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FLUID AND ELECTROLYTE IMBALANCE

|IMBALANCE |CAUSES |SIGNS/SYMPTOMS |TREATMENT |

|Potassium (K) | | | |

|3.5 – 5 mEq/L | | | |

|Critical Values | | | |

|< 2.5 or > 6.5 mEq/L | | | |

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|hyperkalemia | | | |

| |renal failure |Early signs |serum K+ 4-6hour |

| |acidosis |cramps | |

| |cellular damage |muscle twitching |monitor HR/rhythm |

| |with crushing |nausea/weakness | |

| |injuries |abdominal/general |monitor I & 0 |

| |burns |Later signs |K+ restricted diet |

| |other causes |apathy | |

| | |confusion |Kayexalate |

| | |paresthesias | |

| | |ileus, |Lasix - K+ depletion |

| | |ascending paralysis lead to respiratory | |

| | |arrest |NaHCO3-K+ moves into cells (life threatening) |

| | |ECG changes | |

| | |severe bradycardia, | |

| | |arrhythmias lead to 3rd degree heart block asystole | |

|hypokalemia |excessive vomiting |Early signs |K+ replacement oral or IV |

| |diarrhea |muscle weakness | |

| |diuretics |cramps |serum K+ every 8 hours |

| |diabetic ketoacidosis |lethargy | |

| |TPN |apathy |high K+ foods |

| |medications |drowsiness | |

| |Geocillin |confusion | |

| |Diamox |irritability | |

| |Garamycin with CHG and chronic |decreased bowel motility | |

| |hypertension |cardiac abnormalities | |

| | |Later signs | |

| | |extreme muscle weakness | |

| | |paralysis | |

| | |respiratory arrest | |

|Sodium (Na) | | | |

|136 – 145 mEq/L | | | |

|Critical Values | | | |

|< 120 or > 160 mEq/L | | | |

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| | |Early signs |hypotonic saline.solutions; |

|hypernatremia |diabetes insipidus |dry, red, sticky tongue and mouth |0.45% NaCl |

| |exc. perspiration |restless | |

| |copious diarrhea |irritable |sodium restricted diet |

| |impaired renal function |Later signs | |

| |decreased fluid intake |delirium |Lasix, HCTZ |

| |nephrotic syndrome |twitching | |

| | |seizures | |

| |. |coma | |

| | |increased muscle tone | |

| | |hyperactive deep tendon reflexes | |

| | |metabolic acidosis | |

| | |death | |

|hyponatremia |extensive vomiting |Early signs |normal saline infusion |

| |diarrhea |thirsty | |

| | |anorexia |serum Na+ 2-4 hour |

| |Addisons'disease |abdominal cramping | |

| | |confusion |weigh daily |

| |extensive burns |lethargy | |

| |low-salt diets diuretic therapy |muscle twitching | |

| |increase water |seizures | |

| |renal failure. |loss of coordination | |

| | |generalized weakness | |

| | |coma | |

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|Phosphate (PO4) | | | |

|3 – 4.5 mg/dl | | | |

|Critical Values | | | |

|< 1 mg/dl | | | |

| | | | |

|hypophosphatemia | | | |

| |malabsorption syndromes |Early signs |oral supplements |

| |colitis |weakness |Neutra Soda |

| |shortened GI tract |tissue hypoxia |Phospho soda |

| |excess thiazide |Later signs | |

| |diuretics |mental confusion | |

| | |irritability | |

| | |severe anemia |IV sodium/KI |

| | |bone brittleness (stress fractures) |phosphate |

|Hyperphosphatemia |renal failure |hypocalcemia s/s |phosphate binder |

| |usually hypocalcemia |predominate | |

| |concurrently | |restrict high phosphate foods |

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|Calcium (Ca) | | | |

|9 – 10.5 mg/dl | | | |

|Critical Values | | | |

|< 6 mg/dl (may lead to tetany) | | | |

|> 14 mg/dl (may lead to coma & cardiac arrest) | | | |

| | | | |

| | |Early signs | |

|Hypocalcemia | |numbness/tingling of lips | |

| | |anxiety/irritability | |

| |malabsorption |twitching, cramps |Trousseau’s phenomenon |

| |parathyroid hormone deficiency |grimacing | |

| |burns |increased deep tendon reflexes |Chyostek’s sign |

| |copious wound drainage |Later signs | |

| | |bruising |serum calcium |

| | |impaired coagulation |monitor ECG |

| | |generalized muscle spasms | |

| | |gluconate |diet rich in calcium/Vitamin D |

| | |convulsion | |

| | |cardiac arrhythmias |calcium gluconate or chloride |

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|hypercalcemia |excessive use of milk/alkali products for peptic |Early signs |IV fluids Isotonic saline |

| |ulcer |lethargy |(5-6L 1st 24 hours, 3L/day thereafter) |

| |multiple fractures |depression | |

| |multiple myeloma |apathy |Lasix |

| |prolonged immobilization |malaise wekaness |force fluids (cranberry) |

| |renal failure |constipation |Neutra Phos/Fleets |

| | |nausea/vomiting |Phospho soda |

| |Malignant growths |anorexia | |

| | |diarrhea | |

| | |arrhythmias | |

| | |Later signs | |

| | |headache, | |

| | |polydepsia | |

| | |abdominal pain | |

| | |polyuria | |

| | |clumsiness | |

| | |confusion | |

| | |slurred speech | |

| | |memory loss | |

| | |hypertension | |

| | |ECG changes | |

| | |paranoia | |

| | |stupor | |

| | |coma | |

| | |flaccid paralysis | |

| | |renal failure | |

| | |renal calculi | |

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|Magnesium | | | |

|1.3 – 2.1 mEq/L | |Early signs | |

|Critical Values | |anorexia/diarrhea | |

|< 0.5 mEq/L > 3 mEq/L | |muscle tremors | |

| | |muscle twitches |diet high magnesium |

| | |agitation | |

| | |irritability |magnesium-based antacids |

|hypomagnesemia | |nausea/vomiting | |

| |alcoholism |Later signs |magnesium sulfate IM/IV |

| |malabsorption due to colitis |hyperactive deep tendon reflexes | |

| |cancer |ataxia |serum Mg+ after every 16 mEq |

| |hyperthyroidism |vertigo | |

| |corticosteroid |Severe signs |keep supine |

| |drugs |clonus | |

| |massive blood transfusion |tetany |handle patients gently |

| | |nystagmus | |

| | |coma | |

| | |delieium | |

| | |hallucinations | |

| | |hypotension | |

| | |cardiac arrhythmias | |

| | |seizures | |

| | |CHF | |

|Hypermagnesemia |renal failure |Early signs |IV hydration |

| |heavy use of antacids/laxatives |weak | |

| |dialysis or TPN |hypotensive |thiazide diuretics |

| |hypoaldosterionism |flushed | |

| | |hot |calcium chloride or gluconate |

| | |absent deep tendon reflexes | |

| | |slurred speech | |

| | |drowsiness | |

| | |lethargy | |

| | |cardiac arrhythmias | |

| | |Later signs | |

| | |flaccid muscle | |

| | |paralysis | |

| | |respiratory depression leading to coma | |

| | |apnea | |

| | |heart block | |

| | |cardiac arrest | |

|v:\word\syllabus\vocation\level i\fluid and electrolyte imbalance 11/2012 |

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