Electrolyte Imbalances

www.meejuru.com ELECTROLYTE IMBALANCES Signs and symptoms of a fluid and electrolyte imbalance are often subtle blood chemistry tests help diagnose and evaluate electrolyte imbalance. ELECTROLYTE DIAGNOSTIC SIGNS AND SYMPTOMS TEST RESULTS IMBALANCES *Muscle twitching and weakness due to osmotic swelling of cells *Lethargy, confusion, *Serum sodium <135 mEa/l seizures,and coma due to *Decreased urine specific gravity altered neurotransmission *Decreased serum osmalality *Hypertension and tachycardia *Urine sodium > 100 mEq/24 hours HYPONATREMIA due to decreased extracellular *Increased red blood cell count circulating volume *Nausea,vomiting, and abdominal cramps due to edema affecting receptors in the brain or vomiting center of the brain stem *Oliguria or anuria due to renal dysfunction *Agitation, restlessness, fever, and decreased level of consciousness due to altered *Serum sodium > 145 mEq/l cellular metabolism *Urine sodium <40 mEq/24 hours *Hypertension, tachycardia, *High serum osmolality pitting edema, and excessive weight gain due to water shift HYPERNATREMIA from intracellular to extracellular fluid *Thirst, increased viscosity of saliva, rough tongue due to fluid shift *Dyspnea, respiratory arrest, and death from dramatic increase in in osmotic pressure *Dizziness, hypotension, *Serum potassium < 3.5 mEq/l arrhythmias, electrocardiogram *coexisting low serum calcium HYPOKALEMIA (ECG) changes, and cardiac and magnesium levels not arrest due to changes in responsive to treatment for membrane excitability hypokalemia usually suggest hypomagnesemia

*Nausea, vomiting, anorexia, diarrhea, decreased peristalsis, *metabolic alkalosis and abdominal distention due to *ECG changes include flattened decreased bowel motility Waves, elevated U waves, *Muscle weakness, fatigue, and Depressed ST segment leg cramps due to decreased neuromuscular excitability *Tachycardia changing to bradycardia,ECG changes, and *Serum potassium > 5mEq./l cardiac arrest due to *Metabolic acidosis hypopolarization and alterations *ECG changes include tented in repolarization and elevated T waves, widened *Nausea, diarrhea, and QRS complex, HYPERKALEMIA abdominal cramps due to prolonged PR interval, flattened decreased gastric motility or absent P waves, depressed *Muscle weakness and flaccid ST segment paralysis due to inactivation of membrane sodium channels *Muscle hypertonicity and tetany *Serum chloride <98 mEq/l *Shallow, depressed breathing *Serum pH > 7.45 (supportive value) *Usually associated with *Serum CO2 >32 mEq/l HYPOCHLOREMIA hyponatremia and its (supportive value) characteristic symptoms, such as muscle weakness and twitching *Deep, rapid breathing *Serum chloride > 108 mEq/l *Weakness HYPERCHLOREMIA *Serum pH < 7.35, serum CO2 *Diminished cognitive ability, <22 mEq/l (Supportive values) possibly leading to coma *Anxiety, irritability, twitching *Serum calcium <8.5 mg/dl around the *Low platelet count mouth,laryngospasm,seizures, *ECG shows lengthened QT Chvostek's and Trousseau's interval, prolonged ST segment, HYPOCALCEMIA signs due to enhanced arrhythmias neuromuscular irritability *Possible changes in serum *Hypotension and arrhthmeas protein because half of serum due to decreased calcium influx calcium is bound to albumin *Drowsiness, lethargy, *Serum calcium > 10.5 mg/dl HYPERCALCEMIA headaches, irritability, *ECG shows signs of heart confusion, depression, or apathyblock and shortened QT interval

due to decreased neuromuscular irritability ( increased threshold) *Weakness and muscle *Azotemia flaccidity due to depressed *Decreased parathyroid neuromuscular irritability and hormone level release of acetylcholine of the *Sulkowitch urine test shows myonearal junction increased calcium precipitation *Bone pain and pathological fractures due to calcium loss from bones *Heart block due to decreased neuromuscular irritability *Anorexia, nausea, Vomiting, constipation, and dehydration due to kidney stone formation *Nearly always coexists with hypokalemia and hypocalcemia *Serum magnesium < 1.5 mEq/l *Hyperirritability, tetany, leg *Coexisting low serum and foot cramps, positive potassium and calcium levels Chvostek's and Trousseau's signs HYPOMAGNESEMIA confusion in neuromuscular transmission *Arrhythmias, vasodilation, and hypotension due to enhanced inward sodium current or concurrent effects of calcium and potassium imbalance *Hypermagnesemia is uncommon, caused by *Serum magnesium > 2.5 mEq/l decreased renal excretion (renal *Coexisting elevated potassium failure) or increased intake of magnesium and calcium levels *Diminished reflexes, muscle weakness to flaccid paralysis due to suppression of acetylcholine release of the myoneural HYPERMAGNESEMIA junction, blocking cell excitability *respiratory distress secondary to respiratory muscle paralysis *Heart block, bradycordia due to decreased inward sodium current *Hypotension due to relaxation of vascular smooth muscle and reduction of vascular wall surface

*Muscle weakness, tremor, and *Serum phosphates < 2.5mg/dl paresthesia due to deficiency of *Urine phosphate > 1.3 g/24 hours HYPOPHOSPHATEMIA adenosine triphasphate *Peripheral hypoxia due to 2,3 - diphosphoglycerate deficiency *Serum phosphates > 4.5 mg/dl *Usually asymptomatic unless *Serum calcium < 9mg/dl HYPERPHOSPHATEMIA leading to hypocalcemia, with *Urine phosphorus < 0.9 g/24 tetany and seizures hours