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ELECTROLYTE ABNORMALITIES CALCIUM (Ca+)

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ELECTROLYTE ABNORMALITIES CALCIUM (Ca+) ELECTROLYTE ABNORMALITIES CALCIUM (Ca+) Electrolyte Imbalance Signs and Symptoms Causes Treatment Hypercalcemia Lethargy, fatigue, AMS renal disease normal saline to promote Ca > 10.5 mg/dL DTR decreased hyperparathyroidism diuresis (if hypercalcemic, will also muscle weakness prolonged immobility furosemide to increase renal be in hypophosphatemia) kidney stones cancer excretion (monitor N/V, metallic taste hypokalemia) calcitonin glucocorticoids Hypocalcemia anxiety, irritability acute pancreatitis IVF, normal saline Ca < 8.5 mg/dL laryngospasm hypoparathyroidism calcium gluconate (if hypocalcemic, will also seizures chronic renal failure calcium chloride be in hyperphosphatemia) torsades de pointes Vitamin D deficiency Vitamin D + Chvostek sign hypoalbuminemia correct any + Trousseau sign alkalotic states (prolonged respiratory alkalosis vomiting, hyperventilation) ELECTROLYTE ABNORMALITIES PHOSPHATE (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 POTASSIUM (K+) Electrolyte Signs and Symptoms Causes Treatment Hyperkalemia muscle weakness, irritability Renal Failure kayexalate K > 5.1 mEq/L muscle cramps, pain massive crush injuries dialysis n/v/d burns (early) calcium chloride, calcium ECG: Peaked T-waves, QRS acidosis gluconate, sodium bicarbonate, widening, loss of P-waves adrenal cortical insufficiency insulin/glucose, albuterol bradycardia, PEA excessive intake furosemide Hypokalemia muscle weakness, ↓DTR diuretics potassium chloride (KCl) K < 3.5 mEq/L n/v/d metabolic alkalosis lactated ringers shallow respirations acute alcoholism* magnesium sulfate *may be low, related to low mental depression cirrhosis correct alkalosis magnesium (hypomagnesemia) ECG: irritable, fast uncontrolled diabetes VT/VF excessive perspiration 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 laxative abuse (that contain substances ECG: bradyarrythmias magnesium) give calcium (if hyperkalemic) hypotension antacid abuse (that contain furosemide lethargy, coma magnesium) dialysis n/v, flushing Iatrogenic OD Hypomagnesemia hyperreflexia chronic alcoholism* administer magnesium sulfate Mg < 1.6 mEq/L* + Chvostek sign n/v/d (max of 1 gram/minute, + Trousseau sign NGT to suction emergent) Ventricular arrhythmias, 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+ malnutrition ELECTROLYTE ABNORMALITIES SODIUM (Na+) Electrolyte Signs and Symptoms Causes Treatment Hypernatremia thirst, tachycardia, orthostasis, insensible losses correct slowly to prevent Na > 145 mEq/L hypotension dehydration cerebral edema dry mucous membranes osmotic diuresis (mannitol) D5W or 0.45% NS restlessness, irritability DKA, HHS sodium restriction stupor, coma diabetes Insipidus (DI) identify causes: vasopressin for DI urine Na > 20 in hypovolemia Hyponatremia 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, diarrhea SIADH severe: 3% saline, mannitol seizures, coma, brain herniation excessive IVF (D5W).
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