Cardiovascular Health and Electrolyte Imbalances

Elevated Central Venous Pressure

• Distended neck veins
• Engorged varicose veins
• Weight gain
• Increased respiratory rate
• Pitting edema in dependent areas

Hypernatremia

• High sodium levels
• Can cause dehydration and altered mental status
• Risks:
  • Dehydration
  • Diabetes insipidus
  • Excessive sodium intake (dietary or from infusion)
    • Sources of sodium:
• Prevention:
  • Follow a low-sodium diet
  • Ensure adequate fluid intake
  • Monitor for signs
    • Thirst, confusion

Hyponatremia

• Low sodium levels
• Can cause confusion and seizures
• Risks:
  • Excessive water intake
  • Syndrome of inappropriate antidiuretic hormone (SIADH)
  • Diuretic use (especially thiazides)
  • Severe vomiting or diarrhea
  • Heart failure and Liver disease that affects fluid balance
• Prevention:
  • Follow fluid restrictions in conditions like heart failure
  • Encourage appropriate sodium intake (especially in patients with GI problems)
  • Monitor sodium levels regularly in at-risk patients
• Changes that occur:
  • Increased motility
  • Nausea
  • Diarrhea
  • Abdominal cramping
  • Deep tendon reflexes diminish
  • Muscle weakness is worse in the legs and arms

Hypercalcemia

• High calcium levels
• Can cause weakness and confusion
• Risks:
  • Hyperparathyroidism
  • Cancer (specifically bone metastasis or certain tumors)
  • Excessive vitamin D intake
  • Prolonged immobilization
  • Use of thiazide diuretics
• Prevention:
  • Limit calcium and vitamin D intake in at-risk patients
    • Patients with hyperparathyroidism are at increased risk
  • Encourage hydration to prevent kidney stones
  • Promote physical activity to prevent calcium release from bones
• Changes that occur:
  • Short attention span, agitation, and confusion
  • Muscle weakness and twitching
  • Reduced deep tendon reflexes
  • Increased pulse rate
  • Peripheral pulses difficult to palpate and easily blocked
  • Hypotension
  • Severe orthostatic hypotension
  • Reduced pulse pressure
  • Slow to normal bounding pulses
  • Peripheral pulses that are full and difficult to block
  • Neck veins that are distended, even in an upright position
  • Increased blood pressure, especially diastolic blood pressure

Hypocalcemia

• Low calcium levels
• Can cause muscle spasms and cardiac arrhythmias
• Risks:
  • Vitamin D deficiency
  • Hypoparathyroidism
  • Chronic kidney disease
  • Magnesium deficiency
• Prevention:
  • Encourage a calcium-rich diet
    • Dairy, leafy green vegetables
  • Ensure adequate vitamin D intake for calcium absorption
  • Monitor calcium levels in patients with thyroid or parathyroid disorders

Hyperkalemia

• High potassium levels
• Can cause life-threatening arrhythmias
• Risks:
  • Kidney failure
  • Use of potassium sparing diuretics
  • Adrenal insufficiency
  • Excessive potassium intake
    • Sources of potassium:
  • Tissue damage
• Prevention:
  • Limit potassium-rich food intake
    • Bananas, oranges, potatoes
  • Regularly check medications
  • Monitor potassium levels in patients with kidney issues or on medications

Hypokalemia

• Low potassium levels
• Can cause arrhythmias and muscle weakness
• Risks:
  • Use of diuretics
  • Severe vomiting or diarrhea
  • Excessive laxative use
  • Alkalosis
  • Inadequate potassium diet intake
• Prevention:
  • Encourage potassium-rich foods
    • Bananas, spinach, oranges, potatoes
  • Monitor diuretic usage and promote potassium supplementation if necessary
  • Teach athletes/patients who sweat excessively to replace potassium loss

Hyperphosphatemia

• Normal Level: 3.5-5.0

Basic Metabolic Panel (BMP)

• A blood test that measures electrolytes, glucose, and kidney function.
• Commonly Measured:
  • Sodium (Na+)
  • Potassium (K+)
  • Chloride (Cl-)
  • Carbon Dioxide (CO2)
    • Reflective of bicarbonate levels and helps asses acid and base balance
    • Abnormalities:
      • Metabolic acidosis (low CO2)
      • Metabolic alkalosis (high CO2)
  • Blood Urea Nitrogen (BUN)
    • Indicates kidney function and hydration status
    • Abnormalities:
      • Elevated - dehydration or kidney dysfunction
  • Glucose
    • Provides energy and regulates metabolism
  • Calcium
    • Important for bones, muscles, and nerves.
  • Magnesium (not in initial BMP)
  • Normal Level: 1.7 - 2.2
  • 24 hour urine:
    • Measures how well kidneys excrete electrolytes and other substances in a full day
    • We don’t use the first morning urine, urine needs to be stored in a cool place
    • Measures Excretion of:
      • Volume
      • Creatinine
      • Protein
      • Sodium
      • Potassium
      • Calcium
      • Magnesium
      • Phosphate
      • Cortisol
      • Oxalate
      • Citrate
      • Chloride
      • Sulfate
      • Nitrogen
      • Uric acid
      • Ammonia

Risk Factors Related to Electrolyte Imbalances

• Dehydration
  • Risks:
    • Inadequate fluid intake
    • Excessive fluid loss (e.g., vomiting, diarrhea, sweating)
    • Certain medical conditions (e.g., diabetes insipidus, kidney failure)
    • Medications (e.g., diuretics)
• Exemplars:
  • Specific electrolyte imbalances (e.g., hypernatremia, hypokalemia)
  • Dehydration
  • Fluid Volume Overload (e.g., heart failure, kidney failure)
• Nursing Process:
  • Specific electrolyte imbalances
  • Dehydration

Fluid & Electrolyte Balance

• Regulates extracellular and intracellular fluid volume, body fluid osmolality, and plasma electrolyte concentrations.
• Osmosis: Water moves across a semipermeable membrane from low solute concentration to high solute concentration, aiming to equalize concentration on both sides. Normal plasma osmolality is 290.
• Diffusion: Passive movement of molecules from high concentration to low concentration. Think of pouring koolaid into a pool or airing out a bad smell.
• Filtration: Movement of water and solutes across a membrane driven by hydrostatic pressure. This pressure is crucial, often exerted by blood pressure. Fluid passes through capillaries, but large molecules like proteins are retained.
• Active Transport: Movement of molecules across a cell membrane against their concentration gradient. Requires ATP and carrier proteins.
• Intracellular: Refers to anything inside cells.
• Extracellular: Refers to anything outside cells.
• Isotonic: Solution with the same concentration as inside a cell.
• Hypertonic: Solution with a higher concentration of solutes compared to the inside of a cell.
• Hypotonic: Solution with a lower concentration of solutes compared to the inside of a cell.

Assessment

Labs

• Basic Metabolic Panel (BMP):

  • Sodium: 135-145 mEq/L
  • Potassium: 3.5-5.0 mEq/L
  • Chloride: 96-106 mEq/L
  • Carbon Dioxide (CO2): 23-30 mEq/L, reflects bicarbonate levels and assesses acid-base balance.
    • Abnormalities:
      • Metabolic Acidosis: Low CO2
      • Metabolic Alkalosis: High CO2
  • Blood Urea Nitrogen (BUN): 7-20 mg/dL, indicates kidney function and hydration status.
    • Elevated BUN could indicate dehydration or kidney dysfunction.
  • Glucose: 70-100 mg/dL, provides energy and regulates metabolism.
  • Calcium: 8.5-10.2 mg/dL, important for bones, muscles, and nerves.
  • Bonus: Magnesium: 1.7-2.2 mg/dL, Not included in BMP.

• 24-Hour Urine:

  • Measures kidney excretion of electrolytes and other substances over a full day.
  • First morning urine is not used, and urine should be stored in a cool place.
  • Measures excretion of:
    • Volume
    • Creatinine
    • Protein
    • Sodium
    • Potassium
    • Calcium
    • Magnesium
    • Phosphate
    • Cortisol
    • Oxalate
    • Citrate
    • Chloride
    • Sulfate
    • Nitrogen
    • Uric Acid
    • Ammonia

Exemplars

• Specific electrolyte imbalances
• Dehydration
• Fluid Volume Overload

Nursing Process

• Specific electrolyte imbalances
• Dehydration

Risk Factors Related to Electrolyte Imbalances

Dehydration

• Risks:
  • Inadequate fluid intake
  • Excessive fluid loss
  • Increased urination
  • Elderly age (decreased thirst sensation)
  • Hot climates or strenuous exercise
• Prevention Strategies:
  • Encourage adequate hydration
  • Teach signs of dehydration:
    • Dry mouth, Thirst, Dark urine
  • Adjust fluid intake based on needs
• What occurs during dehydration?
  • Increased heart rate
  • Weak peripheral pulses, difficult to find and easily blocked
  • Decreased blood pressure and pulse pressure, with a greater decrease in systolic blood pressure (orthostatic hypotension).
  • Lightheadedness and dizziness, increasing fall risk
  • Flat neck and hand veins when supine or hands below heart level.
  • Laboratory findings can show hemoconcentration, causing elevation in:
    • Hemoglobin
    • Hematocrit
    • Serum osmolarity
    • Glucose
    • Protein
    • Blood urea nitrogen
    • Electrolytes

Fluid Overload (Hypervolemia)

• Risks:
  • Kidney failure
  • Congestive heart failure
  • Liver cirrhosis
  • Excessive intravenous fluid administration
  • Hormonal imbalances: High levels of aldosterone (causes water retention)
• Prevention Strategies:
  • Monitor daily fluid intake
  • Follow fluid restriction orders
  • Limit sodium intake (often in processed and canned foods)
  • Encourage daily weight checks: Report sudden gain of 2 or more pounds/day.
• Changes that occur as a result of hypervolemia:
  • Increased pulse rate
  • Bounding pulse quality
  • Elevated blood pressure
  • Decreased pulse pressure
  • Reduced deep tendon reflexes

Hypocalcemia

• Low Calcium Levels
• Can cause muscle spasms and cardiac arrhythmias
• Risks:
  • Vitamin D deficiency
  • Hypoparathyroidism
  • Chronic kidney disease
  • Magnesium deficiency
• Prevention:
  • Encourage a calcium-rich diet: Dairy, leafy green vegetables.
  • Ensure adequate vitamin D intake for calcium absorption.
  • Monitor calcium levels in patients with thyroid or parathyroid disorders.

Hyperkalemia

• High Potassium Levels
• Can cause life-threatening arrhythmias
• Risks:
  • Kidney failure (impaired potassium excretion)
  • Use of potassium-sparing diuretics
  • Adrenal insufficiency (reduced aldosterone, reduced potassium excretion)
  • Excessive potassium intake (Bananas, oranges, potatoes, etc.)
  • Tissue damage (releases potassium)
• Prevention:
  • Limit potassium-rich food intake
  • Regularly check medications
  • Monitor potassium levels in patients with kidney issues or on medications.

Hypokalemia

• Low Potassium Levels
• Can cause arrhythmias and muscle weakness
• Risks:
  • Use of diuretics
  • Severe vomiting or diarrhea
  • Excessive laxative use
  • Alkalosis (shifts potassium into cells)
  • Inadequate potassium diet intake
• Prevention:
  • Encourage potassium-rich foods: Bananas, spinach, oranges, potatoes
  • Monitor diuretic usage and promote potassium supplementation if necessary
  • Teach athletes/patients who sweat excessively to replace potassium loss.

Hyperphosphatemia

• High Phosphate Levels
• Risks:
  • Chronic kidney disease (impaired excretion)
  • Hypoparathyroidism (reduced parathyroid hormone leads to less excretion)
  • Excessive phosphate intake or IV intake
  • Rhabdomyolysis or tumor lysis syndrome (massive cell breakdown releases phosphate)

Hypermagnesemia

• High Magnesium Levels
• Risks:
  • Chronic kidney disease (impaired excretion)
  • Excessive magnesium intake (from supplements or laxatives)
  • Adrenal insufficiency
  • Medicines with magnesium (antacids or laxatives)
• Prevention:
  • Limit magnesium-containing medications: Such as laxatives and antacids.
  • Monitor magnesium levels, especially in patients with kidney disease.
  • Educate about signs: Muscle weakness, lethargy, slow reflexes.

Hypomagnesemia

• Low Magnesium Levels
• Risks:
  • Chronic alcoholism
  • Diuretic use (especially loop diuretics)
  • Severe diarrhea/vomiting
  • Malabsorption disorders (such as Crohn's)
  • Inadequate dietary intake
• Prevention:
  • Promote magnesium-rich foods: Nuts, seeds, whole grains, leafy greens
  • Monitor diuretic use
  • Monitor alcohol use

Pharmacology

Types of Intravenous Fluids

• Isotonic Solutions:
  • Definition: Solutions with the same osmotic pressure as blood plasma.
  • Common Examples: Normal Saline (0.9% NaCl), Lactated Ringer's, Dextrose 5% in water (D5W).
• Hypertonic Solutions:
  • Definition: Solutions with a higher osmotic pressure than blood plasma, causing fluid to move out of cells.
  • Common Examples: 3% Sodium Chloride, Dextrose 10% in water (D10W).
• Hypotonic Solutions:
  • Definition: Solutions with a lower osmotic pressure than blood plasma, causing fluid to move into cells.
  • Common Examples: 0.45% Sodium Chloride (half-normal saline), Dextrose 2.5% in water.

Electrolyte Replacements

• Sodium:

### Fluid & Electrolyte Balance

• Regulating the extracellular and intracellular fluid volume, body fluid osmolality and plasma concentrations of electrolytes.

Basic Principles

• Osmosis: Movement of water molecules across a selectively permeable membrane from an area of low solute concentration to an area of high solute concentration. The goal is to equalize the concentration on both sides of the membrane. The normal fluid osmolality value for plasma is ~290.
• Diffusion: Passive movement of molecules (particles like gas, ions, or small molecules) from an area of higher concentration to an area of lower concentration.
• Filtration: Movement of water and solutes across a membrane driven by hydrostatic pressure. Typically force exerted by blood pressure; fluid passes through capillaries but large molecules like proteins are held back.
• Active transport: Movement of molecules across a cell membrane against their concentration gradient; Requires ATP and involves carrier proteins.
• Intracellular: Anything occurring inside the cells.
• Extracellular: Anything outside of the cells.
• Isotonic: Solution that has the same concentration as the inside of a cell.
• Hypertonic: Solution that has a higher concentration of solutes compared to inside of cell.
• Hypotonic: Solution that has a lower concentration of solutes compared to inside of cell.

Assessment

• Labs:
  • Basic Metabolic Panel (BMP):
    • Sodium: Normal Level: 135-145
    • Potassium: Normal Level: 3.5-5.0
    • Chloride: Normal Level: 96-106
    • Carbon Dioxide: Normal Level: 23-30; Reflective of bicarbonate levels and helps asses acid and base balance. Abnormalities include metabolic acidosis (low CO2) and metabolic alkalosis (high CO2)
    • BUN: Normal Level: 7-20; Indicates kidney function + hydration status. Elevated BUN may indicate dehydration or kidney dysfunction.
    • Glucose: Normal Level: 70-100
    • Calcium: Normal Level: 8.5-10.2; Important for bones, muscles, and nerves.
    • Magnesium: Normal Level: 1.7-2.2; Not in BMP.
  • 24 Hour Urine: Measures how well kidneys excrete electrolytes + other substances in a full day. We don’t use the first morning urine, urine needs to be stored in a cool place. Measures Excretion of volume, creatinine, protein, sodium, potassium, calcium, magnesium, phosphate, cortisol, oxalate, citrate, chloride, sulfate, nitrogen, uric acid, ammonia.

Risk Factors Related to Electrolyte Imbalances

• Dehydration:

  • Risks: Inadequate fluid intake, elevated central venous pressure, distended neck and hand veins, engorged varicose veins, weight gain, increased respiratory rate, pitting edema in dependent areas.

• Hypernatremia: High Sodium Levels; Can cause dehydration + altered mental status

  • Risks: Dehydration, Diabetes insipidus (leads to excessive water loss), excessive sodium intake (dietary or from infusion). Sources of sodium: processed foods, canned foods, salt.
  • Prevention: Follow a low-sodium diet, ensure adequate fluid intake, monitor for signs (thirst, confusion).

• Hyponatremia: Low Sodium Levels; Can cause confusion + seizures.

  • Risks: Excessive water intake, Syndrome of inappropriate antidiuretic hormone, diuretic use (especially thiazides), severe vomiting or diarrhea, heart failure +Liver disease that affects fluid balance.
  • Prevention: Follow fluid restrictions in conditions like heart failure, encourage appropriate sodium intake (especially in patients with GI problems), monitor sodium levels regularly in at-risk patients.
  • Changes that occur: Increased motility, nausea, diarrhea, abdominal cramping, deep tendon reflexes diminish, muscle weakness is worse in the legs and arms.

• Hypercalcemia: High Calcium Levels; Can cause weakness + confusion.

  • Risks: Hyperparathyroidism, cancer (specifically bone metastasis or certain tumors), excessive vitamin D intake, prolonged immobilization (causes bone breakdown + increased calcium release), use of thiazide diuretics.
  • Prevention: Limit calcium and vitamin D intake in at risk patients, encourage hydration to prevent kidney stones, promote physical activity to prevent calcium release from bones.
  • Changes that occur: Short attention span, agitation, and confusion, muscle weakness + twitching, reduced deep tendon reflexes, increased pulse rate, peripheral pulses difficult to palpate and easily blocked, hypotension, severe orthostatic hypotension, reduced pulse pressure, slow to normal bounding pulses, peripheral pulses that are full and difficult to block, neck veins that are distended, even in an upright position, increased blood pressure, especially diastolic blood pressure.

• Hypocalcemia: Low Calcium Levels; Can cause muscle spasms + cardiac arrhythmias.

  • Risks: Vitamin D deficiency, hypoparathyroidism, chronic kidney disease, magnesium deficiency.
  • Prevention: Encourage a calcium-rich diet (dairy, leafy green vegetables), Ensure adequate vitamin D intake for calcium absorption, monitor calcium levels in patients with thyroid or parathyroid disorders.

• Hyperkalemia: High Potassium Levels; Can cause life-threatening arrhythmias.

  • Risks: Kidney failure (impaired potassium excretion), use of potassium-sparing diuretics, adrenal insufficiency (reduced aldosterone, reduced potassium excretion), excessive potassium intake, tissue damage (which releases potassium). Sources of potassium: bananas, oranges, potatoes, etc.
  • Prevention: Limit potassium-rich food intake, regularly check medications, monitor potassium levels in patients with kidney issues or on medications.

• Hypokalemia: Low Potassium Levels; Can cause arrhythmias + muscle weakness.

  • Risks: Use of diuretics, severe vomiting or diarrhea, excessive laxative use, alkalosis (shifts potassium into cells), inadequate potassium diet intake.
  • Prevention: Encourage potassium rich foods (bananas, spinach, oranges, potatoes), Monitor diuretic usage and promote potassium supplementation if necessary, teach athletes/patients who sweat excessively to replace potassium loss.

• Hyperphosphatemia: High Phosphate Levels.

  • Risks: Chronic kidney disease (impaired excretion), hypoparathyroidism (reduced parathyroid hormone leads to less excretion), excessive phosphate intake or IV intake, rhabdomyolysis or tumor lysis syndrome (massive cell breakdown releases phosphate).

• Hypermagnesemia: High Magnesium Levels.

  • Risks: Chronic kidney disease (impaired excretion), excessive magnesium intake (from supplements or laxatives), adrenal insufficiency, medicines with magnesium (antacids or laxatives).
  • Prevention: Limit magnesium-containing medications (such as laxatives and antacids), monitor magnesium levels especially in patients with kidney disease, educate on signs! muscle weakness, lethargy, slow reflexes.

• Hypomagnesemia: Low Magnesium Levels.

  • Risks: Chronic alcoholism, diuretic use (especially loop diuretics), severe diarrhea/vomiting, malabsorption disorders (such as Chron’s), inadequate dietary intake.
  • Prevention: Promote magnesium rich foods (nuts, seeds, whole grains, leafy greens), monitor diuretic use, monitor alcohol use.

### Pharmacology

• Types of Intravenous Fluids:
  • Isotonic Solutions: Solutions that have the same osmotic pressure as blood plasma; Common Examples: Normal Saline (0.9% NaCl), Lactated Ringer's, Dextrose 5% in water (D5W).
  • Hypertonic Solutions: Solutions that have a higher osmotic pressure than blood plasma, causing fluid to move out of cells; Common Examples: 3% Sodium Chloride, Dextrose 10% in water (D10W).
  • Hypotonic Solutions: Solutions that have a lower osmotic pressure than blood plasma, causing fluid to move into cells; Common Examples: 0.45% Sodium Chloride (half-normal saline), Dextrose 2.5% in water.
• Electrolyte Replacements:
  • Sodium:
    • Sodium Chloride 0.9%
    • Sodium Bicarbonate
    • Sodium Phosphate

Fluid & Electrolyte Balance

• Regulating fluid volume within and outside cells, body fluid concentration, and electrolyte levels in blood

Basic Principles

• Osmosis: Water moves across a membrane from lower solute concentration to higher solute concentration to equalize. Normal plasma osmolality is 290.
• Diffusion: Movement of particles from high concentration to low concentration.
• Filtration: Water and solutes move across a membrane driven by hydrostatic pressure – blood pressure forcing fluids through capillaries.
• Active Transport: Movement of molecules against concentration gradient, requiring energy (ATP) and carrier proteins.
• Intracellular: Inside cells.
• Extracellular: Outside cells.
• Isotonic: Solution with the same concentration as inside a cell.
• Hypertonic: Solution with higher concentration of solutes compared to inside a cell.
• Hypotonic: Solution with lower concentration of solutes compared to inside a cell.

Assessment: Labs

• Basic Metabolic Panel:
  • Sodium: 135 – 145 mEq/L
  • Potassium: Important for heart function and nerve impulses.

Dehydration

• Causes: Excessive fluid loss, increased urination, elderly age, hot climates, strenuous exercise.
• Prevention: Encourage adequate hydration, teach signs of dehydration (dry mouth, thirst, dark urine), adjust fluid intake based on needs.
• Changes: Increased heart rate, weak & difficult to find peripheral pulses, decreased blood pressure and pulse pressure, lightheadedness, dizziness, flat neck and hand veins.
• Hemoconsentration: Dehydration causes elevation in hemoglobin, hematocrit, serum osmolarity, glucose, protein, BUN, and electrolytes.

Fluid Overload (Hypervolemia)

• Risks: Kidney failure, congestive heart failure, liver cirrhosis, excessive IV fluid administration, hormonal imbalances (high aldosterone).
• Prevention: Monitor daily fluid intake, follow fluid restriction orders, limit sodium intake, encourage daily weight checks (report sudden gain of 2+ lbs/day).
• Changes: Increased pulse rate, bounding pulses, elevated blood pressure, decreased pulse pressure, elevated central venous pressure, distended neck and hand veins, engorged varicose veins, weight gain, increased respiratory rate, pitting edema (swelling) in dependent areas.

Hypernatremia

• High Sodium Levels
• Causes: Dehydration, Diabetes Insipidus, excessive sodium intake (dietary or infusion).
• Prevention: Low-sodium diet (avoid canned/processed foods), ensure adequate fluid intake, monitor for signs (thirst, confusion).

Hyponatremia

• Low Sodium Levels
• Causes: Excessive water intake, Syndrome of Inappropriate Antidiuretic Hormone (SIADH), diuretic use, severe vomiting/diarrhea, heart failure, liver disease.
• Prevention: Follow fluid restrictions (heart failure), ensure appropriate sodium intake (GI problems), monitor sodium levels in at-risk patients.
• Changes: Increased intestinal motility, nausea, diarrhea, abdominal cramping, decreased deep tendon reflexes, muscle weakness (worse in legs & arms).

Hypercalcemia

• High Calcium Levels
• Causes: Hyperparathyroidism, cancer (bone metastasis or certain tumors), excessive Vitamin D intake, prolonged immobilization, thiazide diuretics.
• Prevention: Limit calcium and Vitamin D intake (especially for hyperparathyroidism), encourage hydration (prevent kidney stones), promote physical activity (reduce calcium release from bones).
• Changes: Short attention span, agitation, confusion, muscle weakness and twitching, reduced deep tendon reflexes, increased pulse rate, peripheral pulses difficult to palpate, hypotension, severe orthostatic hypotension, reduced pulse pressure, bounding pulses, distended neck veins, increased blood pressure.

Hypocalcemia

• Low Calcium Levels
• Causes: Vitamin D deficiency, hypoparathyroidism, chronic kidney disease, magnesium deficiency.
• Prevention: Calcium-rich diet (dairy, leafy greens), ensure adequate Vitamin D intake, monitor calcium levels in patients with thyroid or parathyroid disorders.

Hyperkalemia

• High Potassium Levels
• Causes: Kidney failure, potassium-sparing diuretics, adrenal insufficiency, excessive potassium intake, tissue damage.
• Prevention: Limit potassium-rich foods (bananas, oranges, potatoes), regularly check medications, monitor potassium levels in patients with kidney issues or on medications.

Hypokalemia

• Low Potassium Levels
• Causes: Diuretics, severe vomiting/diarrhea, excessive laxative use, alkalosis, inadequate potassium diet intake.
• Prevention: Encourage potassium-rich foods (bananas, spinach, oranges, potatoes), monitor diuretic usage, potassium supplementation, teach athletes/patients who sweat excessively to replace potassium loss.

Hyperphosphatemia

• High Phosphate Levels
• Causes: Chronic kidney disease, hypoparathyroidism, excessive phosphate intake (oral or IV), rhabdomyolysis, tumor lysis syndrome.

Hypermagnesemia

• High Magnesium Levels
• Causes: Chronic kidney disease, excessive magnesium intake (supplements, laxatives), adrenal insufficiency, magnesium-containing medications.
• Prevention: Limit magnesium-containing medications, monitor magnesium levels, especially in patients with kidney disease, educate on signs (muscle weakness, lethargy, slow reflexes).

Hypomagnesemia

• Low Magnesium Levels
• Causes: Chronic alcoholism, diuretic use, severe diarrhea/vomiting, malabsorption disorders, inadequate dietary intake.
• Prevention: Promote magnesium-rich foods (nuts, seeds, whole grains, leafy greens), monitor diuretic use, monitor alcohol use.

Pharmacology

• Intravenous Fluids:

  • Isotonic Solutions: Same osmotic pressure as blood plasma (Normal Saline, Lactated Ringer’s, D5W).
  • Hypertonic Solutions: Higher osmotic pressure than blood plasma (3% Sodium Chloride, D10W).
  • Hypotonic Solutions: Lower osmotic pressure than blood plasma (0.45% Sodium Chloride, D2.5W).

• Electrolyte Replacements

  • Sodium: Needed for fluid balance, nerve impulses, and muscle contractions.