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TABLE 3-6 Electrolyte Imbalances Abnormalities and Common Causes Signs and Symptoms Treatment Hyponatremia ({Na) * Diuretics * Gl fluid loss * Hypotonic tube feeding * DsW or hypotonic IV fluids * Diaphoresis * Anorexia, nausea, vomiting * Weakness * Lethargy » Confusion * Muscle cramps, twitching * Seizures * Na <135 mEqg/L Restrict fluids (safer). If IV saline solutions prescribed, administer very slowly; use isotonic saline if fluid restriction not effective. Hypernatremia (TNa) * Water deprivation * Hypertonic tube feeding * Diabetes insipidus » Heatstroke » Hyperventilation * Watery diarrhea * Renal failure * Cushing syndrome * Thirst * Hyperpyrexia * Sticky mucous membranes * Dry mouth * Hallucinations * Lethargy * Irritability * Seizures * Na >145 mEq/L Restrict sodium in the diet. Beware of hidden sodium in foods and medications. Increase water intake. Hypokalemia (1K) * Diuretics * Diarrhea * Vomiting * Gastric suction » Steroid administration * Hyperaldosteronism * Amphotericin B * Fatigue * Anorexia * Nausea, vomiting * Muscle weakness * Decreased Gl motility * Dysrhythmias * Paresthesia * FlatT waves on ECG Administer potassium supplements orally or IV. Oral forms of potassium are unpleasant tasting and are irritating to the Gl tract (do not give on empty stomach; dilute). * Never give IV bolus; must be well diluted. Assess renal status, i.e., un administering. * Encourage foods high in potassium (e.g., bananas, * Hemolyzed serum sample produces pseudohyperkalemia * Oliguria * Acidosis * Renal failure * Addison disease * Multiple blood transfusions * Bradycardia * Dysrhythmias * Flaccid paralysis * Intestinal colic * Tall'T waves on ECG * K>5.0 mEq/L * Bulimia * K <3.5 mEqg/L oranges, cantaloupes, avocados, spinach, potatoes). * Cushing syndrome Hyperkalemia (TK) * Muscle weakness * Eliminate parenteral potassium from IV infusions and medications. * Administer 50% glucose with regular insulin. * Administer cation exchange resin (Kayexalate). * Monitor ECG. * Administer calcium gluconate to protect the heart. * |V loop diuretics may be prescribed. * Renal dialysis may be required. Hypocalcemia (1Ca) * Renal failure * Hypoparathyroidism » Malabsorption * Pancreatitis * Diarrhea * Numbness * Tingling of extremities » Convulsions * Positive Trousseau sign * Administer calcium supplements orally 30 minutes before meals. * Administer calcium IV slowly; infiltration can cause tissue necrosis. Increase calcium intake (e.g., dairy products, greens). * Hyperparathyroidism * Malignant bone disease * Prolonged immobilization * Excess calcium supplementation * Constipation * Anorexia * Nausea, vomiting * Polyuria * Polydipsia * Neurosis * Alkalosis * Positive sign * Ca <85 mEq/L * At risk for tetany Hypercalcemia (1Ca) * Muscle weakness * Eliminate parenteral calcium. » Administer agents such as calcitonin to reduce calcium. * Avoid calcium-based antacids. * Renal dialysis may be required. Search documents and