Slide 1

ELECTROLYTE IMBALAMCE

PRESENTED BY- Mr.Hrishikesh D Gore CON,PIMS(DU)

What is Electrolytes? Electrolytes are the substances that becomes ions in solution and have capacity to carry positive or negative electrical charge . Electrolytes maintain voltage across cell membranes and cell use electrolytes to conduct electrical impulse like nerve impulse,muscle contraction.

ELECTROLYTESNa+: most abundant electrolyte in the body

K+: essential for normal membrane excitability for nerve impulse

Cl-: regulates osmotic pressure and assists in regulating acid-base balanceCa2+: usually combined with phosphorus to form the mineral salts of bones and teeth, promotes nerve impulse and muscle contraction/relaxation

Mg2+: plays role in carbohydrate and protein metabolism, storage and use of intracellular energy and neural transmission. Important in the functioning of the heart, nerves, and muscles

What is Electrolyte Imbalance?

Normal electrolyte values

Potassium ImbalanceHypokalemia-Is defined as plasma potassium level less than 3.5mEq/L.

It is common electrolyte disorder especially in the older adult population .

Etiology of HypokalemiaProlonged diuretic therapyInadequate intake Severe diaphoresisGastric suctioning, laxative use, vomitingExcess insulinExcess stressHepatic diseaseAcute alcoholismDiarrheaDiuretics

Clinical manifestationAbnormal ECG

AnorexiaDrowsiness, lethargy, confusionLeg crampsMuscle weaknessHypotensionCardiac dysrhythmiasPolyuria(production of large amount of urine)

Medical managementIt focus on identifying and correcting cause of imbalance.Restore potassium level. IV or PO replacementGive K+ IV diluted in a large vein.Oral potassium replacement therapy is usually prescribed for mild hypokalemia

Inj.Potassium Chloride

Nursing management Monitor patients at riskMonitor I/OMonitor EKGMonitor Serum K+Watch urine outputWatch patients who take Digitalis for toxicity.Teach family and patient dietary changes.

High-potassium food.FishWhole grainsvegetables- cabbage,carrot,cucumber,mushrooms,potatoes, spinach.Fruits:bananas,guava,oranges,straberries, watermelon

Low potassium FoodVegetables: Corn, sweet potatoes, french-fried potatoes.Fruits: apple, blueberriesBeverages: instant coffee, cola, lemon-lime soda.

Hyperkalemia-is defined as an elevation of the potassium level greater than 5mEq/L.

Hyperkalemia is rare in clients with normal kidney function but affects more than half of people with acute and chronic renal failure.

EtiologyIncreased dietary intakeExcessive administration of K+Excessive use of salt substitutesWidespread cell damage, burns, traumaAdministration of larger quantities of blood that is oldHyponatremiaRenal failure

17

Clinical manifestationApathyConfusionNumbness/paresthesia of extremitiesAbdominal crampsNauseaFlaccid musclesDiarrheaOliguriaBradycardiaCardiac arrest

Medical managementThe goal of medical management are to correct the potassium level as quickly as possible to prevent life threatening consequences.Calcium gluconate IV may be give as an antidoteD 50 and regular insulin to facilitate movement into the cells

Nursing managementMonitor patients at riskCardiac monitoringMonitor pulse, rate and rhythm, and B/PAssess for hyperactive bowel soundsAssess sensory and motor functionMonitor neurological status

Calcium imbalanceHypocalcemia- it is defined as plasma calcium level less than 4.5mEq/L.

EtiologySurgically induced hypoparathyroidismRenal failureVitamin D deficiencyInadequate exposure to ultraviolet lightAcute pancreatitishyperphosphatemia

Medical managementThe goal of medical management are to determine and correct the cause of the hypocalcemia, restore calcium value to normal level.

Nursing managementAssess clients at risk; surgery/transfusionsSeizure precautionsAdminister IV Ca++ slowly; watch for infiltrationKeep calcium gluconate at bedsideAssess nutritional intake of Ca++Watch for sensitivity if taking Digitalis, may cause lead to cardia arrest

HypercalcemiaIt is defined as level of plasma calcium level greater than 5.5mEq/L.

EtiologyExcessive intakeExcessive use of antacids with phosphate-bindingProlonged immobilityExcessive vitamin D intakeThiazide diureticsCancerThyrotoxicosis

Clinical manifestationMuscle weaknessPersonality changesNausea and vomitingExtreme thirstAnorexiaConstipationPolyuriaPathological fracturesCalcifications in the skin and corneaCardiac arrest

Medical managementThe goal of medical management are to determine and correct the cause of hypercalcemia

Nursing managementMonitor clients at risk; immobile, cancerAmbulate clients earlyDrink plenty of fluids, 3-5 liters to help excrete excess Ca++Administer IV NS 200-500/hr if tolerated or for moderate hypercalcemiaAdminister loop diureticsAdminister CalcitoninTeach client to avoid dairy products

Magnesium imbalanceHypomagnesemia- it is defined as a plasma magnesium level less than 1.5mEq/L.

EtiologyExcessive dietary intake of Ca++ or vitamin DLosses from gastric suctioningSevere nausea, vomiting or diarrhea, Pancreatitis, alcoholismExcessive diuretic therapyAdministration of fluids without MgStarvationUlcerative colitisHypercalcemia. High dose steroid useCancer chemotherapy

Clinical manifestationCardiac dysrhythmias hypotensiontremorHyperactive deep tendon reflexesMemory lossEmotional labilityConfusionHallucinationsSeizures

Medical managementTreatment of hypomagnesemia includes oral magnesium in the form of magnesium containing antacidIncreasing diatary intake of magnesium also helps ensure balance and stability.

Nursing managementMonitor clients at riskWatch for digitalis toxicityCardiac monitoringSeizure precautionsTreat with oral, IM, IV or Mg saltsMonitor urine outputTeach patients about foods high in MgGreen vegetablesNutsBeansfruits

HypermagnesemiaDefinition-it is define as plasma magnesium level greater than 2.5mEq/L.

Usually results from renal failureExcessive intake usually involves OTC RXProduces sedative effect on neuromuscular junctions, diminishes muscle cell excitabilityCan cause hypotension or cardiac arrest

EtiologyRenal failureExcessive use of Mg containing antacidsUntreated diabetic ketoacidosisHypoadrenalism

Clinical manifestation Lethargy and drowsinessDepress neuromuscular activityDepresses respiratonsSensation of warmth throughout the bodyHypoactive deep tendon reflexesHypotensionBradycardiaCardiac arrest

Medical managementMedical management of hypermagnesemia includes decreasing use of magnesium sulfate.Saline infusion with a diuretic increases renal elemination of magnesium.Albuterol is also used to reduce magnesium level.If renal failure is present hemodyalysis may be necessary.

Nursing managementMonitor clients at riskMonitor Vital Sign, especially B/PAssess neuromuscular statusCardiac monitoringBe prepared to give Ca gluconateMinimize intake.

Sodium imbalanceHyponatremia- definition-it is defined as decrease level of sodium less than 135mEq/L.

Etiology Prolonged diuretic therapyExcessive diaphoresisInsufficient Na intakeGI losses suctioning, laxatives, vomitingAdministration of hypotonic fluidsCompulsive water drinkingLabor induction with oxytocinCystic fibrosisalcoholism

CLINICAL MANIFESTATIONSCardiovascular manifestation- decrease BP, Orthostatic hypotension, weak pulse, tachycardia,TachypneaDyspneaOrthopneaHyperventilationGI ManifestationNausea,vomitting,hyperactive bowel sound,abdominal cramp,diarrhea

Medical managementRestrict fluidsMonitor Vital SignsMonitor serum Na levelsIV normal saline or Lactated Ringers If Na is below 115, mEq/L hypertonic saline is orderedMay give a diuretic for increasing H2O lossEncourage a balanced dietIntake outputSafety for weakness or confusionAssist with ambulation if low B/P

Nursing managementAssessmentMuscle weaknessTachycardia FatigueApathyDry skin, pale mucus membranesConfusionHeadache Nausea/Vomiting, Abdominal crampsOrthostatic hypotension

HypernatremiaDefinition: it is defined as plasma sodium level greater than 145mEq/L.

EtiologyVomiting/diarrheaDiaphoresisInadequate ADHSome drugs Hypertonic fluids/tube feedingsMajor burns

Clinical manifestationThirstFlushed skinDry mucus membranesLow UOPTachycardiaSeizures Hyperactive deep tendon reflexes

Medical managementThe goal of medical management is correction of plasma sodium sodium level for client experiencing minor manifestation from Hypovolemia hypernatremia.The focus is on correcting the underlying disorder and giving oral fluid replacement.

Nursing management Assessment:Low Na dietMay use salt substitutes if K+ Encourage H2O consumptionMonitor fluid intake on patients with heart or renal diseaseObserve changes in B/P, and heart rate if hypovolemicMonitor serum Na levelsAssess respiratory for cracklesWeigh daily

Assess skin and mucus membranesAssist with oral hygieneCheck neurological statusTeach patient to monitor I/O and watch for edemaTeach patient and family signs and symptoms and when to report them

Role of nurse?

Role of nurse? Dilution of electrolytes solutions?Storage of electrolytes?