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Electrolyte Imbalances 1.

HYPONATREMIA~
Related Causes: -GI Loss: vomiting, diarrhea, NG suction -Renal Loss: kidney disease resulting in salt wasting; diuretics; adrenal insufficiency -Skin Loss: excessive perspiration; burns -Psychogenic Polydipsia -Syndrome of inappropriate ADH (SIADH) Physical Examination: -apprehension, personality change, postural hypotension, postural dizziness, abdominal cramping, nausea and vomiting, diarrhea, tachycardia, dry mucous membranes, convulsions and coma. Laboratory Findings: -serum sodium level below 135 mEq/L, serum osmolality 280 mOsm/kg, and urine specific gravity below 1.010 (if not caused by SIADH)

2. HYPERNATREMIA~
Related Causes: -Excess salt intake; ingestion of large amounts of concentrated salt solutions; iatrogenic administration of hypertonic saline solution parenterally -Excess aldosterone secretion -Diabetes insipidus -Increased sensible and insensible water loss -Water deprivation Physical Examination: -extreme thirst, dry and flushed skin, dry and sticky tongue and mucous membranes, postural hypotension, fever, agitation, convulsions, restlessness and irritability Laboratory Findings: -serum sodium levels above 145 mEq/L, serum osmolality 300 mOsm/kg, and urine specific gravity 1.030 (if not caused by diabetes inspidus)

3.

HYPOKALEMIA~
Related Causes: -Use of potassium-wasting diuretics -Diarrhea, vomiting, or other GI losses -Alkalosis -Excess aldosterone secretion

-Polyuria -Extreme sweating -Excessive use of potassium-free intravenous (IV) solutions Physical Examinations: -weakness and fatigue, muscle weakness, nausea and vomiting, intestinal distention, decreased bowel sounds, decreased deep tendon reflexes, ventricular dysrhythmias, paresthesias and weak, irregular pulse Laboratory Findings: -serum potassium level below 3.5 mEq/L and electrocardiogram (ECG) abnormalities: flattened T wave; ST segment depression; U wave; potentiated digoxin effects (e.g. ventricular dysrhythmias)

4. HYPERKALEMIA~
Related Causes: -Renal Failure -Fluid Volume Deficit (FVD) -Massive cellular damage such as from burns and trauma iatrogenic administration of large amounts of potassium intravenously -Adrenal Insufficiency -Acidosis, especially diabetic ketoacidosis -Rapid infusion of stored blood -Use of potassium-sparing diuretics -Ingestion of k+ salts substitutes Physical Examinations: -anxiety, dysrhythmias, paresthesia, weakness, abdominal cramps, diarrhea Laboratory Findings: -serum potassium level above 5.0 mEq/L and ECG abnormalities; packed T wave and widened QRS complex (bradycardia, heart block, dysrhythmias); eventually QRS pattern widens and cardiac arrest occurs.

5.

HYPOCALCEMIA:
Related Causes: -Rapid administration of blood transfusions containing citrate -Hypoalbuminemia -Hypoparathyroidism -Vitamin D deficiency -Pancreatitis -Alkalosis -Chronic renal failure -Chronic alcoholism

Physical Examination: -numbness and tingling of fingers and circumoral (around the mouth) region, hyperactive reflexes, positive Trousseaus sign (carpopedal spasm with hypoxia), positive Chvosteks sign (contraction of facial muscles when facial nerve is tapped), tetany, muscle cramps, and pathological fractures (chronic hypocalcemia) Laboratory Findings: -serum ionized calcium level below 4.5 mEq/L or total serum calcium below 8.5 mg/dl and ECG abnormalities: ventricular tachycardia

6.

HYPERCALCEMIA~
Related Causes: -Hyperparathyroidism -Osteometastasis -Pagets Disease -Osteoporosis -Prolonged Immobilization -Acidosis -Thiazide Diuretics Physical Examination: -anorexia, nausea and vomiting, weakness, hypoactive reflexes, lethargy, flank plane (from kidney stones), decreased level of consciousness, personality changes, and cardiac arrest Laboratory Findings: -serum ionized calcium level above 5.5 mEq/L or total serum calcium level above 10.5 mEq/dl; xray examination showing generalized osteoporosis, widespread bone activation, radiopaque urinary stones; and elevated blood urea nitrogen (BUN) level 25mg/100ml and elevated creatine level 1.5mg/100ml caused by fluid volume deficit (FVD) or renal damage caused by urolinthiasis; ECG abnormalities; heart block.

7. HYPOMAGNESEMIA~
Related Causes: -Inadequate intake; malnutrition and alcoholism -Inadequate absorption or loss; diarrhea, vomiting, nasogastric drainage, fistule, diseases of small intestine -Excessive loss resulting from Thiazide Diuretics -Aldosterone excess -Polyuria Physical Examination: -muscular tremors, hyperactive deep tendon reflexes, confusion and disorientation, tachycardia, hypertension, dysrhythmias, and positive Chvosteks sign and Trousseaus sign Laboratory Findings:

-serum magnesium level below 1.5 mEq/L

8. HYPERMAGNESEMIA~
Related Causes: -Renal Failure -Excess oral parenteral intake of magnesium Physical Examination: -acute elevations in magnesium levels; hypoactive deep tendon reflexes, decreased depth and rate of respirations, hypotension and flushing Laboratory Findings: -serum magnesium level above 2.5 mEq/L; ECG abnormalities: prolonged QT interval, AV block

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