Electrolytes

This PPT is mainly useful for MBBS as well as other branch of Medicine to have an basic idea about Electrolytes. Also about What to see & What to do in cases of Electrolytes Imbalances.

1. Electrolytes

2. Objectives
•Electrolytes – Cations & Anions
•Functions – Electrolytes
•Electrolyte Imbalances – You See &
You Do

3. Electrolytes
•Charged particles in solution
•Cations (+)
•Anions (-)
•Integral part of metabolic and
cellular processes

5. Composition of Body FluidsComposition of Body Fluids

6. Major Cations
•EXTRACELLULAR
–SODIUM (Na+)
•INTRACELLULAR
–POTASSIUM (K+)

7. What do Electrolytes - Do?
•Promotes neuromuscular impulses.
•Maintain body fluid volume & Osmolarity.
•Distribute body water between fluid
compartments.
•Regulate acid base balance.

8. Electrolyte Imbalances
•Hyponatremia/
Hypernatremia
•Hypokalemia/
Hyperkalemia
•Hypomagnesemia/
Hypermagnesemia
•Hypocalcemia/
Hypercalcemia
•Hypophosphatemia/
Hyperphosphatemia
•Hypochloremia/
Hyperchloremia

9. Hyponatremia
•Serum Na+ level < 135 mEq/L
•Deficiency in Na+ related to amount of body
fluid
•Several types
–Dilutional
–Depletional
–Hypovolemic
–Hypervolemic
–Isovolemic

10. Surgical Causes - Hyponatremia
•Intestinal obstruction
•Intestinal fistulas – biliary / duodenal /
gastric / pancreatic
•GOO – severe vomiting
•Ryle’s tube aspiration
•Severe diarrhoea – Colitis / colerectal polyps
•After surgery & trauma – occurs

11. What Do You See ?
•Sunken eyes, Dry coated
tongue, poor skin turgor
•Headache, N/V, muscle
twitching, altered mental
status
•Irritability, neurological
symptoms, convulsions ,
coma

12. What Do We Do?
•MILD / CHRONIC
CASE
–Na < 115 mEq/ L
–Restrict fluid intake for
hyper/isovolemic
hyponatremia
–IV fluids and/or
increased Na+ intake
for hypovolemic
hyponatremia
•SEVERE / ACUTE
CASE
–Na < 100 mEq/L
–Infuse hypertonic
NaCl solution (3% or
5% NaCl)
–Frusemide to remove
excess fluid
–Monitor client in ICU

13. Hypernatremia
•Excess Na+ relative to body water
•Occurs less often than hyponatremia
•Na > 150 mEq / L
•When hypernatremia occurs, fluid shifts
outside the cells
•May be caused by water deficit or over-
ingestion of Na+ - Renal dysfuction
•Also may result from diabetes insipidus,
Cardiac failure, Drug – NSAID / Steroids

14. What Do You See ?
•Think S-A-L-T
Skin flushed
Agitation
Low grade fever
Thirst
•Neurological symptoms
•Signs of hypovolemia
Firm,

15. What Do We Do?
•Correct underlying
disorder
•Restrict saline &
sodium
•Gradual / Slow fluid
replacement
•Monitor for s/s of
cerebral edema
•Monitor serum Na+
level
•Seizure precautions

16. Potassium
•Major intracellular cation
•Untreated changes in K+ levels can lead to
serious neuromuscular and cardiac
problems
•Normal K+ levels = 3.5 - 5 mEq/L

17. Balancing Potassium
•Most K+ ingested is excreted by the kidneys
•Three other influential factors in K+ balance :
–Na+/K+ pump
–Renal regulation
–pH level

18. Hypokalemia
•Serum K+ < 3.5 mEq/L
•Caused by –
•SUDDEN = Pts in
Diabetic coma
•GRADUAL
–Diarrhoea – Villous+UC
–PS + GOO
–Duodenal fistula
–Ileostomy / USD
–Poisoning
–Beta agonists

19. What Do You See?
•Think S-U-C-T-I-O-N
–Skeletal muscle weakness / Slurred speech
–U wave (ECG changes) - Arrythmias
–Constipation, ileus
–Tone – Hypotonia = Sign
–I rregular, weak pulse
–O rthostatic hypotension
–N umbness (paresthesias)

20. HypokalemiaHypokalemia

21. What Do We Do?
•Increase dietary K+
•Oral KCl supplements
•IV K+ replacement
•Change to K+-sparing diuretic
•Monitor ECG changes

22. IV K+ Replacement
•Mix well when
adding to an IV
solution bag
•Concentrations
should not exceed
40-60 mEq/L
•Rates usually 10-
20 mEq/hr
NEVER GIVE IV NEVER GIVE IV
PUSH PUSH
POTASSIUMPOTASSIUM

23. Hyperkalemia
•Serum K+ > 6 mEq/L
•Less common than
hypokalemia
•Caused by altered
kidney function,
increased intake (salt
substitutes), blood
transfusions, meds
(K+-sparing diuretics),
cell death (trauma)

24. What Do You See?
•Irritability
•Paresthesia
•Muscle weakness (especially legs)
•ECG changes (tented / peak T wave)
•Irregular pulse
•Hypotension
•Nausea, abdominal cramps, diarrohea

26. What Do We Do?
•Mild
–Loop diuretics (Lasix)
–Dietary restriction
•Moderate
–Cation-exchange resin
such as Kayexalate (act by
exchanging the cations in
the resin for the potassium
in the intestine) potassium
is then excreted in the stool
•Emergency
–10% calcium
gluconate for cardiac
effects
–Sodium bicarbonate
for acidosis

27. Calcium
•99% in bones, 1% in serum and soft tissue
(measured by serum Ca++)
•Works with phosphorus to form bones and
teeth
•Role in cell membrane permeability
•Affects cardiac muscle contraction
•Participates in blood clotting
•Normal value 8.5 – 10.5 mg/dl

28. Hypocalcemia
•Serum calcium < 8.9 mg/dl
•Caused by inadequate intake, malabsorption,
pancreatitis, thyroid or parathyroid surgery,
loop diuretics, low magnesium levels

29. What Do You See?
•Neuromuscular
–Anxiety, confusion, irritability, muscle
twitching, paresthesias (mouth, fingers,
toes), tetany, carpopedal spasms
•Fractures
•Diarrohea
•Diminished response to digoxin
•EKG changes

30. TESTS USED TO ELICIT SIGNS OF CALCIUM DEFICIENCYTESTS USED TO ELICIT SIGNS OF CALCIUM DEFICIENCY

32. What Do We Do?
•Calcium gluconate for postop thyroid or
parathyroid client
•Cardiac monitoring
•Oral or IV calcium replacement

33. Hypercalcemia
•Serum calcium > 10.1 mg/dl
•Two major causes
–Cancer
–Hyperparathyroidism

34. What Do You See?
•Fatigue, confusion, lethargy, coma
•Muscle weakness, hyporeflexia
•Bradycardia Þ cardiac arrest
•Anorexia, nausea/vomiting, decreased bowel
sounds, constipation
•Polyuria, renal calculi, renal failure

35. CLINICAL MANIFESTATIONS OF HYPERCALCEMIACLINICAL MANIFESTATIONS OF HYPERCALCEMIA
Decreased GI Decreased GI
MotilityMotility
Cardiac DysrhythmiasCardiac Dysrhythmias
ConstipationConstipation
NauseaNausea
Mental status changes: Mental status changes:
lethargy, confusion, lethargy, confusion,
memory lossmemory loss

36. CLINICAL MANIFESTATIONS OF HYPERCALCEMIACLINICAL MANIFESTATIONS OF HYPERCALCEMIA
ImmobilizationImmobilization Bone Bone
DemineralizationDemineralization
Calcium Calcium
accumulates in accumulates in
the ECF and the ECF and
passes through passes through
the kidneysthe kidneys
Ca PrecipitationCa Precipitation
Calcium StonesCalcium Stones

37. What Do We Do?
•If asymptomatic, treat underlying cause
•Hydrate the patient to encourage diuresis
•Loop diuretics
•Corticosteroids

38. Magnesium
•Cofactor for many enzymes – ATP
utilisation in muscle fiber
•Role in protein synthesis &
carbohydrate metabolism
•Helps cardiovascular system function
(vasodilation)
•Regulates muscle contractions

39. Hypomagnesemia
•Serum Mg++ level <
1.5 mEq/L
•Caused by poor
dietary intake, poor GI
absorption, excessive
GI/urinary losses
•High risk clients
–Chronic alcoholism
–Malabsorption
–GI/urinary system
disorders
–Sepsis
–Burns
–Wounds needing
debridement

40. What Do You See?
•CNS
–Altered LOC
–Confusion
–Hallucinations
•Neuromuscular
–Muscle weakness
–Leg/foot cramps
–Hyper DTRs
–Tetany

41. CLINICAL MANIFESTATIONS OF HYPOMAGNESEMIACLINICAL MANIFESTATIONS OF HYPOMAGNESEMIA
CONFUSIONCONFUSION
DEPRESSIONDEPRESSION
CRAMPSCRAMPS
TETANYTETANY CONVULSIONSCONVULSIONS

42. What Do You See?
•Cardiovascular
–Tachycardia
–Hypertension
–ECG changes
•Gastrointestinal
–Dysphagia
–Anorexia
–Nausea/vomiting

43. What Do We Do?
•Mild
–Dietary replacement
•Severe
–IV or IM magnesium sulfate
•Monitor
–Neuro status
–Cardiac status
–Safety

44. Mag Sulfate Infusion
•Use infusion pump - no faster than 150
mg/min
•Monitor vital signs for hypotension and
respiratory distress
•Monitor serum Mg++ level q6h
•Cardiac monitoring
•Calcium gluconate as an antidote for
overdosage

45. Hypermagnesemia
•Serum Mg++ level > 2.5 mEq/L
•Not common
•Renal dysfunction is most common
cause
–Renal failure
–Addison’s disease
–Adrenocortical insufficiency
–Untreated DKA

46. What Do You See?
•Decreased neuromuscular activity
•Hypoactive DTRs
•Generalized weakness
•Occasionally nausea/vomiting

47. What Do We Do?
•Increased fluids if renal function normal
•Loop diuretic if no response to fluids
•Calcium gluconate for toxicity
•Mechanical ventilation for respiratory
depression
•Hemodialysis (Mg++-free dialysate)