306696
| Question | Answer |
| Serum level Sodium | 135-145 mEq/L |
| Critically Low Limit: Sodium | <115mEq/L |
| Critically High Limit: Sodium | >155 mEq/L |
| Serum level Potassium | 3.5-5.0 mEq/L |
| Serum level: Calcium | 8.5 - 10.5 mg/dL |
| Serum level: Magnesium | 1.2 - 2.1 mEq/L |
| Serum level: Phosphorus | 1.8 - 2.6 mEq/L |
| Critical Low: Potassium | <3.0 mEq/L |
| Critical Low: Calcium | < 7mg/dL |
| Critical Low: Magnesium | <1.0 mEq/L |
| Critical Low: Phosphorus | <1.0mg/dl |
| Critical High: Potassium | > 6.4 mEq/L |
| Critical High: Calcium | >12mg/dL |
| Critical High: Magnesium | >3 mEq/L |
| Critical High: Phosphorus | >5mg/dL |
| S/S: cerebral edema and increased ICP, mental status changes, decreased LOC, lethargy, confusion, muscle twitching, weakness, hyperreflexia, headache, personality change, hemiparesis, seizures, muscle cramps, exhaustion, anorexia | Hyponatremia |
| S/S: thirst, altered neuro-function, restlessness, weakness, disorientation, lethargy, delusions, stupor, convulsions, coma, dry swollen tongue, increased temp, increased excitability/conductivity of nerve cells, muscle irritability and twitching, peripheral/pulmonary edema or postural hypotension | Hypernatremia |
| S/S: fatigue, muscle weakness, leg cramps, paresthesia, confusion, slowed GI motility, N/V, anorexia, flat T waves, depressed ST, elevated U wave, dig. toxicity, cardiac/respiratory arrest | hypokalemia |
| peaked narrow T waves, prolonged PR, widened QRS may progress to atrial systole, dysrhythmias, heightened neuromuscular activity, speeds up GI: diarrhea, abdominal cramping, anxiety irritability, paresthesia, muscle tremor, twitching muscle weakness, flaccid paralysis, respiratory paralysis | hyperkalemia |
| tetany, convulsions, tingling numbness, hyperactive reflexes, positive Chvostek's and Trousseau's signs, bronchospasms, abd. pain, laryngospasm, respiratory arrest, impaired memory, confusion, delirium, depression, prolonged QT and ST, V-tach | hypocalcemia |
| muscle weakness, incoordination, anorexia, constipation, abd. pain, bone pain, abd. distention and paralytic ileus, confusion, impaired memory, slurred speech, lethargy, acute psychotic behavior, coma, short QT and ST, renal calculi | hypercalcemia |
| hyperexcitable muscles with weakness, tremor, tetany, seizures, laryngeal spasms, positive Chvostek's and Trousseau's, dysrhythmias, mood alterations, apathy, depression, apprehension, agitation, dizziness, insomnia, confusion, paresthesia, dysphagia | hypomagnesemia |
| CNS depression, peripheral vasodilation, low BP, N/V, soft tissue calcification, facial flushing, feeling warm --> increases to lethargy, difficulty speaking, drowsiness, decreased/absent DTR, muscle weakness --> >10mEq coma, A/V block, cardiac arrest | hypermagnesemia |
| irritability, fatigue, paresthesia, confusion, seizures, apprehension, weakness, numbness, coma, muscle damage weakness and pain, impaired ventilation due to respiratory muscle weakness, platelet dysfunction (bruising/bleeding), altered granulocyte function, anorexia, dysphagia, N/V decreased motility of GI | hypophosphatemia |
| tetany, hypocalcemia, anorexia, N/V, muscle weakness, hyperreflexia, tachycardia | hyperphosphatemia |
| Caused by: vomiting, diarrhea, fistulas, excess sweating, diuretics, aldosterone deficiency, excessive water: water intoxication, GI irrigation, electrolyte poor fluids,tap water enemas | hyponatremia |
| causes: hypertonic enteral formulas and IV solution, salty foods, medications, drowning in salt water, water loss: altered thirst mechanism, NPO/elderly water deprivation, watery diarrhea, burns, diaphoresis, fevers, hyperfunction of aldosterone, diabetes insipidus, osmotic diuresis (Hyperglycemia) | hypernatremia |
| Causes: diuretics, sodium-antibiotics, penicillin, glucocorticoids, osmotic diuresis, DM, hyperaldosteronism (CHF, renal disease, cirrhosis, adrenal adenomas), vomiting, diarrhea, laxative overuse, excessive ileostomy drainage, suction, extended therapy without X - replacement, alkalosis, burns, trauma, starvation, high insulin | hypokalemia |
| high x intake, decreased excretion by kidneys (renal disease x-sparing meds, hypovolemia, adrenal insufficiency, rapid infusion of blood, metabolic acidosis, hyperglycemia, crush injuries, burns, trauma, severe infection, chemo | hyperkalemia |
| Causes: large transfusion of citrated blood, decreased PTH, alkalosis, rapid infusion of IV phosphate, cimetidine, phenytoin, heparin, loop diuretics, MgSO4, gentamicin, decreased absorption due to bowel disease, deficient vit D/sunlight, acute pancreatitis, hypoparathyroidism, bed rest/decreased mobility | hypocalcemia |
| Causes: hyperparathyroidism, malignancies of the bone, lack of stress on bone, paget's disease, multiple fractures, addison's disease, overuse of antacids, excess milk intake, IV od, thiazide diuretics | hypercalcemia |
| Causes: alcoholism, esp with withdrawal, GI tract, NG suction, diarrhea, fistulas, IBD, disruption of bowel function, starvation, aminoglycosides, cyclosporin, diuretics, digitalis, rapid infusion of citrated blood, DKA, sepsis, burns, hypothermia | Hypomagnesemia |
| renal failure, excessive antacid use or laxative use, excessive Mg, adrenocortical insufficiency, addison's disease, hypothermia | hypermagnesemia |
| TPN with insufficient x, severe protein-cal malnutrition, aloholism, anorexia nervosa, prolonged intense hyperventilation, DKA, major burns, metabolic or respiratory acidosis, antacids, excess calcium, vomiting/diarrhea, decreased absorption, increased renal excretion, glycosuria, polyuria, diuretics | hypophosphatemia |
| Causes: Renal failure, chemo, hypoparathyroidism and decreased calcium, respiratory acidosis, DKA, increased intake, muscle necrosis, hyperthyroidism | Hyperphosphatemia |
| Tx: increase intake, if hypovolemia - isotonic LR or NS, GRADUAL increase! If VERY low - hypertonic NS, ICU care, and if hypervolemic - loop diuretics | hyponatremia |
| Tx: gradually decrease, hypotonic IV solution, diuretics, restrict intake | hypernatremia |
| replace with oral supplement, salt substitutes, IV supplement, KCL (NEVER BOLUS) | hypokalemia |
| Restrict x, calcium gluconate, monitor EKG, IV sodium bicarbonate, hypertonic dextrose and insulin for temporary shift, beta2agonist, kayexalate, dialysis | hyperkalemia |
| oral supplement, or IV calcium gluconnate, but gradually as rapid infusion could cause bradycardia and cardiac arrest, may cause dig. toxicity | hypocalcemia |
| Tx: treat cause, IV fluids to promote excretion, restrict in diet, give IV phosphorus, lop diuretics, calcitonin IM, mithramycin | hypercalcemia |
| Tx: diet (peanut butter, chocolate, green leafy veggies, nuts) x salts - be careful they may cause diarrhea in excess, IV | hypomagnesemia |
| restrict intake, DC antacids/laxatives, give calcium to antagonize, resp. support, loop diuretics and hypotonic saline | hypermagnesemia |
| Tx: replace orally of if <1mg/dl give IV | hypophosphatemia |
| Tx: treat underlying cause, restrict x-rich foods (cheese, cream, nuts, whole grains, dried fruits), restrict meds, increase GI/urinary elimination | hyperphosphatemia |
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