Electrolytes

Front 1

Hypernatremia (serum sodium > 145 mEq/L)

Back 1

• Vital signs: Possibly hyperthermia, tachycardia, orthostatic hypotension.
• Neuromusculoskeletal: Restlessness, irritability, muscle twitching to the point of muscle weakness including respiratory compromise, increased deep tendon reflexes (DTR) to the point of absent DTRs, seizures, coma.
• Gastrointestinal: Thirst, dry mucous membranes, increased motility, hyperactive bowel sounds, abdominal cramping, nausea.
• Other signs: Edema, warm flushed skin, oliguria.
• Replacement of fluid loss if that is cause– provider may prescribe hypotonic IV fluids (0.45% sodium chloride) or isotonic IV fluids (0.9% sodium chloride).
• Encourage water intake and discourage sodium intake if excessive sodium intake is cause.
• Provider may prescribe diuretics (loop diuretics) for clients with poor renal excretion.
• Monitor the client’s vital signs and level of consciousness.
• Monitor intake and output and daily weight and alert provider of significant findings.
• Encourage client to consume a low-sodium diet, read food labels to check sodium content, and keep a record of daily sodium intake.

Front 2

Hyponatremia (serum sodium < 135 mEq/L)

Back 2

• Clinical indicators depend on whether it is associated with a normal, decreased, or increased ECF volume.
• Vital signs: Possibly hypothermia, tachycardia, hypotension.
• Neuromusculoskeletal: Headache, confusion, lethargy, muscle weakness to the point of possible respiratory compromise, fatigue, decreased deep tendon reflexes, seizures.
• Gastrointestinal: increased motility, hyperactive bowel sounds, abdominal cramping, nausea.
• If cause is fluid overload, provider will prescribe restricted water intake.
• For clients with heart failure and hyponatremia, loop diuretics and ACE inhibitors are often prescribed.
• With acute hyponatremia: Hypertonic oral and IV fluids are often prescribed and administered cautiously due to risk of cerebral edema.
• The client should be encouraged to consume foods and fluids high in sodium (canned soups/veggies, cheeses, condiments).
• The client’s intake and output, daily weight, vital signs and level of consciousness should be monitored closely and abnormal findings reported to the provider.

Front 3

Hyperkalemia (serum potassium > 5.0 mEq/L)

Back 3

• Vital signs: Slow, irregular pulse, hypotension
• Neuromusculoskeletal: Restlessness, irritability, weakness to the point of ascending flaccid paralysis, paresthesias.
• ECG: Premature ventricular contractions, ventricular fibrillation, peaked T waves, and widened QRS.
• Gastrointestinal: Nausea, vomiting, increased motility, diarrhea, hyperactive bowel sounds.
• Report abnormal findings to the provider.
• Provide a potassium-restricted diet (avoid foods high in potassium such as avocados, broccoli, dairy products, dried fruit, cantaloupe, bananas).
• Administer sodium bicarbonate to reverse acidosis.
• Monitor the client’s cardiac rhythm and intervene promptly as needed.
• Administer loop diuretics (furosemide [Lasix]) if prescribed and renal function is adequate.
• Reinforce client education on a potassium-restricted diet.
• Administer cation exchange resins as prescribed (sodium polystyrene sulfonate [Kayexalate]).

Front 4

Hypokalemia (serum potassium < 3.5 mEq/L)

Back 4

• Vital signs: Weak, irregular pulse, hypotension, respiratory distress.
• Neuromusculoskeletal: Weakness to the point of respiratory collapse and paralysis, muscle cramping, decreased muscle tone and hypoactive reflexes, paresthesias, mental confusion.
• ECG: premature ventricular contractions (PVCs), bradycardia, blocks, ventricular tachycardia, inverted T waves, and ST depression.
• Gastrointestinal: decreased motility, abdominal distention, constipation, ileus, nausea, vomiting, anorexia.
• Arterial blood gases: metabolic alkalosis (pH > 7.45).
• ECG will show findings of dysrhythmias (premature ventricular contractions, ventricular tachycardia, inverted T waves, ST depression). Replacement of potassium: Encourage foods high in potassium (avocados, broccoli, dairy products, dried fruit, cantaloupe, bananas).
• Oral or IV potassium supplementation as prescribed.
• Monitor and maintain adequate urine output.
• Monitor the client’s cardiac rhythm and intervene promptly as needed.
• Monitor clients receiving digoxin (Lanoxin). Hypokalemia increases the risk for toxicity.
• Monitor level of consciousness and maintain client safety.
• Monitor bowel sounds and abdominal distention and intervene as needed.
• Monitor kidney function (BUN, GFR, Creatinine).
• Reinforce client education regarding potassium-rich foods.

Front 5

Hypercalcemia (serum calcium >10 mg/dL)

Back 5

• Lethargy, weakness, depressed reflexes, decreased memory, anorexia, bone pain, stupor, coma, ventricular arrythmias
• Promote excretion of calcium (Loop diuretics as prescribed)
• Increase fluids unless contraindicated.

Front 6

Hypocalcemia (serum calcium <8.5 mg/dL

Back 6

• Paresthesia of the fingers and lips (early symptom)
• Muscle twitches/tetany
• Frequent, painful muscle spasms at rest
• Hyperactive deep tendon reflexes
• Positive Chvostek’s sign (tapping on the facial nerve triggering facial twitching)
• Positive Trousseau’s sign (hand/finger spasms with sustained blood pressure cuff inflation)
• Cardiovascular: Decreased myocardial contractility (decreased heart rate and hypotension)
• Gastrointestinal: Hyperactive bowel sounds, diarrhea, abdominal cramping
• ECG changes: Prolonged QT interval
• Administer calcium supplements as prescribed.
• Implement/maintain seizure precautions.
• Have emergency equipment on standby.
• Encourage foods high in calcium including dairy products and dark green vegetables.
• Reinforce client education about consuming foods high in calcium (yogurt, milk) and ways to increase calcium.

Front 7

Hypermagnesium (serum magnesium >2.5 mEq/L)

Back 7

• Lethargy, drowsiness, later-lost deep tendon reflexes, respiratory and then cardiac arrest
• Hold/discontinue magnesium containing drugs
• IV administration of calcium chloride or gluconate as prescribed to oppose the effects on the cardiac muscle, promote urinary excretion

Front 8

Hypomagnesium (serum magnesium <1.5 mEq/L)

Back 8

Neuromuscular: increased nerve impulse transmission (hyperactive deep tendon reflexes, paresthesias, muscle tetany), positive Chvostek’s and Trousseau’s signs.
• Gastrointestinal: hypoactive bowel sounds, constipation, abdominal distention, paralytic ileus.
• Discontinue magnesium-losing medications as prescribed (e.g., loop diuretics).
• Administer magnesium sulfate as prescribed and following safety protocols.
• Oral magnesium can cause diarrhea. Monitor the client closely.
Reinforce client education regarding foods that are high in magnesium such as dairy products and dark green vegetables.