5 Electrolytes.pdf

ELECTROLYTES **Kalamias do the SAME AS the prefix, except for heart rate & urine output!! Normal range: 3.5-5 mEq/L HYPERkalemia signs and symptoms: ○ Brain→ irritability, restlessness, agitation ○ Lungs→ tachypnea ○ Heart→ low heart rate, peaked T waves, ST...

ELECTROLYTES **Kalamias do the SAME AS the prefix, except for heart rate & urine output!! Normal range: 3.5-5 mEq/L HYPERkalemia signs and symptoms: ○ Brain→ irritability, restlessness, agitation ○ Lungs→ tachypnea ○ Heart→ low heart rate, peaked T waves, ST elevation ○ Urine→ oliguria ○ Bowel→ diarrhea, borborygmi ○ Muscles→ spasticity ○ Reflexes→+3/+4, clonus (muscle spasm) ○ ↓ HR ↓ UO HYPOkalemia signs and symptoms : ○ Brain→ lethargy ○ Lungs→ bradypnea ○ Heart→ tachycardia ○ Urine →polyuria ○ Bowel→ constipation, ileus; muscles→ flaccidity ○ Reflexes→ +1/+2 ○ Cushings: immunosuppressed (needs PRIVATE room) (aldosterone;→ retain sodium & water; low on potassium) ○ ↑ HR ↑ UO **Calcemias do the OPPOSITE AS the prefix... ( if it skeleton or nerve, blame it on calcium!) Normal range: 8.5-10.5 mg/dL HYPERcalemia signs and symptoms : ○ Brain → lethargy ○ Lungs→ bradypnea ○ Heart→ bradycardia ○ Urine→ oliguria ○ Bowel→ constipation ○ Muscles→ flaccidity ○ Reflexes: +1/+2 HYPOcalemia signs and symptoms : ○ Brain→ irritability, restlessness, agitation ○ Lungs→ tachypnea ○ Heart→ tachycardia ○ Urine→ polyuria ○ Bowel→ diarrhea ○ Muscles→ spasms ○ Reflexes→ +3/+4 ○ Two signs of neuromuscular irritability associated with hypocalcemia: Chvostek sign: When you touch their CHEEK, they go into a spasm of the face (neuromuscular irritability associated with a LOW calcium) Trousseau sign: When you put a blood pressure cuff on, blow it up & they go into a spasm of the hand. **Magnesiums do the OPPOSITE AS the prefix Normal range: 1.5-2.5 mEq/L HYPERmagnesemia signs and symptoms : ○ Brain→ lethargy ○ Lungs→ bradypnea ○ Heart→ bradycardia ○ Urine→ oliguria ○ Bowel→ constipation ○ Muscles→ flaccidity ○ Reflexes→ +1/+2 HYPOmagnesemia signs and symptoms : ○ Brain→ irritability, restlessness, agitation ○ Lungs→ tachypnea ○ Heart→ tachycardia ○ Urine→ polyuria ○ Bowel→ diarrhea ○ Muscles→ spasms ○ Reflexes→ +3/+4 If symptoms involve nerve or skeletal muscle, pick Calcium. For any other symptoms, pick potassium (generally anything affecting BP) In a tie ⇒ DON’T pick Magnesium Example: Which electrolyte imbalance causes diarrhea? Hyperkalemia, hypokalemia, hypocalcemia, hypomagnesemia ○ Symptom is up so find something that causes stuff to go up ○ Potassium do the same as prefix → hyperkalemia = diarrhea; hypokalemia ≠ diarrhea ○ Calcemias do the opposite as prefix → hypocalcemia = diarrhea ○ Magnesiums do the opposite as prefix → hypomagnesemia = diarrhea ○ TIE: hyperkalemia, hypocalcemia, hypomagnesemia Don’t pick magnesium Diarrhea is not skeletal or nerve ≠ calcium Blame it on high potassium *Sodium Normal range: 135-145 mEq/L HYPERnatremia: DEHYDRATION ○ Fluid volume deficit, *DKA*, DI, HHNK ○ Signs and symptoms: poor skin turgor, dark urine, hot dry flushed skin, increased urine specific gravity, weak thready pulse ○ Give fluids  HYPOnatremia: OVERLOAD ○ *Fluid volume excess*, SIADH ○ Signs and symptoms: crackles, distended neck veins, increased weight, edema ○ Fluid restriction, give Lasix **The earliest sign of any electrolyte disorder is numbness and tingling (paresthesias ). Circumoral paresthesias: numbness and tingling around the lips The universal sign/symptom of electrolyte imbalance is muscle weakness (paresis )!!! ELECTROLYTE TREATMENT: (boards should only test potassium) HIGH potassium (will stop your heart) Rules for Potassium: ○ NEVER push IV! ○ NEVER more than 40 of K per liter of IV fluid If more than 40, question & clarify with DOC first! ○ HIGH POTASSIUM = worst electrolyte imbalance! *can STOP heart!* So, how do we lower potassium?!?!  Fastest way →Give D5W with REGULAR insulin “K enters early” ○ Drive potassium into the cell & out of the blood (not a permanent fix) ○ Good: it works fast ○ Bad: it doesn’t last long. Over the next 8 hours, the potassium will leak back into the blood Kayexalate “K exits late” (switch the potassium with sodium) ○ Puts the drug in the gut and is full of Na (oral or rectal administration); As it sits in the gut, Na is picked up by the bloodstream. To maintain equilibrium, potassium has to be kicked out of the blood and into the gut. When you defecate the kayexalate, it is full of potassium. ○ Blood starts out high in potassium but ends up high in sodium They become dehydrated ⇒ give fluids ○ Good: gets rid of high potassium for good ○ Bad: takes a long time to work Give both simultaneously!!