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    electrolytes imbalance

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    Download as pptx, pdf, or txt
    2 views48 pages

    electrolytes imbalance

    Uploaded by

    safebox694

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 48

    DR MADIHA SOBAN

    Assistant Professor
    Biochemistry
    Learning objectives
    • Discuss electrolytes composition in the body
    • Discuss the sources,absorption,excretion &
    functions of :
    • Sodium
    • Potassium
    • Magnesium
    • Explain disorders related to these electrolytes
    Electrolytes Composition in body
    Sodium

    • Normal range – 135 to 145 mEq/L


    • Chief regulator of ECF volume
    • Found associated with NaCl & NaHCO3
    • A loss or gain of sodium is usually accompanied by a
    loss or gain of water
    Sources of Sodium

    • Table salt (main source)


    • Cheese
    • Butter
    Absorption of Sodium

    Two mechanisms:
    1. By freely permeable:
    across intestinal tissues

    2. By symport mechanism:
    with glucose and amino
    acids
    Inhibitors of Na-K Pump

    Ouabain:
    • A glycoside of steroid and digitalis causes inhibition
    by blocking the step of dephosphorylation

    Vanadate:
    • Inhibits the pump when present inside the cell
    Excretion of Sodium

    • Approximately,25000 mmol of
    Na is filtered by the kidneys in
    24 hours

    • Due to tubular reabsorption,


    less than 1 percent of sodium
    is released in the urine
    Functions of Sodium

    • Takes part in:

    • Fluid Balance
    • Neuromuscular excitability
    • Acid base balance
    • Maintenance of viscosity of blood
    • Resting membrane potential
    • Action potential
    Clinical Aspects of Sodium

    Clinical conditions are of two major types:

    I. Hyponatremia
    II. Hypernatremia
    HYPONA TREMIA

    Sodium level less


    than 135 mEq/L
    Causes of Hyponatremia
    Vomiting Diarrhea

    Excessive
    Sweating
    Causes of Hyponatremia
    Kidney Congestive Cardiac
    diseases Failure

    Diuretics
    Clinical Manifestations of
    Hyponatremia
    Dry
    mucosa

    Poor
    Anorexia skin
    turgor
    Headache

    Confusion Lethargy
    Clinical Interventions
    • Assess clinical manifestations
    • Monitor fluid intake and output, vital signs and lab
    data
    • Encourage food and fluids high in Na
    • Limit water intake
    HYPERNA TREMIA

    Sodium level more


    than 145 mEq/L
    Causes of Hypernatremia

    Dehydration
    Causes of Hypernatremia

    Osmotic Excessive Na
    Overloading Intake

    Conns Syndrome
    Clinical Manifestations of
    Hypernatremia
    Extreme
    Thirst

    Sticky
    Confusion mucous
    membrane
    Lethargy

    Flushed Swollen
    skin tongue
    Clinical interventions

    • Monitor behavioural changes


    • Monitor lab findings
    • Encourage fluids
    • Monitor diet as ordered(salt restriction)
    Vital Signs in Na Imbalance
    Vital Signs Hyponatremia Hypernatremia
    Blood Pressure Decreased, Elevated, orthostatic
    orthostatic Hypotension,
    Hypertension, Or normal
    Or normal to elevated

    Heart Rate Increased Increased


    Respiratory Rate Decreased Severely decreased,
    respiratory arrest can
    occur

    Temperature Normal Elevated


    Potassium
    • Normal range – 3.5 to 5.5 mEq/L
    • Major Intracellular electrolyte
    • 98% of the body’s potassium is inside the cells
    Sources of Potassium
    • Widely distributed in vegetables & fruits.
    • Average 4 g of potassium is present in the diet.
    Absorption & Excretion of
    Potassium
    • Potassium is easily absorbed by passive diffusion from
    GIT
    • The amount of potassium in the body depends on the
    balance between its intake & output
    • Potassium is excreted in urine, skin, saliva,GIT, bile &
    pancreatic juice
    Absorption & Excretion of
    Potassium
    Functions of Potassium

    • Takes part in :

    • Muscular Activity
    • Acid base balance
    • Cardiac functions
    • As cofactor for enzyme Pyruvate kinase
    • Nerve conduction process
    Clinical Aspects of Potassium

    Clinical conditions are of two major types:

    I. Hypokalemia
    II. Hyperkalemia
    HYPOKALEMIA

    Potassium level less


    than 3.5 mEq/L
    Clinical interventions
    • Monitor heart rate and rhythm
    • Monitor clients receiving DIGITALIS
    • Administer oral K+ as ordered with food /fluids
    • Administer IV K+ as ordered ,flow rate not more
    than 10-20 meq/hr
    • Teach patients about potassium rich diet and to
    reduce potassium wastage
    HYPERKALEMIA

    Potassium level more


    than 5.5 mEq/L
    Clinical interventions
    • Monitor ECG changes – telemetry

    • Administer Calcium solutions


    to neutralize the potassium
    • Monitor muscle tone

    • Give Kayexelate

    • Give Insulin and D50W


    Magnesium
    • Normal serum magnesium level is
    1.5 to 2.4 mEq/L

    • Have a direct effect on peripheral


    arteries & arterioles
    Sources of Magnesium

    Nuts & Legumes Green leafy vegetables


    Functions of Magnesium
    • It takes part in:
    • Muscle and nerve function
    • Regulation of blood sugar levels &
    • Blood pressure
    • Making protein, bone, and DNA

    magnesium

    #
    HYPOMAGNESEMIA

    magnesium level
    less than 1.5
    mEq/L
    Causes of Hypomagnesemia
    • Chronic Alcoholism
    • Diarrhea, or any disruption in small
    bowel function
    • Diabetic ketoacidosis
    • TPN
    Clinical manifestations
    • Neuromuscular irritability
    • Positive Chvostek’s and Trousseau’s sign
    • EKG changes with prolonged QRS,
    depressed ST segment
    • Cardiac dysrhythmias
    • May occur with hypocalcemia and
    hypokalemia
    Clinical interventions

    • IV/PO Magnesium replacement,


    including Magnesium Sulfate
    • Give Calcium Gluconate if
    accompanied by hypocalcemia
    • Monitor for dysphagia, give soft foods
    • Measure vital signs closely
    HYPERMA GNESEMI A

    magnesium
    level more than 2.4
    mEq/L
    Causes of Hypermagnesemia
    • Renal failure
    • Untreated diabetic ketoacidosis
    • Excessive use of antacids and laxatives
    Clinical manifestations

    • Flushed face and skin warmth


    • Mild hypotension
    • Heart block and cardiac arrest
    • Muscle weakness and even
    paralysis
    Clinical interventions

    • Monitor Mg levels
    • Monitor respiratory rate
    • Monitor cardiac rhythm
    • Increase fluids
    • IV calcium for emergencies
    #

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