Electrolytes and Imbalances

Electrolytes

• Minerals in the body, including in urine, blood, and tissues
• Electrolytes assist in balancing water amounts in the body
• Electrolytes assist in balancing the body’s pH (acid/base) level
• Electrolytes allow the body’s muscles, heart, nerves, and brain to function properly

Common Electrolytes and Values

• Potassium (K+) normal value is 3.5 - 5 mEq/L
• Sodium (Na+) normal value is 136 - 145 mEq/L
• Calcium (Ca2+) normal value is 9 - 10.5 mg/dL
• Magnesium (Mg2+) normal value is 1.3 - 2.1 mg/dL

Lab Values

• Basic Metabolic Panel (BMP) assesses electrolyte/fluid balance, renal function, and glucose levels
• Complete Metabolic Panel (CMP) assesses protein and liver function

Electrolyte Imbalances

• Hypokalemia is low potassium levels
• Hyperkalemia is high potassium levels
• Hyponatremia is low sodium levels
• Hypernatremia is high sodium levels
• Hypocalcemia is low calcium levels
• Hypercalcemia is high calcium levels
• Hypomagnesemia is low magnesium levels
• Hypermagnesemia is high magnesium levels

Fluid Imbalances

• Dehydration is the loss of water, or lack of intake, without loss of sodium
• Hypovolemia is the loss of both fluid and electrolytes, leading to a decrease in circulating blood volume and tissue perfusion
• Hypervolemia is too much water in the body or "fluid overload"
• Dehydration and hypovolemia are not the same
• Older adults are especially vulnerable to fluid imbalances

Dehydration

• Hypernatremia results from dehydration
• Vomiting, diarrhea, sweating, and fever cause dehydration
• Hypernatremia s/s manifest with dehydration
• BMP or CMP, Serum osmolality and Urine sample lab tests can diagnose dehydration
• Treatment focus for dehydration is to replace fluids

Hypovolemia

• Hypovolemia results in a loss of both fluids and electrolytes
• Blood loss, severe burns, and excessive sweating cause hypovolemia
• BMP or CMP (BUN/CR), CBC (hematocrit), and Urine sample lab tests can diagnose hypovolemia
• Treatment focus for hypovolemia is to prevent shock by replacing fluids

Hypervolemia

• Hypervolemia is too much water in the body or fluid overload
• Kidney issues commonly causes hypervolemia
• Peripheral edema and crackles in the lungs are manifestations of hypervolemia
• The goal for treatment is to manage the cause and rid the body of excess fluid

Intravenous Therapy: Crystalloids

• Hypotonic solutions move water into cells, such as 0.45% Sodium Chloride and treat hypernatremia
• Isotonic solutions do not move water in or out, such as 0.9% Sodium Chloride and treat dehydration
• Hypertonic solutions move water out of cells, such as 3% Sodium Chloride and treat symptomatic hyponatremia

Blood Transfusions

• Blood transfusions are given when fluid loss is caused from bleeding/hemorrhage
• During the first 15 minutes to stay the client and check VS before and after, and per policy
• Transfusion associated circulatory overload, Hemolytic, Febrile (non-hemolytic), and Allergic & anaphylaxis are types of transfusion reactions
• If a sign or symptom of reaction is present, stop the infusion immediately

Intake and Output

• A nurse’s responsibility includes all liquid taken in and excreted from the body needs to be recorded in chart at least every 8 hours or per policy, and more frequently based on client's condition.

Acid-Base Balance

• This consists of the correct balance of acidic and basic (alkaline) compounds in the blood with Normal pH for humans = 7.35-7.45
• Buffers, respiratory and renal regulation control acid base balance, requiring ABGs lab to assess

ABG = Arterial Blood Gases

• Normal pH is 7.35 to 7.45 where pH = acidosis or alkalosis
• Normal PaCO2 is 35 to 45 mm Hg, representing the respiratory component
• Normal HCO3 is 22 to 26 mEq/L, representing the metabolic component
• Normal PaO2 is 80 to 100 Hg
• Normal O2 sat is 95% to 100%

Interpreting Arterial Blood Gases

• Determine if pH is acidic, basic/alkaline, or normal; is it acidosis or alkalosis or neither?
• Look at PaCo2 (respiratory component); is it Below, above, or within normal range and is it out of range and going in opposite direction of pH?
• Look at HCO3 (metabolic component); is it Below, above, or within normal range and is it out of range and going in the same direction of pH?

Acid-Base Imbalances

• Metabolic Acidosis can stem from Kidney disease, Diabetic Ketoacidosis (DKA), Severe dehydration, or Severe diarrhea
• Metabolic Alkalosis can stem from Diuretic overuse, Alcohol abuse, Excess vomiting, or Significant, quick loss of K+ and Na+
• Respiratory Acidosis can stem from Airway diseases such as COPD and asthma, OSA Medicines that suppress breathing such as narcotics or Severe obesity
• Respiratory Alkalosis can stem from Conditions that cause hyperventilation such as pain, anxiety, stress, head injury, stroke, hyperthyroidism, or meds
• Increased rate and depth of respirations indicates Metabolic Acidosis
• Seizures, headaches, and confusion indicates Metabolic Alkalosis
• Anxiety, SOB, and Lethargy/sleepiness indicates Respiratory Acidosis
• Hyperventilation (fast breathing), dizziness, confusion , chest pain, and tachycardia indicates Respiratory Alkalosis