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Home , Chvostek sign, Electrolyte imbalance, Hypocalcemia

ABNORMALITIES (Ca+)

Electrolyte Imbalance Causes Treatment

Hypercalcemia Lethargy, fatigue, AMS renal disease normal saline to promote Ca > 10.5 mg/dL DTR decreased diuresis (if hypercalcemic, will also muscle weakness prolonged immobility to increase renal be in ) stones cancer excretion (monitor N/V, metallic taste ) calcitonin glucocorticoids anxiety, irritability acute IVF, normal saline Ca < 8.5 mg/dL laryngospasm hypoparathyroidism (if hypocalcemic, will also chronic renal failure be in ) deficiency Vitamin D + hypoalbuminemia correct any + Trousseau sign alkalotic states (prolonged respiratory , hyperventilation) ELECTROLYTE ABNORMALITIES (Ph)

Electrolyte Imbalance Signs and Symptoms Causes Treatment

Hyperphosphatemia anxiety, irritability Due to decrease Phosphate binders Ph > 4.5 mEq/L laryngospasm renal excretion Calcium carbonate (if hyperphosphatemia, will seizures renal failure also be in hypocalcemia) Same as hypocalcemia

Hypophosphatemia Lethargy, fatigue, AMS alcoholism replace phosphate Ph < 3.0 mEq/L DTR decreased increased cellular uptake of (if hypophosphatemia, will muscle weakness phosphorous with TPN also be in hypercalcemia) constipation increase glucose uptake with peptic ulcers TPN abdominal pain same as hypercalcemia ELECTROLYTE ABNORMALITIES (K+)

Electrolyte Signs and Symptoms Causes Treatment

Hyperkalemia muscle weakness, irritability Renal Failure kayexalate K > 5.1 mEq/L muscle , pain massive crush injuries dialysis n/v/d burns (early) calcium chloride, calcium ECG: Peaked T-waves, QRS gluconate, bicarbonate, widening, loss of P-waves adrenal cortical insufficiency insulin/glucose, albuterol , PEA excessive intake furosemide

Hypokalemia muscle weakness, ↓DTR potassium chloride (KCl) K < 3.5 mEq/L n/v/d metabolic alkalosis lactated ringers shallow respirations acute alcoholism* sulfate *may be low, related to low mental depression correct alkalosis magnesium (hypomagnesemia) ECG: irritable, fast uncontrolled diabetes VT/VF excessive excess aldosterone ELECTROLYTE ABNORMALITIES MAGNESIUM (Mg)

Electrolyte Signs and Symptoms Causes Treatment

Hypermagnesemia ↓DTR renal failure discontinue magnesium Mg > 2.5 mEq/L respiratory depression, arrest abuse (that contain substances ECG: bradyarrythmias magnesium) give calcium (if hyperkalemic) antacid abuse (that contain furosemide lethargy, coma magnesium) dialysis n/v, flushing Iatrogenic OD

Hypomagnesemia hyperreflexia chronic alcoholism* administer Mg < 1.6 mEq/L* + Chvostek sign n/v/d (max of 1 gram/minute, + Trousseau sign NGT to suction emergent) Ventricular , PSVT Post-CABG, Acute MI normal rate 1 gram/hour ↑ digoxin sensitivity DKA, HHK, ↑thyroid *will vary agitation, confusion aminoglycosides, diuretics, hinders potassium correction ETOH, digoxin, cisplatin insulin resistance, low K+ ELECTROLYTE ABNORMALITIES SODIUM (Na+)

Electrolyte Signs and Symptoms Causes Treatment

Hypernatremia thirst, , orthostasis, insensible losses correct slowly to prevent Na > 145 mEq/L hypotension cerebral edema dry mucous membranes osmotic diuresis () D5W or 0.45% NS restlessness, irritability DKA, HHS sodium restriction stupor, coma (DI) identify causes: vasopressin for DI urine Na > 20 in hypovolemia edema fluid overload identify causes: Na < 135 mEq/L fatigue, muscle cramps, heart failure fluid overload, water toxicity: weakness cirrhosis fluid restriction lethargy, confusion, ↓DTR excessive water ingestion loop diuretics abdominal cramps, SIADH severe: 3% saline, mannitol

seizures, coma, excessive IVF (D5W)