Electrolytes lite version

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Electrolytes lite version
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Wheres the juice?
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(No Transcript)
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Most plentiful electrolytes in the body

• ICF
• Potassium
• Magnesium
• Calcium

• ECF
• Sodium
• Chloride
• Calcium

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elephantiasis
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Electrolyte imbalances are common among
hospitalized patients

• Diuretics both potassium-sparing and
  potassium-wasting
• IV fluid replacement
• Compromised kidney function
• Cellular damage
• High dose corticosteroids, antibiotics
• Malnourishment
• Vomiting, diarrhea, GI suctioning

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Two most common critical electrolytes K Na
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Potassium (K)

• 3.5-5.3mEq/L
• Held in cells (ICF)
• Maintenance of K is through oral intake
  (50-100mEq/day) and excretion (40-60mEq/day) by
  the kidneys
• Needed for transmission and conduction of nerve
  impulses, allowing contraction of skeletal,
  smooth, and cardiac muscles

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Sources of Potassium

• Fruits dried, fresh, juice
• Vegetables
• Meats
• Nuts
• bananas and OJ

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Normal potassium movement

• K leaves cells when they are fatigued or damaged

• K reenters the cells during rest and cellular
  rebuilding

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Potassium Excretion

• Working kidneys slowly excrete 20-120mEq/L of
  extra potassium/day
• Altered by
• Renal failure
• Diuretics potassium-sparing (spironolactone) and
  potassium-wasting (Lasix)
• Potassium-wasting diuretics usually
  include daily K supplement
  (Slow K, KCl, K-lyte)

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Other routes of potassium loss

• Corticosteroids endocrine dysfunction
• Aldosterone-like effect
• Potassium loss
• Sodium retention

• GI losses
• Malnutrition (anorexia)
• Vomiting, diarrhea, laxative abuse
• Other eating or purging disorders
• Excessive GI suctioning

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Signs and symptoms of hypokalemia

• Changes the conduction rate of nerve impulses and
  weakens the heart muscle
• Muscle fatigue
• Soft, distended muscles
• Irregular pulse
• Hypotension
  (with dizziness)
• Uneasiness

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Potassium Replacement

• Severity of Hypokalemia is based on serum level
  and ECG
• Dietary increase
• Oral supplement
• IV replacement
• No faster than 10mEq/hour
  diluted in solution.
• NEVER IV PUSH!
• Result cardiac arrest

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Hyperkalemia Potassium Retention/ Excess

• Inadequate kidney excretion decreased urine
  output
• Potassium-sparing diuretics (spironalactone)
• Too much potassium replacement (oral or IV)
• Too much intake
• Cellular damage (potassium has just been released
  from cells and is in high concentration in the
  ECF) BLOOD DRAWS!

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Signs and symptoms of Hyperkalemia

• Causes irritability of the cardiac muscle,
  increasing and then decreasing the heart rate in
  an unpredictable manner.
• Abdominal cramps
• Tachycardia (early) bradycardia (later)

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Management of Hyperkalemia

• Correct the cause
• Restrict intake
• IV sodium bicarbonate (raises pH, causing K to
  move into cells)
• IV 10 calcium gluconate (decreases the cardiac
  irritability)
• Kayexalate (makes K exit) PO or rectal. Ion
  exchange (exchanges sodium for potassium)

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Hypokalemia/ Hyperkalemia

• Potentially serious
• complications
• Either can cause life
• threatening cardiac rhythm
• abnormalities
• May lead to cardiac
• arrest!
• lt2.5mEq/L or gt7.0mEq/L
• Best diagnostics serum
  levels and ECG

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Sodium and Chloride Imbalances

• Principle electrolytes in ECF fluid
• Sodium 135-145 mEq/L (Na)
• Chloride 95-108 mEq/L (Cl)
• Responsible for maintaining fluid balance in the
  body
• Also functions with potassium as part of the
  sodium-potassium pump

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Sources of Sodium and Chloride

• Daily sodium need 2-4g
• One tsp of salt 2.3g of sodium
• Foods high in sodium replace with
• Processed, canned homemade
• Aged meats, pickled fresh meats, fresh foods
• Potato chips baked potato

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Sodium and Chloride Movement and excretion

• Chief regulation occurs in the kidneys and is
  influenced by ADH

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Hyponatremia

• Can occur with ECF excess (kidneys arent
  excreting enough water, ECF dilution)
• S/S caused by malfunction of the Na-K pump
• Nerve conduction and muscle abnormalities
• Headaches, lethargy, muscular weakness

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Whos at risk for hyponatremia?

• GI loss vomiting, suctioning, diarrhea, surgery
  (fluid loss) isotonic
• Renal failure (hemodilution)
• Heart failure (hemodilution)
• Excess electrolyte-free fluids (hemodilution)
• Hormonal influences (SIADH or corticosteroids)
• Syndrome of Inappropriate ADH (SIADH) excessive
  excretion of ADH
• may occur following severe physical stress (head
  trauma, surgery, narcotics)

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Management of Hyponatremia

• Isotonic normal saline (0.9 NaCl) or a
  hypertonic saline (3 NaCl) is given IV
• What is the risk?

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S/S of Hypernatremia

• Rough, dry tongue, tachycardia, flushed, dry
  skin, restlessness, agitation
• Increased cellular depolarization rate, leads to
  increased cellular activity (irritability)
• How would you expect this is managed?

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Calcium Imbalances

• Calcium (Ca) greater concentration in ECF
• 99 of Ca is in teeth and bones (1 ECF)
• Serum level 4.5-5.5 mg/dl
• Functions
• Nerve and muscle activity
• Myocardium contraction
• Cellular membrane potential
• Coagulation of blood
• Formation of teeth and bones

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Sources of Calcium

• Dark green vegetables
• Orange juice
• Dairy products
• Sardines,
  canned salmon, clams
• Needs vit D for absorption

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Calcium movement in the body
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How much Calcium do we need and how will we get
it?

• http//depts.washington.edu/bonebio/bonStrength/ca
  lcium/calciumintro.html
• 1200mg/day

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Hypocalcaemia

• Tissues most affected
• Peripheral nerves, skeletal and smooth muscles,
  cardiac muscle
• Effect
• Tetany symptoms hyperreflexia, twitching,
  tremors
• Calcium converts prothrombin into thrombin,
  hypocalcaemia may result in hemorrhage
• Chronic lows osteoporosis

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Hypercalcemia

• Frequently the result of loss from bones
• Fracture, immobility, malignancy
• Decreases nerve and muscle activity
• Slowed GI motility
• Cardiac dysrhythmias
• Heart block (no conduction)
• ECG changes
• May cause renal calculi
• Acidify urine, H2O, prevent UTIs

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Management of Calcium Imbalances

• Hypocalcemia
• Oral calcium supplements
• IV calcium solution diluted in D5W (Dextrose 5
  in Water)
• Never normal saline (causes calcium loss)
• Weight-bearing exercise
• Nutritional sources

• Hypercalcemia
• Correct underlying cause
• Calcitonin (encourages reabsorption of calcium by
  the bones)
• IV normal saline (0.9)to encourage calcium loss
  through the kidneys
• Loop diuretic (lasix) to prevent fluid excess

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Phosphorus

• Found in ICF
• Similar effects to calcium
• Norms 2.5-4.5 mg/dl
• Sources
• Milk (esp skim)
• Meat (beef and pork
• Whole-grain cereals
• Dried beans

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Magnesium

• Found in ICF
• Similar to potassium
• Norms 1.8-3.0 mg/dl
• Sources
• Green vegetables
• Whole grains
• Fish and seafood

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General Pointers