Electrolyte imbalances

Electrolyt
e

Potassiu
m

Value

3.5
5.0

Food
Source
Avocado,
bananas,
cantaloupe,
carrots, fish,
oranges,
potatoes,
strawberries,
tomatoes,
raisins

K dilution of
no >
1mEq/10ml

Hypo
Causes: diuretics,
diarrhea, vomiting,
gastric suction,
corticosteroids, Cushings
syndrome, bulimia,
wound, drainage,
amphotericin B,
hyperaldosteronism,
renal disease, NPO,
alkalosis (K moving from
ECF to ICF),
hyoerinsulinism, water
intoxication
s/s: fatigue, anorexia,
n/v, muscle weakness,
dec GI motility,
dysrhythmias,
paresthesia, weak
peripheral pulses,
diminished breath
sounds, anxiety, dec
DTRs,

Infusion rate
5-10 mEq/hr;
NEVER
exceed 20
mEq/hr

EKG changes: ST
depression; flat or
inverted T waves; U wave

Sodium

135 145

Bacon, butter,
canned foods,
cheese,
ketchup, lunch
meat,
processed
foods

Treatment: administer K
supplements- never give
PO on empty stomach,
NEVER given BOLUS;
assess renal function
(output) before
administering; IV infusion
always diluted.
Causes: sodium
excretion, excessive
diaphoresis, diuretics,
hypotonic tube feedings,
D5W IV fluids, vomiting,
diarrhea, wound
drainage, renal disease,
dec secretion of
aldosterone, SIADH,
hyperglycemia, CHF, NPO

Hyper
Causes: oliguria, acidosis
(K moving from ICF to
ECF) , renal failure,
addisons disease, salt
substitutes, potassiumsparing diuretics, tissue
damage
s/s: muscle weakness,
bradycardia, dysrhythmias,
flaccid paralysis, intestinal
colic, dec BP, inc gastric
motility, hyperactive bowel
sounds, diarrhea
EKG: tall peaked T waves,
flat P waves, widened QRS,
prolonged PR interval
Treatment: administer
10-20% glucose with
regular insulin, administer
Kayexalate-promote
sodium absorption/K
excretion; D/C IV K
infusions, diuretics, avoid
foods high in K

Cause: dec excretioncorticosteroids, cushings

syndrome, renal failure,
hyperaldosteronism; inc
oral intake; dec water
intake- NPO; inc water lossinc rate of metabolism,
fever, hyperventilation,
infection, excessive
diaphoresis, watery
diarrhea, DI; hypertonic

s/s: anorexia, n/v,

weakness, lethargy,
confusion, muscle
cramps, twitching, dec
DTRs, seizures,
hyperactive bowel
sounds, inc urinary
output, dry mucous
membranes, dec urinary
specific gravity <1.016

tube feedings; heat stroke

treatment: administer
IV saline infusions, inc
oral intake

treatment: administer
D5W, restrict sodium in
diet, monitorcardiovascular, respiratory,
neuromuscular, cerebral,
renal, and integumentary
status.

CAUTION: causes dec

Lithium excretion
resulting in Lithium
toxicity.

Calcium

NOTE: a dec
in Calcium =
inc
phosphorus

8.6 - 10

Cheese,
collard greens,
milk, sardines,
spinach, tofu,
yogurt

Causes: renal failure,

alkalosis,
hypoparathyroidism,
lactose intolerance,
pancreatitis,
malabsorption- Crohns
disease, inadequate Vit D
intake, diarrhea, GI
wound drainage,
hyperphosphetemia,
immobility
s/s: diarrhea,
numbness, , tingling
extremities, dec
peripheral pulses,
convulsions, bradycardia,
+ Chevosteks &
Trousseaus sign, tetany,
twitches, cramps,
hyperactive DTRs, nc
gastric motility,
hyperactive bowel
sounds; magnesium level
<1.6
EKG: prolonged ST & QT
interval
Treatment: administer
calcium supplements Po

s/s: thirst, hyperpyrexia,

sticky mucous membranes,
dry mouth, hallucinations,
lethargy, irritability,
siezures, pulmonary
edema, absent DTRs, dec
urinary output, inc urinary
specific gravity > 1.022

Causes: excess calcium/Vit

D supplements, malignant
bone disease,
hyperparathyroidism,
prolonged immobilization,
renal disease, thiazide
diuretics, hyperthyroidism,
dehydration,
glucocorticosteroids, use of
lithium
s/s:
tachycardia/bradycardia,
anorexia, n/v, muscle
weakness, constipation,
polyuria, polydipsia,
neurosis, dysrhythmias,
absent DTRs, flank painformation of renal calculi,
hypoactive bowel sounds,
dec gastric motility
EKG: shortened ST
segment, widened T wave
Treatment: administer
calcitonin, D/C IV calcium &
thiazide diuretics, avoid
calcium based antacids,
diuretics, strain the urine
for presence of urinary

Magnesiu
m

1.6
2.6

Avocado,
cauliflower,
green leafy
vegetables,
milk, oatmeal,
peas, canned
white tuna,
legumes, fish

IM
magnesium
injections
cause pain &
tissue
damage

stones, renal dialysis, avoid

foods high in calcium

Causes: alcoholism,
DKA, malabsorption,
prolonged gastric suction,
vomiting, diarrhea,
celiac/Crohns disease,
diuretics, sepsis,
hyperglycemia, insulin
administration

Causes: renal failure,

adrenal insufficiency,
excess replacement,
laxatives

s/s: anorexia, distention,

irritability, depression,
disorientation,
tachycardia, HTN,
twitches, hyperactive
DTRs, +
Chvosteks/Trousseaus,
EKG: tall T waves,
depressed ST segment

PO
magnesium
preparations
can cause
diarrhea and
increase loss

Phosphor
us

30 min before meals,

calcium IV slowlyinfiltration can cause
tissue necrosis, inc
calcium intake, aluminum
hydroxide dec
phosphorus/ inc calcium
levels, initiate seizure
precautions, 10%
calcium gluconate for
acute calcium deficit

Treatment: administer
Magnesium sulfate IV,
initiate seizure
precautions, monitor
DTRs, encourage foods
high in magnesium

2.7
4.5

Fish, organ
meats, nuts,
whole-grain
breads and
cereals, pork,
beef, chicken

Causes: refeeding after

starvation, alcohol
withdrawal, DKA,
respiratory alkalosis,
hyperparathyroidism- inc
phosphorus excretion,
use of magnesium-based
or aluminum hydroxidebased antacids,
hyperglycemia
s/s: paresthesias, muscle

s/s: flushing, hypotension,

drowsiness, lethargy,
hypoactive reflexes,
depressed respirations,
bradycardia, absent DTRs,
EKG: prolonged PR
interval, widened QRS
Treatment: avoid
magnesium-based
antacids/laxatives, restrict
foods high in magnesium,
diuretics, Calcium
gluconate to reverse the
effects of magnesium on
the heart (antidote for
magnesium overdose),
restrict foods high in
magnesium

Causes: renal failure,

excess intake of
phosphorus, tumor lysis
syndrome, overuse of
phosphate-containing
laxatives or enemas,
hypoparathyroidism
s/s: short term tetany,
diarrhea, numbness, ,
tingling extremities, dec
peripheral pulses,

NOTE: inc
phosphorus
= dec
calcium

weakness, muscle pain,

mental changes,
cardiomyopathy,
respiratory failure, dec
contractility, dec cardiac
output, slowed peripheral
pulses, dec DTRs,
irritability, confusion, dec
platelet aggregation, inc
bleeding,
immunosuppression
treatment: administer
PO phosphates with Vit
D.; administer IV
phosphorus when levels
fall <1 /g/dl; assess renal
function before
administering, encourage
foods high in phosphorus

Calcium =

phosphorus

convulsions, bradycardia,
+ Chevosteks &
Trousseaus sign, tetany,
twitches, cramps,
hyperactive DTRs, nc
gastric motility,
hyperactive bowel sounds;
Treatment: administer
aluminum hydroxide with
meals to bind phosphorus,
restrict foods high in
phosphorus & phosphatebased laxatives and
enemas.

( & vise versa)