiovascular, respiratory, Monitor cardiovascular, respiratory, neuromuscular, cerebral, renal and neuromuscular, cerebral, renal and integumentary status.integumentary status.

If the cause is fluid loss, prepare to If the cause is fluid loss, prepare to administered IV infusions.administered IV infusions.

If the cause is inadequate renal excretion If the cause is inadequate renal excretion of sodium, prepare to administer diuretics of sodium, prepare to administer diuretics that promote sodium loss.that promote sodium loss.

Restrict sodium and fluid intake as Restrict sodium and fluid intake as prescribed. prescribed.

ECGECG

An electrocardiogram (EKG, ECG) translates the heart's An electrocardiogram (EKG, ECG) translates the heart's electrical activity into line tracings on paper. The spikes electrical activity into line tracings on paper. The spikes and dips in the line tracings are called waves. and dips in the line tracings are called waves.

The The P waveP wave is a record of the electrical activity through is a record of the electrical activity through the upper heart chambers (atria). the upper heart chambers (atria).

The The QRS complexQRS complex is a record of the movement of is a record of the movement of electrical impulses through the lower heart chambers electrical impulses through the lower heart chambers (ventricles). (ventricles).

The The ST segmentST segment shows when the ventricle is contracting shows when the ventricle is contracting but no electricity is flowing through it. The ST segment but no electricity is flowing through it. The ST segment usually appears as a straight, level line between the QRS usually appears as a straight, level line between the QRS complex and the T wave. complex and the T wave.

The The T waveT wave shows when the lower heart chambers are shows when the lower heart chambers are resetting electrically and preparing for their next muscle resetting electrically and preparing for their next muscle contraction.contraction.

HYPOKALEMIAHYPOKALEMIA

Serum potassium level lower than Serum potassium level lower than 3.5 mEq/L3.5 mEq/L

Deficit is pontentially life threatening Deficit is pontentially life threatening because every body system is because every body system is affected.affected.

CausesCauses

Actual total body potassium lossActual total body potassium loss Excessive use of medication such as diuretics or Excessive use of medication such as diuretics or

corticosteroidscorticosteroids Increased secretion of aldosterone such in Increased secretion of aldosterone such in

Cushing syndromeCushing syndrome Vomiting, diarrheaVomiting, diarrhea Wound drainage, praticualry gastrointestinal Wound drainage, praticualry gastrointestinal Prolong nasogastric suctionProlong nasogastric suction Excessive diaphoresisExcessive diaphoresis Renal disease impairing reabsorption of Renal disease impairing reabsorption of

potassium potassium

CausesCauses Inadequate potassium intake: nothing Inadequate potassium intake: nothing

by mouthby mouth Movements of potassium from the Movements of potassium from the

extracelluar fluids to the intracellular extracelluar fluids to the intracellular fluidsfluids AlkalosisAlkalosis HyperinsulinismHyperinsulinism

Dilution of serum potassiumDilution of serum potassium Water intoxicationWater intoxication Intravenous therapy with potassium poor Intravenous therapy with potassium poor

solutions.solutions.


CardiovascularCardiovascular Thready, weak, irregular pulseThready, weak, irregular pulse Peripheral pulse weakPeripheral pulse weak Orthostatic hypotensionOrthostatic hypotension Electrocardiogram changes: ST depression, Electrocardiogram changes: ST depression,

shallow, flat or inverted T wave, and prominent shallow, flat or inverted T wave, and prominent U wave.U wave.

RespiratoryRespiratory Shallow, ineffective respiration that result from Shallow, ineffective respiration that result from

profound weakness of the skeletal muscles of profound weakness of the skeletal muscles of respiration.respiration.

Diminished breath sounds.Diminished breath sounds.


NeuromuscularNeuromuscular Anxiety, lethargy, confusion, comaAnxiety, lethargy, confusion, coma Skeletal muscle weakness, eventual flaccid paralysisSkeletal muscle weakness, eventual flaccid paralysis Loss of tactile discriminationLoss of tactile discrimination Deep tendon hyporeflexiaDeep tendon hyporeflexia

GastrointestinalGastrointestinal Decreased motility, hypoactive to absent bowel soundsDecreased motility, hypoactive to absent bowel sounds Nausea, vomiting, constipation, abodminal distentionNausea, vomiting, constipation, abodminal distention Paralytic ileusParalytic ileus

RenalRenal Decreased urinary specific gravityDecreased urinary specific gravity Increased urinary outoutIncreased urinary outout

InterventionIntervention Monitor cardiovascular, respiratory, Monitor cardiovascular, respiratory,

neuromuscular, gastrointestinal and neuromuscular, gastrointestinal and renal status and place on a cardiac renal status and place on a cardiac monitor.monitor.

Monitor electrolyte values.Monitor electrolyte values. Administer potassium supplements Administer potassium supplements

orally or intravenously as prescribed. orally or intravenously as prescribed. Oral potassium supplementsOral potassium supplements Institutes safety measure for the Institutes safety measure for the

clients experiencing muscle weaknessclients experiencing muscle weakness

InterventionIntervention Take the following precaution with Take the following precaution with

intravenously administered potassium:intravenously administered potassium: Never given by IV push or by the intramuscular Never given by IV push or by the intramuscular

or subcutaneous route.or subcutaneous route. Dilution of no more than 1mEq/ 10 ml of Dilution of no more than 1mEq/ 10 ml of

solution is recommended.solution is recommended. After adding potassium to an IV solution, rotate After adding potassium to an IV solution, rotate

and invert the bag to ensure that the potassium and invert the bag to ensure that the potassium is distributed evenly throughout the IV solution. is distributed evenly throughout the IV solution.

Ensure that the IV bag containing potassium is Ensure that the IV bag containing potassium is properly labeled.properly labeled.

The maximum recommended infusion rate is 5 The maximum recommended infusion rate is 5 to 10 mEq/hr, never to exceed 20 mEq/hr under to 10 mEq/hr, never to exceed 20 mEq/hr under any circumstances. any circumstances.

InterventionIntervention A client receiving more than 19 mEq/hr should A client receiving more than 19 mEq/hr should

be placed on a cardiac monitor and monitored be placed on a cardiac monitor and monitored far cardiac changes, and the infusion should be far cardiac changes, and the infusion should be controlled by an infusion device. controlled by an infusion device.

Potassium infusion can cause phlebitis.Potassium infusion can cause phlebitis. The nurse should assess renal function before The nurse should assess renal function before

administering potassium and monitor intake administering potassium and monitor intake and output during administration.and output during administration.

If the client is taking a potassium losing If the client is taking a potassium losing diuretic, it may be discontinued; a diuretic, it may be discontinued; a potassium sparing diuretic may be potassium sparing diuretic may be prescribed.prescribed.

Instruct the client about the food that are Instruct the client about the food that are high in potassium high in potassium

HYPERKALEMIAHYPERKALEMIA

Is a serum potassium level that Is a serum potassium level that exceeds 5.1 mEq/Lexceeds 5.1 mEq/L

CausesCauses Excessive potassium intakeExcessive potassium intake

Over ingestion of potassium containing Over ingestion of potassium containing foods or medications such as potassium foods or medications such as potassium chloride or salt substitutes. chloride or salt substitutes.

Rapid infusion of potassium containing IV Rapid infusion of potassium containing IV solutionsolution

CausesCauses Decreased potassium excretionDecreased potassium excretion

Potassium sparing diureticsPotassium sparing diuretics Renal failureRenal failure Adrenal insufficiency, such as in addison’s Adrenal insufficiency, such as in addison’s

disease.disease. Movements of potassium from the Movements of potassium from the

intracellular fluid to the extracelluar fluidintracellular fluid to the extracelluar fluid Tissues damageTissues damage AcidosisAcidosis HyperuricemiaHyperuricemia HypercatabolismHypercatabolism


Slow, weak, irregular heart rateSlow, weak, irregular heart rate Decreased blood pressureDecreased blood pressure Electrocardiographic changes: tall peaked Electrocardiographic changes: tall peaked

I waves, flat P waves, widened QRS I waves, flat P waves, widened QRS complexes, and prolong PR intervals.complexes, and prolong PR intervals.

Respiratory: profound weakness of the Respiratory: profound weakness of the skeletal muscles leading to respiratory skeletal muscles leading to respiratory failure. failure.


Early: muscle twitches, cramps, Early: muscle twitches, cramps, parasthesiasparasthesias

Late: profound weakness, ascending Late: profound weakness, ascending flaccid paralysis in the arms and legsflaccid paralysis in the arms and legs

GastrointestinalGastrointestinal Increased motility, hyperactive bowel Increased motility, hyperactive bowel

soundssounds DiarrheaDiarrhea

InterventionsInterventions Monitor cardiovascular, respiratory, Monitor cardiovascular, respiratory,

neuromuscular, renal, and gastrointestinal neuromuscular, renal, and gastrointestinal status; place the client on a cardiac monitor.status; place the client on a cardiac monitor.

Discontinue IV potassium and hold oral Discontinue IV potassium and hold oral potassium supplements.potassium supplements.

Initiate a potassium restricted diet.Initiate a potassium restricted diet. Prepare to administered potassium excreting Prepare to administered potassium excreting

diuretics if renal function is not impaired.diuretics if renal function is not impaired. Prepare the client for dialysis if potassium Prepare the client for dialysis if potassium

level are critically high.level are critically high. Prepare for the IV administration of Prepare for the IV administration of

hypertonic glucose with regular insulin to hypertonic glucose with regular insulin to move excess potassium into the cells. move excess potassium into the cells.

InterventionIntervention Monitor renal functionMonitor renal function When blood transfusions are prescribed for When blood transfusions are prescribed for

the client with potassium imbalance, the the client with potassium imbalance, the client should received fresh blood, if possible client should received fresh blood, if possible transfusions of stored blood may elevate the transfusions of stored blood may elevate the potassium level because the breakdown of potassium level because the breakdown of older blood cells releases potassium.older blood cells releases potassium.

Teach the client to avoid food high in Teach the client to avoid food high in potassiumpotassium

Instruct the client to avoid the use of salt Instruct the client to avoid the use of salt substitutes or other potassium containing substitutes or other potassium containing substances. substances.

HYPOCALCEMIAHYPOCALCEMIA

Serum calcium level lower than 8.6 Serum calcium level lower than 8.6 mg/dLmg/dL

CausesCauses Inhibition of calcium absorption from the Inhibition of calcium absorption from the

gastrointestinal tract gastrointestinal tract Increased calcium excretionIncreased calcium excretion Conditions that decrease the ionized Conditions that decrease the ionized

fraction of calciumfraction of calcium ImmobiltyImmobilty Removal or destruction of the parathyroid glandsRemoval or destruction of the parathyroid glands Acute pancreatitisAcute pancreatitis


Decreased heart rateDecreased heart rate HypotensionHypotension Diminished peripheral pulsesDiminished peripheral pulses Electrocardiographic changes: prolonged ST Electrocardiographic changes: prolonged ST

interval, prolong QT intervalinterval, prolong QT interval Respiratory: not directly affected; however Respiratory: not directly affected; however

respiratory failure or arrest can result from respiratory failure or arrest can result from decreased respiratory movement because decreased respiratory movement because of muscle tetany or seizures.of muscle tetany or seizures.

AssessmentAssessment Neuromuscular Neuromuscular

Irritable skeletal muscles; twitches, cramps, Irritable skeletal muscles; twitches, cramps, tetany, seizures.tetany, seizures.

Painful muscle spasms in the calf or foot during Painful muscle spasms in the calf or foot during periods of inactivity.periods of inactivity.

Paresthesias followed by numbness that may Paresthesias followed by numbness that may affect the lips, nose, and ears in addition to the affect the lips, nose, and ears in addition to the limbs.limbs.

Positive Trousseau’s and Chvostek’s signsPositive Trousseau’s and Chvostek’s signs Hyperactive deep tendon reflexesHyperactive deep tendon reflexes Anxiety, irritability Anxiety, irritability

AssessmentAssessment Gastrointestinal Gastrointestinal

Incrased gastrc motility; hypeactive Incrased gastrc motility; hypeactive bowel soundsbowel sounds

Abdominal cramping, diarrheaAbdominal cramping, diarrhea

InterventionIntervention Monitor cardiovascular, respiratory, neuromuscular, Monitor cardiovascular, respiratory, neuromuscular,

renal, and gastrointestinal status; place the client on renal, and gastrointestinal status; place the client on a cardiac monitor.a cardiac monitor.

Administer calcium supplements orally or calcium Administer calcium supplements orally or calcium intravenously. intravenously.

Administered medication that increase calcium Administered medication that increase calcium absorption.absorption.

Provide quite environment to reduce environmental Provide quite environment to reduce environmental stimuli.stimuli.

Initiate seizure precautions.Initiate seizure precautions. Move the carefully, and monitor for signs of a Move the carefully, and monitor for signs of a

fracture.fracture. Keep 10% calcium gluconate available for treatment Keep 10% calcium gluconate available for treatment

of acute calcium deficit. of acute calcium deficit. Instruct the client to consume foods high in calcium.Instruct the client to consume foods high in calcium.

HYPERCALCEMIAHYPERCALCEMIA

Serum calcium level that exceeds Serum calcium level that exceeds 10.0 md/dL10.0 md/dL

CausesCauses Increased calcium absorption Increased calcium absorption

Excssive oral intake of calciumExcssive oral intake of calcium Excessive oral intake of vitamin DExcessive oral intake of vitamin D

Decreased calcium excretionDecreased calcium excretion Renal failureRenal failure Use of thiazide diureticsUse of thiazide diuretics

CausesCauses Increased bone resorption of calciumIncreased bone resorption of calcium

HyperparathyrodismHyperparathyrodism HyperthyroidismHyperthyroidism MaligancyMaligancy ImmobilityImmobility Use of glucocorticoidsUse of glucocorticoids

HemoconcentrationHemoconcentration DehydrationDehydration Use of lithiumUse of lithium Adrenal insufficiencyAdrenal insufficiency


Increased heart rate in the early phase, Increased heart rate in the early phase, bradycardia that can lead to cardiac arrest bradycardia that can lead to cardiac arrest in late phase. in late phase.

Increased blood pressureIncreased blood pressure Bounding, full peripheral pulsesBounding, full peripheral pulses Electrocardiographic changes: shortened ST Electrocardiographic changes: shortened ST

segments, widened T wavesegments, widened T wave RespiratoryRespiratory

Ineffective respiratory movements as a Ineffective respiratory movements as a result of profound skeletal muscle result of profound skeletal muscle weakness. weakness.


Profound muscle weaknessProfound muscle weakness Diminished or absent deep tendon reflexesDiminished or absent deep tendon reflexes Disorientation, lethargy, comaDisorientation, lethargy, coma

RenalRenal Increased urinary output leading to dehydrationIncreased urinary output leading to dehydration Formation of renal calculiFormation of renal calculi

Gastrointestinal Gastrointestinal Decreased motility and hypoactive bowel soundsDecreased motility and hypoactive bowel sounds Anorexia, nausea, abdominal distention, Anorexia, nausea, abdominal distention,

constipation. constipation.

InterventionIntervention Discontinue IV infusion of solution containing Discontinue IV infusion of solution containing

calcium and oral medication containing calcium or calcium and oral medication containing calcium or vitamin Dvitamin D

Administered medications as prescribed that inhibit Administered medications as prescribed that inhibit calcium resorption from the bone, such as calcium resorption from the bone, such as phosphorus, calcitonin, bisphosphonates, and phosphorus, calcitonin, bisphosphonates, and prostaglandin synthesis inhibitorsprostaglandin synthesis inhibitors

Prepare the client with sever hypercalcemia for Prepare the client with sever hypercalcemia for dialysis if medications fail to reduce the serum dialysis if medications fail to reduce the serum calcium level.calcium level.

Move the client carefully and monitor for signs of a Move the client carefully and monitor for signs of a fracture.fracture.

Monitor for flank or abdominal pain, and strain the Monitor for flank or abdominal pain, and strain the urine to check for the presence of urinary stones.urine to check for the presence of urinary stones.

Instruct the client to avoid foods high in calcium. Instruct the client to avoid foods high in calcium.

HYPOMAGNESEMIAHYPOMAGNESEMIA Serum magnesium level lower than 1.6 Serum magnesium level lower than 1.6

mg/dLmg/dL CausesCauses

Insufficient magnesium intakeInsufficient magnesium intake Malnutrition and starvationMalnutrition and starvation Vomiting and diarrheaVomiting and diarrhea Malabsorption syndromeMalabsorption syndrome Celiac diseaseCeliac disease Crohn’s diseaseCrohn’s disease

Increase magnesium secretion Increase magnesium secretion Medication such as diureticsMedication such as diuretics Chronic alcoholismChronic alcoholism

Intracellular movement of magnesiumIntracellular movement of magnesium HyperglycemiaHyperglycemia Insulin administration Insulin administration sepsissepsis


Electrocardiographic changes: Tall T Electrocardiographic changes: Tall T waves, depressed ST segmentswaves, depressed ST segments

TachycardiaTachycardia HypertensionHypertension

GastrointestinalGastrointestinal Decreased motility, decreased bowel Decreased motility, decreased bowel

soundsound Anorexia, nausea, abdominal distentionAnorexia, nausea, abdominal distention

Respiratory: Shallow respirationRespiratory: Shallow respiration


NeuromuscularNeuromuscular Twiches, paresthesiasTwiches, paresthesias Positive trousseu’s and Chvostek’s signsPositive trousseu’s and Chvostek’s signs HyperreflexiaHyperreflexia Tetany, seizuresTetany, seizures

Central nervous systemCentral nervous system IrritabilityIrritability ConfusionConfusion

InterventionIntervention Administer magnesium sulfate by the IV Administer magnesium sulfate by the IV

route in severe cases; monitor serum route in severe cases; monitor serum magnesium levels frequently.magnesium levels frequently.

Initiate seizure precautionInitiate seizure precaution Monitor for reduce deep tendon reflexes, Monitor for reduce deep tendon reflexes,

suggesting hypermagnesemia, during the suggesting hypermagnesemia, during the administration of magnesium.administration of magnesium.

Oral preparations of magnesium may Oral preparations of magnesium may cause diarrhea and increase magnesium cause diarrhea and increase magnesium lossloss

Instruct the client to increase the intake of Instruct the client to increase the intake of foods that contain magnesium. foods that contain magnesium.

HYPERMAGNESEMIAHYPERMAGNESEMIA

Serum magnesium level that exceeds Serum magnesium level that exceeds 2.6 mg/dL2.6 mg/dL

CausesCauses Increased magnesium intakeIncreased magnesium intake

Magnesium containing antacids and laxativesMagnesium containing antacids and laxatives Excessive administration of magnesium Excessive administration of magnesium

intravenouslyintravenously Decreased renal excretion of magnesium Decreased renal excretion of magnesium

as a result of renal insufficiencyas a result of renal insufficiency


Bradycardia, dysrhythmiasBradycardia, dysrhythmias Hypotension Hypotension Electrocardiographic changes: Prolong PR Electrocardiographic changes: Prolong PR

interval, widened QRS complexesinterval, widened QRS complexes Respiratory: respiratory insufficiency when Respiratory: respiratory insufficiency when

the skeletal muscles of respiration are the skeletal muscles of respiration are involvedinvolved

Neuromuscular Neuromuscular Diminished or absent deep tendon reflexesDiminished or absent deep tendon reflexes Skeletal muscle weaknessSkeletal muscle weakness

Central nervous system: drowsiness and Central nervous system: drowsiness and lethargy that progresses to coma. lethargy that progresses to coma.

Intervention Intervention

Acid – Base Balance Acid – Base Balance

blood test that is performed using that is performed using blood from an from an artery. It involves . It involves puncturing an artery with a thin needle puncturing an artery with a thin needle and syringe and drawing a small and syringe and drawing a small volume of blood. The most common volume of blood. The most common puncture site is the puncture site is the radial artery at the at the wrist, but sometimes the , but sometimes the femoral artery in the in the groin or other or other sites are used sites are used

http://en.wikipedia.org/wiki/Blood_test

http://en.wikipedia.org/wiki/Blood

http://en.wikipedia.org/wiki/Artery

http://en.wikipedia.org/wiki/Radial_artery

http://en.wikipedia.org/wiki/Wrist

http://en.wikipedia.org/wiki/Femoral_artery

http://en.wikipedia.org/wiki/Groin

PHPH

pH usually stays slightly alkaline pH usually stays slightly alkaline between 7.35 to 7.45 between 7.35 to 7.45

pH below 7.35 is abnormally acidicpH below 7.35 is abnormally acidic

Documents

Fluids and Electrolyte disturbances