• excessive hypotonic IV fluids
• adrenal insufficiency
• Vomiting / diarrhea
• diuretic therapy
• Suctioning NGT
• renal failure
• diaphoresis
• polydipsia
• SIADH
• CHF

Signs & Symptoms of Hyponatremai

w/ hypovolemia: orthostatic hypotension

w/ hypervolemia: hypertension

*decreased deep tendon reflexes

behavior & LOC changes

abdominal cramps

*bounding pulse

muscle cramps

*hypotention

*tachycardia

*weakness

*seizures

diarrhea

nausea

Treatment of Hyponatremia

stop / reduce loop & thiazide diuretics

increase oral intake of Na+

restric fluids & H2O

seizure precautions

w/ FVD: isotonic fluids / hypertonic if severe

w/ FVE: osmotic diuretic (Mannito)

Causes of Hypernatremia

excessive Na+intake or retentioin

increased rate of metabolism

excessive diaphoresis

hyperaldosteronism

vomiting / diarrhea

hyperventilation

corticosteroids

renal failure

infection

GI loss

fever

skeletal muscle changes

restless / delirium

dry, flushed skin

dry & sticky MM

hyperthermia

lethargy

thirst

administer IV fluids - based on serum osmolarity:

hypotonic / isotonic

administer diuretic = loop

increase oral fluid intake

low Na+ diet

Causes of Hypokalemia

K+ < 3.5

Renal disease impairing reabsorption of K+

Use of loop diuretics or Corticosteroids

Increased secretion of aldosterone

Pronlonged use of IV fluids w/o K+

Metabolic alkalosis

Wound drainage

malnutrrtion

Diaphoresis

starvation

NPO
DKA
TPN

Signs & Symptoms of Hypokalemia

ECG changes - dysrhythmias = tachycardia

hypoactive deep tendon reflexes

muscle cramping & weakness

respiratory distress - failure

absent bowel sounds

distended abdomen

nausea / vomiting

constipation

polyuria

K+ replacement: potassium chloride

encourage foods high in K+

IV NS w/ 10mEq K+

NEVER PUSH K+ IV

Causes of Hyperkalemia

K+ > 5.0

Blood transfusions

• Decreased excretion:
  • renal failure
  • severe dehydration
  • K+ sparing diuretics
  • Adrenal insufficiency

• extracellular shifts
  • acidosis
  • sepsis
  • trauma / crushing injury
  • fever
  • MI

muscle cramps / numbness

restless / irritable

diarrhea

nausea/ vomiting

abdominal cramps

hyperactive bowel sounds

increased motility

ECG changes - bradycardia = life threatening dysrhythmias

K+ restriction: stop IV infusion

Administer sodium polystryrene sulfonate (Kayexalete) = promotes K+ exretion & Na+ absorption into L. intestine

IV fluids w/ dextrose

NaHCO3 to reverse metabolic acidosis

Causes of Hypocalcemia

Ca < 8.5

Hypothyroidism

Renal failure

alkalosis

acute pancreatitis

immobility

removal or destruction of parathyroid glands

malabsorption syndromes: Chronhn's, Celiac

Inadequate intake of calcium or Vit. D

Corticosteroid use

Calcium binders

Lactose intolerance

diarrhea

ECG changes

Bradycardia

Hypotension

abdominal cramps / diarrhea

abnormal blood clotting

tingling / numbness in fingers

tetany

Positive Trousseau's sign

Positive Chvostek's sign

hyperactive deep tendon reflexes

seizures

Calcium citrate (citracal)

Vitamin D

maintain a relaxed, quiet environment

encourage calcium - rich foods: dairy, broccoli, green beans

Seizure precautions

Causes of Hypercalcemia

Ca > 10.5

Hyperparathyroidism

hyperthryroidism

excessive intake of Ca or Vit D

Cancer - esp bone

Thiazide drugs

immobility

dehydration

anorexia

Nausea / vomitng

constipation

Altered LOC: confusion, slurred speech

lethargy

coma

At 1st: tachycardia & hypertension

blood clots

severe muscle weakness

decreased deep tendon reflexes

fractures

osteoporosis

Calcitonin - hyperparathyroidism

wt bearing exercies / activities

adequate fluid intake & dietary fiber

Dialysis for severe hypercalcemia

calcium binders

Causes of Hypophosphatemia

Phosphate < 3.0

hyperparathyroidism

hypercalcemia

renal failure

hyperglycemia

respiratory alkalosis

malnutrition

starvation

Decreased stroke volume / decreased cardiac output

muscle weakness

decreased respiratory movement

respiratory failure

fractures

irritabilty

seizures

coma

D/C drugs promoting phos loss: antacids, osmotic diuretics, calcium supplement

Oral replacement of phosphorus & Vit. D

IV phosphorus - only given if phos < 1mg/dL

decrease calcium rich foods

Causes of Hyperphosphatemia

Phosphate > 4.5

renal insufficiency

certain cancer treatments

hypoparathyroidism

decreased renal excretion

Signs & Symptoms of Hyperphosphatemia

goes with hypocalcemia:

Bradycardia

hypotension

adbominal cramps / diarrhea

tingling / numbness in fingers

tetany

hyperative deep tendon reflexes

seizures

phosphate binders

aluminum hydroxide gel

antacids

Causes of Hypomagnesemia

Mg < 1.5

starvation

malabsorption

diarrhea

celiac disease

crohn's disease

GI & renal losses

diuretics

aminoglycoside antibiotics

Amphotericin B

Signs & Symptoms of Hypomagnesemia

increase nerve transmission

hyperactive deep tendon reflexes

numbness / tingling

Positive Chvostek's & Trouseeau's sign: offen accompanies hypocalcemia

tetany

depression / confusion / psychosis

anorexia

nausea

constipation

adbominal distention / reduced motility

Stop drugs promoting Mg loss: high-ceiling loop diuretics, osmotic diuretics, meds containing phosphorus

Administer Mg salts:

    Magnesium chloride (Slo-Mag)

    Magnesium sulfate

Causes of Hypermagnesemia

Mg > 2.5

renal failure

severe dehydration

bradycardia

peripheral vasodilation

hypotension

ECG changes

possible cardiac arrest

depressed nerve impulse transmission

lethargy

drowsiness

coma

absent deep tendon reflexes

muscle in lungs become weak→ respiratory insufficiency → respiratory failure / death

stop all magnesium containing drugs

give Lasix

IV fluids

From pituitary gland

Controlled by the hypotalamus via. negative feedback

Acts on the distal renal tubules to increased membrance permeability to H2O thus increasing the rate of H2O reabsorption

↓FV = ↑___

renin is released if blood flow or pressure to kidneys is ↓

Causes conversion of Angiotensinogen to Angiotensin I or II

Angiotensin II acts directly on the nephrons

Angiotensin II promotes Na+ & H2O retention via vasoconstriction of certain blood vessels

Angiotensin II promotes release of aldosterone when Na is ↓

In adrenal gland

Acts on the distal renal tubules

Caues reabsorption of Na+ & H2O

Causes excretion of K+

Powerful vasodilator

Protein hormone secreted by the heart muscles cells

Released in response to high BP

Promotes Na+ loss

Inhibits the thirst mechanism