Electrolyte Electrolyte ImbalancesImbalances

Part IIPart II

Peggy D. JohndrowPeggy D. Johndrow

20092009

PotassiumPotassium Potassium major ICF cationPotassium major ICF cation Sources Sources

Fruits and vegetables (bananas and Fruits and vegetables (bananas and oranges)oranges)

Salt substitutes Salt substitutes Potassium medications (PO, IV)Potassium medications (PO, IV) Stored bloodStored blood

HyperkalemiaHyperkalemia

CausesCauses Increased retentionIncreased retention

Renal failureRenal failure Potassium sparing diuretics Potassium sparing diuretics

Increased intakeIncreased intake Mobilization from ICF Mobilization from ICF

Tissue destruction Tissue destruction Acidosis Acidosis

Hyperkalemia Clinical ManifestationsHyperkalemia Clinical Manifestations

Skeletal muscles weak or paralyzedSkeletal muscles weak or paralyzed Ventricular fibrillation or cardiac standstill Ventricular fibrillation or cardiac standstill Cardiac depolarization is impairedCardiac depolarization is impaired Repolarization occurs more quicklyRepolarization occurs more quickly Abdominal cramping or diarrheaAbdominal cramping or diarrhea

Hyperkalemia ManagementHyperkalemia Management

Eliminate oral and parenteral K intakeEliminate oral and parenteral K intake Increase elimination of K (diuretics, Increase elimination of K (diuretics,

dialysis, Kayexalate)dialysis, Kayexalate) Force K from ECF to ICF by IV insulin or Force K from ECF to ICF by IV insulin or

sodium bicarbonatesodium bicarbonate Reverse membrane effects of elevated Reverse membrane effects of elevated

ECF potassium by administering calcium ECF potassium by administering calcium gluconate IVgluconate IV

Nursing DiagnosesNursing Diagnoses

Potential complication: dysrrhythmiasPotential complication: dysrrhythmias Risk for injury r/tRisk for injury r/t Risk for decreased cardiac output r/tRisk for decreased cardiac output r/t Imbalanced nutrition r/tImbalanced nutrition r/t Diarrhea r/tDiarrhea r/t

Nursing ActionsNursing Actions

Monitor S/SMonitor S/S Do not use tourniquet long when drawing Do not use tourniquet long when drawing

blood can cause false high K+blood can cause false high K+ Monitor serum electrolytesMonitor serum electrolytes Monitor ECGMonitor ECG Assess renal functionAssess renal function Old blood release K+; use fresh bloodOld blood release K+; use fresh blood

HypokalemiaHypokalemia

CausesCauses Increased lossIncreased loss

AldosteroneAldosterone Loop diuretics Loop diuretics GI lossesGI losses Associated with Mg deficiency Associated with Mg deficiency Movement into cellsMovement into cells

Hypokalemia Clinical Hypokalemia Clinical ManifestationsManifestations Potentially lethal ventricular arrhythmias Potentially lethal ventricular arrhythmias Impaired repolarizationImpaired repolarization Increased digoxin toxicity if taking drugIncreased digoxin toxicity if taking drug Skeletal muscle weakness and paralysis Skeletal muscle weakness and paralysis Muscle cell breakdown- leads to myoglobin in Muscle cell breakdown- leads to myoglobin in

plasma & urineplasma & urine Decreased GI motilityDecreased GI motility Altered airway responsivenessAltered airway responsiveness Impaired regulation of arterial blood flowImpaired regulation of arterial blood flow DiuresisDiuresis HyperglycemiaHyperglycemia

ManagementManagement

Replacement PO or IVReplacement PO or IV Never push IVNever push IV Painful in peripheral veinsPainful in peripheral veins Never give with anuric renal failureNever give with anuric renal failure

Teach prevention methods Teach prevention methods

Nursing DiagnosesNursing Diagnoses

Potential complication: dysrrhythmiasPotential complication: dysrrhythmias Risk for injury r/tRisk for injury r/t Risk for ineffective breathing pattern r/tRisk for ineffective breathing pattern r/t Decreased cardiac output r/tDecreased cardiac output r/t Constipation r/tConstipation r/t Imbalanced nutrition r/tImbalanced nutrition r/t Fatigue r/t Fatigue r/t IW Bullets p 188IW Bullets p 188

Nursing ActionsNursing Actions I&O possible hourly, daily wtI&O possible hourly, daily wt Urine output > 20-30cc/hour; essential if Urine output > 20-30cc/hour; essential if

give K+ supplements & IV fluidgive K+ supplements & IV fluid Assess clients on digoxin carefully for dig Assess clients on digoxin carefully for dig

toxicitytoxicity Monitor serum K+ levelMonitor serum K+ level Caution with salt substitutes if on K+ Caution with salt substitutes if on K+

sparing diureticssparing diuretics IW Chart 13-7 p 189IW Chart 13-7 p 189

Which is most dangerous Which is most dangerous hyperkalemia or hypokalemia?hyperkalemia or hypokalemia?

Hyperkalemia can cause cardiac arrestHyperkalemia can cause cardiac arrest

Will hypokalemia be resolved if Will hypokalemia be resolved if magnesium is low?magnesium is low?

No; magnesium deficiency must be No; magnesium deficiency must be corrected before potassium deficit will be corrected before potassium deficit will be correctedcorrected

Mg affects ATP which affects movement Mg affects ATP which affects movement of electrolytesof electrolytes