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N112 Electrolytes
N112 - Potassium & Sodium
| Question | Answer |
|---|---|
| What is the dominant intracellular fluid electrolyte? | Potassium is the primary buffer in the cell. Normal serum K+ is 3.5-5.0 mEq/L, serum levels of K+ are low because bulk of K+ is in the cells. |
| How is potassium secreted? | If H+ is greater than K+, the kidney tubules will secrete H+ instead of K+. |
| What will increased potassium levels do? | Increased potassium levels stimulate aldosterone release from the adrenal gland, which promotes retention of sodium & excretion of potassium. |
| What influences the movement of potassium? | The movement of potassium is influenced by changes in pH, insulin, adrenal hormones & changes in serum sodium. |
| If the potassium balances changes, what happens? | Changes in K+ means that cells will fire excessively with little stimulation or cells will barely respond to stimulation. K+ changes the contractility of muscles especially the heart. |
| What are the functions of potassium? | Potassium functions include: the ability of nerve & muscle cells to fire, cardiac impulse conduction & muscle contractility, acid-base balances, activation of enzyme actions, influencing kidney function. |
| What is hypokalemia? | Hypokalemia is low serum potassium, <3.5 mEq/L. |
| What are some causes of hypokalemia? | Excessive fluid loss from diarrhea, vomiting, NG suction, diuretic drugs (esp. Lasix), loss of K+ in urine, heart failure - retention of H2O & Na+, IV insulin & glucose, insulin pulls K+ into cells. |
| What can decreased serum potassium cause? | Generalized muscle weakness, cardiac dysrhythmias, enhanced effects of digitalis, abdominal pain, N/V, metabolic alkalosis - high pH, body saving H+ & excreting K+. |
| What cardiac changes can be seen with low serum potassium? | Forceful contractions, weak pulse, digitalis toxicity - low K+ makes the heart muscle more sensitive to the action of digitalis. |
| What is the treatment for hypokalemia? | Oral or intravenous administration of K+, do not use if urine output is insufficient, must have adequate kidney function. |
| What is hyperkalemia? | High serum potassium >5.0 mEq/L. |
| What can cause hyperkalemia? | Decreased excretion of K+ by kidneys, decreased urine output, excessive administration of K+, intestinal obstruction, insulin deficit, hemorrhagic shock, hemolysis of RBC, extensive surgery, infection. |
| What are the symptoms of hyperkalemia? | Fatal dysrhthmias, cardiac arrest, hypotension, generalized muscle weakness, numbness, tingling |
| What cardiac changes can be seen with elevated potassium? | Sluggish, flaccid myocardial muscle action, bradycardia, ventrical fibrillation. |
| How do you treat hyperkalemia? | Calcium to counteract the effect of K+ on the heart muscle, sodium bicarbonate to alkalinize body fluids, Kayexelate by mouth or enema - pulls K+ & water into intestines, small dose of insulin & 50% glucose IV to aid transfer of glucose & K+ into cells. |
| What is the dominant electrolyte in extracellular fluid? | Sodium, normal serum sodium levels are 135-145 mEq/L. |
| How is sodium related to acid-base balance? | Sodium & potassium exchange with hydrogen in the kidney tubule to maintain electrolyte & acid base balance. |
| What is hyponatremia? | Hyponatremia means a serum sodium level below normal. |
| What can cause hyponatremia? | Excess intake of water or forcing hypotonic fluids, kidney failure, retention of water, excess tap water enemas, excess IV fluids of dextrose in water. |
| True hyponatremia is caused by | Poor salt intake, diuretic drugs which cause Na+ loss, burns, wounds, or wound drainage, cystic fibrosis, adrenal insufficiency, kidney disease, excessive GI loss |
| What are neurological symptoms of hyponatremia? | Reduced Na+ and excess of water reflect failure of swollen cells to transmit electrical impulses, neurological symptoms are due to cerebral edema and altered nerve conduction, mental confusion, headache, tremors, seizures. |
| What are other symptoms of hyponatremia? | Hypotension, tachycardia, cold, clammy skin, decreased skin turgor, dry mucous membranes, weight loss |
| What is the treatment for hyponatremia? | Treat the cause first, restrict oral & intravenous water intake, increase dietary sodium, change IV fluids to normal saline. |
| What is hypernatremia? | Too much sodium in relation to the amount of water. This imbalance represents a gain of sodium without water loss. |
| What are causes of hypernatremia? | Decreased water intake, excessive water loss without sodium loss through burns, sweating, mechanical ventilation & polyuria. Failure of the kidney to reabsorb water. |
| Symptoms of hypernatremia | Intense thirst, dry sticky mucous membranes, flushed, dry skin, poor skin turgor, olguria, low grade fever. Symptoms are similar to dehydration with the exception of neurological symptoms. |
Created by:
jrb265
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