Electrolyte Imbalances: Sodium Focus

Electrolyte Imbalances

• Electrolytes are crucial for maintaining bodily balance. A relatively equal gain and loss results in balance. Problems occur when there's an abnormal route of electrolyte loss.
• Monitoring for signs of imbalance is essential due to the intricate interactions between electrolytes. Imbalance often involves multiple electrolyte disruptions simultaneously.

Sodium (Na)

• Normal range: 134-145 mEq/L
• Abundant in extracellular fluid, maintaining osmotic pressure, acid-base balance, and nerve impulses.
• Aldosterone regulates serum sodium, a steroid hormone from adrenal glands.
• Sodium balance depends on dietary intake. High sodium intake is common in American diets.
• Patient and family education is key to managing sodium intake.

Hypernatremia (>145 mEq/L)

• This is an excess of sodium.
• Causes: Impaired thirst mechanism, water loss (diabetes, diarrhea, vomiting, renal disease, high protein diets, thiazide diuretics), inappropriate use of electrolyte solutions, burns, heart failure, hypotonic IV fluids, and tube feedings (if hydration isn't adequate).
• Manifestations: Neurological changes (confusion, behavioral changes, seizures, coma).
• Frequent monitoring is required.
• Seizure precautions are crucial (bed rails up, seizure pads, document).

Hyponatremia (<134 mEq/L)

• Insufficient sodium.
• Causes: Very limited information provided on hyponatremia.

Potassium (K)

• Normal range not specified, but crucial for cell function.
• Primarily intracellular electrolyte.
• Kidneys typically filter out excess potassium. Renal failure disrupts this filtering process making monitoring of potassium crucial.
• High dietary intake can cause issues due to the body struggling to eliminate.
• Patients need to be aware of food sources and salt substitutes.

Hyperkalemia (>5 mEq/L)

• Causes: Renal failure, potassium-sparing diuretics (e.g., spironolactone), excessive potassium intake (many fruits, vegetables, dried fruit, and nuts; consider salt substitutes), acidosis, severe tissue trauma.
• Manifestations: Tall, peaked T waves, widened QRS complex on ECG, dysrhythmias, cardiac arrest, nausea, vomiting, and diarrhea.
• Management: Kayexalate (sodium polystyrene sulfonate), calcium gluconate, insulin and glucose, albuterol (for shifting potassium back into cells), and cardiac monitoring and monitoring renal function. Loop diuretics should be used cautiously, as they can also cause potassium loss.

Hypokalemia (<3.5 mEq/L)

• Causes: Diarrhea, vomiting, diuretic use, metabolic & respiratory alkalosis, long-term fluid retention.
• Manifestations: Weakness, increased thirst, Kussmaul respirations (associated with metabolic acidosis).
• Management: Diuretic use evaluation, rehydration with IV solutions (using hypotonic options if the patient is dehydrated), treating the underlying cause.

Chloride (Cl)

• Normal range not explicitly mentioned.
• Crucial for fluid balance and regulating pH.

Hypochloremia (<96 mEq/L)

• Causes: Bowel disorders (IBS), chronic kidney disease, overuse of magnesium-containing antacids or laxatives.
• Manifestations: Muscle weakness, decreased reflexes.
• Management: Stop magnesium-containing products, calcium gluconate, saline, loop diuretics, dialysis (if kidney function is compromised). Constant monitoring of vital signs and mental/motor status is paramount.

Magnesium (Mg)

• Normal range not specified.
• Crucial for nerve and muscle function, blood pressure regulation.

Hypomagnesemia

• Detailed causes and manifestations not provided, though symptoms and management of related issues were included here.