Electrolytes 2023 PDF

Electrolytes By Steve Casarez RN, MICN, Paramedic Updated 2023 What is wrong with this picture? Table 06.T01: Normal Serum Values of the Major Electrolytes Story, L. (2012). Pathophysiology: A practical approach. Jones & Bartlett Learning: Burlington, MA.  Exam...

Electrolytes By Steve Casarez RN, MICN, Paramedic Updated 2023 What is wrong with this picture? Table 06.T01: Normal Serum Values of the Major Electrolytes Story, L. (2012). Pathophysiology: A practical approach. Jones & Bartlett Learning: Burlington, MA.  Example Electrolyte Lab Values “The Fishbone” NA+ Cl- BUN 130-145 98-108 3-11 Glucose 70-120 K+ Co2 Crea 3.5-5 20-32 0.4-1.4 CA++ 8.5-10 Mag ++ Phos 1.8-3.0 2.0-4.5  Electrolyte Lab Values NA+ Cl- BUN 130-145 98-108 3-11 Glucose 70-120 K+ Co2 Crea 3.5-5 20-32 0.4-1.4 CA++ 8.5-10 “Fishbone” Mag ++ Phos 1.8-3.0 2.0-4.5  Electrolyte TX By EMS NA+ Cl- BUN 130-145 98-108 3-11 Glucose 70-120 K+ Co2 Crea 3.5-5 20-32 0.4-1.4 CA++ 8.5-10 “Fishbone” Mag ++ Phos 1.8-3.0 2.0-4.5  Electrolyte Location NA+ Cl- BUN ECF ECF 3-11 Glucose 70-120 K+ Co2 Creat ICF 20-30 0.4-1.4 CA++ ECF Mag ++ Phos 30% ICF ICF  Electrolytes Role Water balance affects electrolytes concentration Electrolytes are acquired by diet intake They are eliminated in urine Frequent diseases that affect electrolyte function ESRD ETOH Cancer TX Malnutrition Dehydration  Sodium Chief extracellular electrolyte 90% in ECF Cation (+) ROLE Maintains water balance Regulates osmotic forces Maintains neuromuscular irritability by working with K+/CA++ Helps maintain acid/base balance  Chloride Major anion in ECF Anion (-) ROLE Maintains normal balance of fluids Counterbalances Sodium Keeps neutral between all other cations Proportional to Sodium Bicarbonate (HCO3) on the RBC  Sodium Chloride EMS fluid of choice 0.9% Sodium Chloride 9 grams of sodium/liter (1000ml) Serum Osmo 308 154 meql/sodium 154 meql/chloride Isotonic solution crystalloid  Sodium and Chloride balance Renin-Angiotensin-Aldosterone system ACE-Inhibitor TX for Released by Kidneys chronic HTN Response to decrease in Renal blood flow Release of Catecholamine's! In lungs, kidneys and plasma EMS drugs to assist with increasing blood pressures: - Epinephrine - Dopamine Responds to - Norepinephrine (Levophed) decrease sodium levels and increase potassium levels  Figure 07.F05: Effects of antidiuretic hormone and aldosterone on the kidneys AAOS. (2004). Paramedic: Anatomy & Physiology. Sudbury, MA: Jones & Bartlett Learning. RAAS  Sodium/Potassium Pump Active Transport System It allows the cells to have action potential Important for cardiac muscle function and nerve cell communication  Sodium Chloride Alterations Dehydration Loss of fluids from tissues Causes Nausea Vomiting Diarrhea TX IV fluid resuscitation with 0.9% or for severe dehydration hypotonic solutions  Sodium and Potassium Balance Act Sodium Potassium 135-145 mEq/L 3.5-5 mEq/L  Hypernatremia >145 mEq/L Caused by increase in sodium intake or fluid loss increasing sodium concentration S/S TX Stupor Oxygen Lethargy POC Tremors Cooling measures if heat SZ exhaustion/heat stroke is presented Polydipsia (excessive thirst) IV access Tachycardia 0.9% NacL fluid SLOW Dry skin with poor skin turgor resuscitation as clinically Oliguria (low urine output) indicated Anuria (no urine output) Hypotonic fluid for sever dehydration Close cardiac monitoring  Hyponatremia 5.5 mEq/L Caused by Renal Failure, Crush Injury, Burns, Infection, Acidosis, Medications (Digitalis Toxicity, beta blockers, succinylcholine) TX S/S High flow oxygen Cardiac dysrhythmias Close cardiac monitoring IV access Bradycardia 0.9% Nacl clinically treat symptoms Peak T waves CA++ Albuterol Wide QRS complex Sodium Bicarbonate Flatten P waves Insulin TX algorithm Dextrose N/V/D Kayexalate Muscle weakness Dialysis  Hypokalemia 10 mEq/L Causes hyperparathyroidism (PTH), tumors, cancers, diuretics S/S TX N/V/D Treating the symptoms General weakness POC Lethargy Clinicians must find the Renal stones cause of the disorder Abdominal pain  Hypocalcemia 3.0 mEq/L Most common cause is impaired renal function S/S TX N/V/D Oxygen Muscle weakness POC ALOC IV access Bradycardia IV administration of CA+ Hypotension which buffers the Mag. Dialysis  Hypomagnesemia