Electrolytes Regulation: Functions, Imbalances & Interventions PDF

FUNCTIONS OF THE RENAL AND URINARY TRACT SYSTEMS 1. Excretion of Nitrogenous Wastes 2. Urine Formation 3. Regulation of Acid-Base Balance 4. Regulation of electrolytes 5. Fluid homeostasis 6. Autoregulation of Blood Pressure 7. Hormones Secretion REGULATION OF ELECTROLYTES Electrol...

FUNCTIONS OF THE RENAL AND URINARY TRACT SYSTEMS 1. Excretion of Nitrogenous Wastes 2. Urine Formation 3. Regulation of Acid-Base Balance 4. Regulation of electrolytes 5. Fluid homeostasis 6. Autoregulation of Blood Pressure 7. Hormones Secretion REGULATION OF ELECTROLYTES Electrolytes are minerals that are found inside and outside the cells of the body that carry an electric charge. electrolytes contribute to the concentration of body solutions and move between the intracellular and extracellular environments. ingested in fluids and foods and are eliminated primarily through the kidneys, as well as through the liver, skin, and lungs. Electrolytes are measured in units called milli equivalents (mEq/L) per liter rather than in milligram weights because of their chemical properties as ions Another measure that may be used is the millimole, an atomic weight of an electrolyte.  MAJOR IONS FUNCTIONS Sodium (Na+) Neuromuscular Function and fluid management Potassium (K+) Neuromuscular and Cardiac Function Calcium (Ca+) Bone structure, neuromuscular function and clotting Magnessium (Mg-) Active transport of Na+ and K+ and neuromuscular function Chloride (Ch-) Osmolality and acid base balance Phospate (Po4-) ATP formation and acid base balance a. One of the major roles of electrolytes is to ensure that fluid levels inside and outside the cell are balanced. b. The cell can adjust its fluid levels by changing the concentration of electrolytes. For example, an increase in electrolytes within the cell draws more fluid in whereas a decrease in electrolytes promotes an efflux of fluids. c. Sustaining this type of osmotic gradient is essential for nerve and muscle function, hydration, and maintaining blood pH levels. d. electrolytes carry electrical impulses across the cell and to neighboring cells in order to promote muscle contractions and nerve impulses. Sodium +Normal : 135- 145 mEq/L ✓is the major cation (positively charged ion) found outside the cell. ✓It regulates the total amount of water in the body and plays a major role in neuronal and nerve signaling  Hypernatremia Hyponatremia +Serum Na+> 145mEq/L ▪Serum Na+ 5 mEq/L pricking, or burning of a person's skin +Results from excessive intake, trauma, crush injuries, burns, renal failure sodium polystyrene sulfonate Kayexalate - to increase +S/S muscle weakness, cardiac excretion of K changes, N/V, paresthesias of face/fingers/tongue +Tx: low K+diet/meds/IV therapy/ possible dialysis Calcium 8.5-10.5mg/ dl 20% of ingested calcium is absorbed into the blood. The remainder is excreted in the feces 99 percent of calcium is stored in the teeth and bones where it helps to make and keep them strong. Extracellular calcium is excreted by the kidneys (1% ECF where 50% is ionized)  calcium is also critical for muscle contraction, nerve signaling, blood clotting and maintaining normal heart function. Inverse relationship with Phosphorus; Vitamin D needed for Ca absorption Vitamin D2 (ergocalciferol) is synthesized by plants, and vitamin D3 (cholecalciferol) is synthesized by humans when skin is exposed to ultraviolet-B (UVB) rays from sunlight. The active form of the vitamin is calcitriol, synthesized from either D2 or D3 in the kidneys. Vitamin D helps to maintain normal blood levels of calcium and phosphorus  Serum calcium regulation is regulated by three hormones Parathyroid Hormone (PTH) Calcitonin Mobilizes skeletal calcium stores Secreted by the thyroid gland In response to high calcium levels Increase calcium absorption in the intestines Promotes calcium reabsorption in the kidneys Inhibits movement of calcium out of bone Reduce intestinal absorption Calcitriol Promotes calcium excretion in the kidneys Stimulates calcium release from the bones Absorption in the intestines Promotes re absorption in the kidneys Hypocalcemia +Results from low intake, loop diuretics, parathyroid disorders, renal failure +S/S osteomalacia, EKG changes, numbness/tingling in fingers, muscle cramps / tetany, seizures, Chovstek Sign & Trousseau Sign +Tx: diet/IV therapy Hypercalcemia +Results from increased resorption of calcium from the bones(hyperparathyroidism, Cancers), prolonged immobilization +S/S muscle weakness, renal calculi, fatigue, altered LOC, decreased GI motility, cardiac changes +Tx: medication/ IV therapy Magnesium 1.7- 2.7mg/dl the fourth most abundant mineral in the body. 1% can be found in the ECF 99% in the bone and within the cells of body tissues and organs. It helps maintain normal muscle and nerve function, keeps the heart rhythm steady, supports a healthy immune system, and keeps bones strong. Magnesium also helps regulate blood sugar levels, promotes normal blood pressure, and is also involved in energy metabolism. FOODS RICH IN MAGNESSIUM Green vegetables Grains Nuts Meats seafoods Hypomagnesemia +Results from decreased intake, prolonged NPO status, chronic alcoholism & nasogastric suctioning +S/S: muscle weakness, cardiac changes, mental changes, hyperactive reflexes & other hypocalcemia S/S. +Tx: replacement IV therapy restore normal Ca levels ( Mg mimics Ca) seizure precautions Hypermagnesemia +Serum>2.7mg/dL +Results from renal failure, increased intake +S/S: flushing, lethargy, cardiac changes (decreased HR),decreased resp, loss of deep tendon reflexes +Tx: restrict intake diuretic rx Chloride +95-105mEq/L +Most abundant anion in ECF +Combines with Na to form salts +Maintains water balance, acid-base balance, aids in digestion (hydrochoric acid) & osmotic pressure (with Na and H20) +Regulated by kidneys +Follows Sodium (Na) Hypochloremia +Serum level 105mEq/L +Results from excessive intake or retention by kidneys – metabolic acidosis +S/S Arrhythmias, decreased cardiac output, muscle weakness, LOC changes, kussmauls resp. +Tx: restore fluid & electrolyte balance Phosphate +2.5-4.5mg/dl +Needed for acid-base balance,neurological & muscle function, energy transfer ATP & affects metabolism of carbs/proteins/lipids, B vitamin synthesis +Found in the bones +Regulated by intake and kidneys +Inversely proportional to Calcium Therefore some regulation by PTH as well Hypophosphatemia +Serum level < 2.4mEq/L +Results from decreased intestinal absorption and increased excretion + S/S bone & muscle pain, mental changes, chest pain, resp. failure +Tx: Diet/ IV therapy Hyperphosphatemia +Serum level > 4.5mEq/L +Results from renal failure, low intake of calcium +S/S: neuromuscular changes (tetany), EKG changes, parathesia-fingertips/mouth +Tx: Diet; hypocalcemic interventions Medications: phosphate binding +The body can tolerate hyperphosphatemia fairly well BUT the accompanying hypocalcemia is a larger problem! Interventions for F/E balance +Assess patient carefully- note changes +Monitor I & O (Intake & Output) +Monitor weight changes +Monitor urine output +Monitor v/s +Monitor lab results and dx test +Maintain proper IV therapy  RENAL HORMONES Hormones are either activated or synthesized by the kidneys 1. Active form of Vit D 2.Erythropoietin 3.Natriuretic hormone Vitamin D + necessary for the absorption of calcium and phosphate by the small intestine +Activation occurs in 2 steps a. liver b. kidneys  Erythropoeitin Stimulates the bone marrow to produce RBCs in response to tissue hypoxia. The stimulus for the production is decreased oxygen delivery to kidney cells Natriuretic Hormone