NURS601 Week 1 Concept 2: Electrolyte imbalance
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Electrolytes are chemicals dissolved in body fluids and are commonly measured in mEq and include: salts, acids, bases, and some proteins
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A natriuretic peptide is a peptide which includes natriuresis - the secretion of sodium by the kidneys
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Atrial natriuretic peptide (ANP) or atrial natriuretic factor (ANF) is a natriuretic peptide hormone secreted from the cardiac atria - the main function of ANP is causing a reduction in expanded extracellular fluid (ECF) volume by increasing renal sodium excretion
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Normal organ & gland function
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Intake, output
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Acid-base balance
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Hormones
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Cell integrity
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Sodium
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Major extracellular electrolyte
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Controls & regulates water balance
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Where sodium goes, water follows
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Potassium
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Major intracellular electrolyte
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Helps maintain intracellular water balance
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Transmit nerve impulses to muscles and contract skeletal and smooth muscles (e.g., cardiac)
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Water excess or loss of sodium
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Causes
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Dilution
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Polydipsia
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Freshwater drowning
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ADH
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CHF (Excess Na+ loss)
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Excretion
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Sweating
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Diuretics
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GI wound drainage
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Renal disease (Excess Na+ loss)
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Intake
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Low salt diet
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Severe vomiting/diarrhea (inadequate Na+ intake to balance loss)
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Signs & Symptoms
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S tupor/coma
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A norexia, nausea & vomiting
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L ethargy
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T endon reflexes decreased
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L imp muscles (weakness)
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O rthostatic hypertension
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S eizures/headaches
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S tomach cramping
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What can you do?
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3% normal saline
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If caused by fluid excess, will need fluid restriction
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Usually can't be fixed by adding sodium to the diet
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Don't forget! Sodium must be replaced slowly!
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Causes
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Vomiting
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NG suction
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Diarrhea
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Medications (diuretics, laxatives, insulin)
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Signs & symptoms
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Dysrhythmias
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Weakness
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Low BP
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Weak pulse
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Muscle weakness and paralysis
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Diuresis
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What can you do?
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Cardiac monitor
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Foods high in potassium
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Potassium IV (only if good urine output)
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Keep patient safe from falls
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Lungs & Liver
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Water & Sodium balance
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Heart
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Excretes sodium via excretion of atrial natriuretic peptide
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Sweat glands
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Excrete Na+, K+, Cl-, water
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GI Tract
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Absorbs fluids & electrolytes
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Kidneys
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Water, electrolytes; K+, Na+, Urea, and H+ ions
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Hypernatremia is too much sodium
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Causes
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Excess Na+ intake
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Inadequate water intake
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Excess water loss
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Hypernatremia relsults in fluid shift from ICF to ECF (water follows sodium)
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Signs & symptoms
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F = Fever (low grade, flushed skin)
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R - Restless (irritable)
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I - Increased fluid retention and increased BP
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E - Edema (peripheral & pitting)
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D - Decreased urine output, dry mouth
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What can you do?
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Treat the underlying cause
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Diuretics
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Sodium restriction
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Seizure precautions
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If severe - dialysis
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Sodium must be reduced slowly to avoid swelling in the brain, causing seizures
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Very dangerous
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Causes
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Kidney failure (most common)
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Use of salt or potassium supplements, recieving old blood (not very common anymore)
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Cell destruction, Acidosis, hypoxia
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Exercise, catabolic state
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Use of potassium-sparing diuretics
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Can get false high results if specimen not handled properly
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Symptoms
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M uscle weakness
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U rine, oliguria, anuria
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R espiratory distress
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D ecreased cardiac contractability
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E CG changes
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R eflexes - hyperflexia, or areflexia
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What can you do?
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Cardiac monitor
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Lasix if kidneys are functioning
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Stop potassium in IV fluids
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Have patient avoid foods high in potassium
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Dialysis if severe
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Hyponatremia
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Not enough salt/increased secretion/dilution
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Confusion, headaches, ado cramps
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Hypernatremia
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Eating too much Na+/water loss/kidney failure
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Fluid retention, edema
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Hypokalaemia
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Vomiting/diarrhea/diuretics
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Dysrhythmias, weakness
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Hyperkalaemia
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Kidney failure/ingesting too much K+/acidosis
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Stops cardiac function/ECG changes
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