Electrolyte Imbalances

Hypocalcemia: Ca (4.0-6.0 mg/dl)

Hypocalcemia- a low bood calcium level, occurs when the concentration of free calcium ions in the blood falls below 4.0 mg/dL (dL = one tenth of a liter). The normal concentration of free calcium ions in the blood serum is 4.0-6.0 mg/dL.

Hypocalcaemia: Ca (4.0-6.0mg/dl)

S&S TREATMENT NURSING

Abdominal and muscle cramps

Lethargy BPTetanySeizureECG changes

Calcium gluconate10% : 1 g in 50-100ml of D5W over 1 hr, then infusion of 1-2 mg/kg/hr.

Given by physician or NP on general care units and by RNs in ICU.

Do not infuse too rapidly- is cardiotoxic and can cause BP.

Never given IM or subcutaneously-causes severe sloughing of tissue.

Check calcium and magnesium levels.

Antidote: IV magnesium sulfate.

Hypercalcemia: Ca (9-10.5 mg/Dl)

Hypercalcemia- the presence of abnormally high levels of calcium in the blood.

Hypercalcemia: Ca (9-10.5 mg/dL)S&S TREATMENT NURSING

DehydrationRenal StonesConfusionSevere thirstConstipationPolyuriaShortening of

QT interval BP.

D5NS at 250-500 mL/hr; furosemide 20-80 mg IV over 2 min to bring Ca down with diuresis.

Monitor electrolyte levels.

Encourage fluid intake.

Provide fiber diet and stool softeners.

Potentiate digoxin toxicity; assess as indicated.

Monitor ECG, if available, or assess pulse for irregular beats.

Hypomagnesemia Mg (1.5 - 2.5 mg/dL. )

Hypomagnesemia - abnormally low magnesium content of the blood.

Hypomagnesemia Mg (1.5 - 2.5 mg/dL. )

S&S TREATMENT NURSING

WeaknessVertigoMuscle

twitchingTachycardiaSeizuresTetanyPVCs

2 g magnesium sulfate in D5W over 10-20 min, then 1 g/hr for 3-4 hr.

Check other electrolyte levels

Can have potassium

phosphate calcium Assess reflexes and

monitor Mg levels.

Hypermagnesemia Mg(1.5-2.5 mEq/L.)

Hypermagnesemia- is an electrolyte disturbance in which there is an abnormally elevated level of magnesium in the blood. Usually this results in excess of magnesium in the body.

Hypermagnesemia Mg(1.5-2.5 mEq/L.)

S&S TREATMENT NURSING

NauseaVomiting BPWeaknessHyperreflexia HRComaRespiratory

failure

Calcium gluconate 10%: 1-10ml in 50-100 ml of D5W over 10-20 minutes.

Assess for changes in LOC.

Assess reflexes Hold medications

containing magnesium, especially in patients with renal failure.

Hypophosphatemia (2.5-4.5 mg/dL)

Hypophosphatemia- is an electrolyte disturbance in which there is an abnormally low level of phosphate in the blood

Hypophosphatemia (2.5-4.5 mg/dL)

S&S TREATMENT NURSING

AnorexiaWeakness

muscle painConfusionRhabdomyolys

isHemolysisCardiac and

respiratory failure

Potassium or sodium phosphate 2 mg/kg IV over 6 hr if P04 level is <1-5 mg/Dl.

Too rapid IV administration can cause severe hypocalemia

Assess for tetany

Hyperphosphatemia (2.5-4.5 mg/dL)

Hyperphosphatemia- is an electrolyte disturbance in which there is an abnormally elevated level of phosphate in the blood.

HyperphosphatemiaMg(1.5-2.5 mEq/L.)

S&S TREATMENT NURSING

Limited sypptoms Possible tetany if

calcium is low, which is a result of hyperphosphatermia

Phosphate binders, possibly acetazolamide, low phosphate diet.

Teach patient about avoiding foods and OTC medications high in phosphorus.

Hyperkalemia (3.5 and 5.0 mEq/L)

Hyperkalemia - refers to the condition in which the concentration of the electrolyte potassium (K+) in the blood is elevated

S&S Malaise Palpitations muscle weakness mild hyperventilation

The patient may have:Muscular weaknessCardiac dysrhythmiasECG Abnormalities ( tall, peaked T waves)

Hypokalemia (3.5 to 5.0 mEq/L)Deficiency of potassium in the

bloodstream.

Hypernatremia (136-145 mM)excessive amounts of sodium in

the blood.

Hyponatremia (136-145 mM) is an electrolyte disturbance in

which the sodium ion concentration in the serum is lower than normal

Hyperglycemia is a condition in which an excessive

amount of glucose circulates in the blood plasma

HypoglycemiaDeficiency of glucose in the

bloodstream.