Electrolyte Imbalances: Nursing Management and Treatment

[00:00:00]Hi, I'm Cathy, with Level up RN. In this video,  we are going to talk about electrolytes and electrolyte imbalances. I'm going to talk about  sodium, calcium, potassium, and magnesium.

[00:00:11]At the end of the video, I'm going to  provide you guys a little knowledge check to test your understanding of some of the key  information I'll be covering in this video, so definitely stay tuned for that. If you  have our medical surgical nursing flashcards, definitely pull those out so you can follow along.  You'll notice on the back of the cards, for these electrolytes, there's a lot of bold red text, so  there are many key points that you have to know in nursing school. So electrolytes  are important to know for Med-Surg, for fundamentals, as well as nutrition. So  pull out those cards and follow along with me.

[00:00:45]First up, we have sodium, which is instrumental  for maintaining the fluid balance in the body and for nerve and muscle function. The normal range  for sodium is between 136 and 145. Different sources will have slightly different ranges,  and I wouldn't get hung up on that because when you're given an out-of-range number for  sodium or another electrolyte on a nursing exam, it will likely be very out of range, on the high  side or the low side, so when I go through these ranges, just kind of keep that in mind. In terms  of hypernatremia, this is where we have a sodium level above 145, causes can include excess  sodium intake, as well as disorders such as Cushing's syndrome or diabetes, and insipidus.  Signs and symptoms can include thirst, agitation, muscle weakness, as well as GI upset. In  terms of treatment, we can provide hypertonic IV fluids such as 0.45% and ACL. Any time we're  trying to correct a patient's sodium balance, we want to do so slowly in order to avoid causing  cerebral edema or seizures. So again, we're not trying to pop that sodium level up or down  very quickly. We're going to correct it slowly.

[00:02:06]We can also use diuretics to help reduce  the patient's sodium level. So furosemide is an example of a diuretic that promotes sodium  loss so that could be used. In addition, we can restrict the patient's intake of sodium  and increase their intake of water.

[00:02:25]All right. Next, we have hyponatremia, this  is where we have a sodium level that is below 136. Possible causes include  diuretics, kidney failure, diathesis, as well as SIADH, hypoglycemia and heart failure.  Signs and symptoms include confusion, which is very common in the elderly in particular. So when  an older patient presents at the hospital with new onset confusion, a lot of times it's due to  an electrolyte imbalance such as hyponatremia, or sometimes it's caused by something like a UTI.  So you definitely want to get the patient's blood, check for those electrolyte imbalances  and maybe get a urine sample as well.

[00:03:13]Aside from confusion, other side effects of-- or  rather other signs and symptoms of hyponatremia include fatigue, nausea and vomiting, as  well as headache. In terms of treatment, we can provide a hypertonic IV fluid replacement,  so this would be 2 to 3 percent NACl. Again, we're going to correct that sodium level slowly.  We can also encourage increased sodium intake and restrict the patient's fluid intake as well. Next, we have calcium, which is an electrolyte that is important for bone and teeth formation,  nerve and muscle function, as well as clotting.

[00:03:54]The normal range for calcium is between 9 and  10.5. So my way of remembering this range, when I see CA for calcium, it makes me think of  California, which is due for the big earthquake sometime. And when that earthquake comes, it may  register between 9 and 10.5 on the Richter scale.

[00:04:16]I've seen another tip about calcium levels, call  911, which will help you remember that calcium levels should be between 9 and 11, roughly.  So hopefully one of those two tricks will help you. If you have another pneumonic or trick  for remembering an electrolyte range, definitely leave it in the comments. So with hypercalcemia,  we have a calcium level that is above 10.5. This can be caused by hyperparathyroidism, so that  parathyroid gland is responsible for regulating calcium, and if it's out of control for whatever  reason, then we can end up with excess calcium.

[00:04:58]We also have causes such as corticosteroids  and bone cancer that can cause hypercalcemia.

[00:05:04]In terms of signs and symptoms, those include  constipation, decreased deep tendon reflexes, as well as kidney stones, lethargy and  weakness. In terms of treatment, we can provide 0.9% IV fluids, so 0.9% NACL. We can give  the patient calcitonin, which tones down the amount of calcium in the bloodstream. And then for  severe hypercalcemia, dialysis may be necessary.

[00:05:34]All right. With hypocalcemia, we have a calcium  level that is under 9. And this can be caused by diarrhea, as well as a vitamin D deficiency.  So vitamin D is essential for the absorption of calcium in the body. So if we don't have  enough vitamin D on board, we are not going to be absorbing calcium. Hypercalcemia can  also be caused by hypoparathyroidism. So if that parathyroid gland is not functioning well,  then we can have decreased levels of calcium.

[00:06:09]And this can also occur if the patient is getting  their thyroid gland removed, so a thyroidectomy sometimes that parathyroid gland can be nicked.  And if that's the case, that can cause decreased calcium levels. In terms of signs and symptoms,  one important sign and symptom to understand is a positive Chvostek sign. This is where if  you tap the patient's cheek, it will twitch.

[00:06:35]So if you look at the word Chvostek, it  starts with CH and so does the word cheek, so that will help you remember what that sign is  all about. We will also see a positive Trousseau sign. This is where we inflate a blood pressure  cuff on the arm, and it causes the contraction of the hand and fingers to make this kind of shape.  Other signs and symptoms include muscle spasms, numbness and tingling in the lips and fingers,  as well as GI upset. In terms of treatment for hypocalcemia, we can provide the patient with  calcium supplements either orally or through their IV. And we should also encourage an  increased intake of calcium rich foods.

[00:07:21]Next, we have potassium, which is an important  electrolyte in maintaining the ICF, and in nerve and muscle function. So the normal range for  potassium is between 3.2 and 5. So my ways of remembering this range, when I think about running  a 5K, then that's about 3.2 miles, roughly, so that helps me to remember 3.2 to 5. You can  also think about buying bananas in a bunch of 3 to 5, and that will help you remember roughly that  expected range for potassium and also help you remember that bananas are rich in potassium. So  hopefully one of those two tricks will help you.

[00:08:08]In terms of hyperkalemia, this is  where we have a potassium level above 5. This can be caused by DKA, so diabetic  ketoacidosis, as well as metabolic acidosis.

[00:08:22]And I really want you guys to remember that  these three things actually go together in most situations. So when a patient presents with DKA,  in all likelihood, they're going to have metabolic acidosis and hyperkalemia. Those three things go  together. Other causes of hyperkalemia include salt substitutes, as well as kidney failure.  In terms of signs and symptoms of hyperkalemia, dysrhythmias is going to be a key one, and  dysrhythmias is actually going to be the key symptom with hypokalemia as well. So anytime we  have excess potassium or not enough potassium, our patient is at risk for dysrhythmias. So in the  hospital, you're going to be closely monitoring your patient's potassium levels to help prevent  that complication. Other signs and symptoms of hyperkalemia include muscle weakness, numbness  and tingling, as well as nausea and vomiting.

[00:09:21]For treatment of hyperkalemia, we can provide  furosemide, which is a diuretic that actually gets rid of potassium. So sometimes we don't want that,  right, that's a key side effect with furosemide is hyperkalemia, but in a situation where we have too  much potassium with hyperkalemia, then furosemide and that side effect is actually helpful. Other  treatments include administration of Kayexalate as well as insulin. So insulin helps the potassium  get from the ECF into the ICF. Something to keep in mind though, when insulin is helping potassium  go into the ICF, it's also moving glucose into the ICU, so it places the patient at risk for  hypoglycemia. So when we get the patient insulin, we also need to give them dextrose to help prevent  that hypoglycemia. And then we could always encourage decreased intake of potassium rich  foods such as bananas, potatoes, cantaloupe, etc. All right. Hypokalemia is where we have a  potassium level that is under 3.5. Causes of this include diuretics, such as furosemide. And like  I said that's a side effect with that medication.

[00:10:45]It can also be caused by GI losses such as  vomiting or NG tube suctioning. It can be caused by diaphoresis, as well as Cushing's syndrome and  metabolic alkalosis. Signs and symptoms include, can you guess, dysrhythmia, so that's going to  be a key one here too. Other signs and symptoms include muscle spasming or weakness, as well  as constipation or an ileus. So with an ileus, our whole GI system peristalsis stops, it's like  paralyzed, basically. In terms of treatment, potassium supplements are definitely  going to be something we're going to do.

[00:11:28]These can be administered orally with like  a huge horse pill, it's like a huge pill that the patient has to swallow. It also comes in  a powder that you can mix with some kind of juice.

[00:11:42]It's pretty disgusting, that's  what my patients tell me at least.

[00:11:46]We can also give it through the IV. Now, potassium  can cause phlebitis, so inflammation of that vein, it could be painful for the patient. So I always  request that the doctor order the potassium to be mixed with Lydocaine to help decrease that pain.  And then we can encourage increased intake of potassium rich foods as well. So again, all those  foods I just mentioned that we want to avoid with hyperkalemia, we actually want to encourage with  hypokalemia, so they should increase their intake of bananas, potatoes, cantaloupe, etc. Finally, we have magnesium, which is an electrolyte that's important for many biochemical  reactions in the body. It's also needed for muscle and nerve function. The normal range for magnesium  is between 1.3 and 2.1. And my way of remembering this range is, I think of one of those little  British MG cars, I don't know if you guys are familiar with them, but you can only fit one  or two people in that car. And so that helps me remember that magnesium levels will be roughly  between 1 and 2. In terms of hypermagnesemia, this is where we have a magnesium level that is  above 2.1. This can be caused by kidney disease.

[00:13:05]It can also be caused by excess intake of antacids  or laxatives that contain magnesium. In terms of signs and symptoms-- signs and symptoms of  hypermagnesemia include hypotension, lethargy, muscle weakness, decreased deep tendon reflexes,  as well as respiratory and cardiac arrest.

[00:13:29]So when magnesium is too high, we're going to have  all these things go low. In terms of treatment, we can provide furosemide to help bring down  those magnesium levels. We also want to provide the patient with calcium to help reverse the  cardiac effects of having excessive magnesium.

[00:13:49]With hypomagnesemia, this is where we have a  magnesium level that is below 1.3. This could be caused by GI losses, as well as diuretics,  malnutrition and alcohol abuse. So when we get patients in the hospital who have an alcohol  abuse disorder, their magnesium levels are often very low, and they require supplements. Signs and  symptoms of hypomagnesemia include dysrhythmia, including one dysrhythmia called Torsades  de pointes. It can also cause tachycardia, hypertension, increased deep tendon reflexes,  as well as tremors and seizures. So as magnesium levels are down, we have an increase of all this  stuff, so it's kind of an opposite situation.

[00:14:42]In terms of treatment, we can provide a patient  with hypomagnesemia with magnesium supplements, either PO or IV, and then we can encourage  increased intake of magnesium rich foods as well.

[00:14:56]All right. Time for a quiz. I have  three questions for you. First question, a positive Chvostek's and Trousseau's sign  are indicative of what electrolyte imbalance?

[00:15:11]The answer is hypocalcemia. Question number two,  what key side effect is caused by hyperkalemia and hypokalemia? The answer is dysrhythmia. Question  number three, signs and symptoms of hypomagnesemia include hypotension and decreased  deep tendon reflexes, true or false?

[00:15:42]The answer is false. So with hypomagnesemia,  we're going to have an increase in DTRs as well as hypertension. Okay. I hope this video has  been helpful. Be sure to review these cards.

[00:15:56]Take them on a walk with you, take them to the  kid pickup line, basically wherever you go, because there's a lot of information  you'll need to review, and it takes repetition for you to remember all that stuff.  So take care and good luck with studying.

[00:16:10]I invite you to subscribe to our channel and share  a link with your classmates and friends in nursing school. If you found value in this video, be sure  to hit the like button and leave us a comment and let us know what you found particularly helpful. I invite you to subscribe to our channel and share a link with your classmates and friends in nursing  school. If you found value in this video, be sure and hit the like button, and leave a comment and  let us know what you found particularly helpful.