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Electrolytes Abnormal


Presentation

  • No lower extremity edema is present. Neurologic examination reveals no focal deficits.[musculoskeletalkey.com]
  • Fever may be present without local signs. Clotting of the vascular access presents as loss of normal bruit or palpable thrill. There may be signs or symptoms of distal limb ischemia.[emedicine.medscape.com]
  • Conclusion Given the clinical presentation, this patient likely presented on the brink of developing frank refeeding syndrome, with cardiac dysfunction and hypovolemia, leading to hepatic hypoperfusion and ischemic hepatitis.[nutritionj.biomedcentral.com]
  • In the present series, serum chloride and bicarbonate had normal mean values in cirrhosis. Liver is involved in the regulation of renal sodium excretion.[jpma.org.pk]
Nocturnal Leg Cramp
  • A few years ago, researchers in the United Kingdom found that 300 mg of supplemental magnesium reduced nighttime or nocturnal leg cramps in individuals who suffered chronic leg cramps.[eletewater.co.uk]
Prolonged Immobilization
  • immobilization, excessive calcium intake, thiazide diuretics muscle weakness, constipation, anorexia, N/V, renal calculi, fatigue, altered LOC, strange behavior, bradycardia decrease dietary calcium intake, increase fluid and fiber intake, monitor serum[quizlet.com]
Muscle Weakness
  • , oliguria, increased temp & pulse, flushed skin, confusion. sodium restriction, increase water intake, monitor I&O, LOC and serum sodium level fatigue, muscle weakness & leg cramps, respiratory insufficiency, decreased GI motility, cardiac arrhythmia[quizlet.com]
  • Hypermagnesemia is characterized by: lethargy hypotension decreased heart and respiratory rate muscle weakness diminished tendon reflexes HYPOMAGNESEMIA.[medical-dictionary.thefreedictionary.com]
  • weakness, Chvostek, and Trousseau signs Electrocardiogram (ECG) – widening QRS or QT and peaked T waves, premature ventricular contractions Etiologies Gastrointestinal losses – diarrhea, small bowel surgery, malabsorption, pancreatitis Renal losses –[arupconsult.com]
  • Common clinical features of hypokalaemia range from muscle weakness and ileus (lack of peristalsis), to serious cardiac arrhythmias such as ventricular tachycardias.[ausmed.com]
  • Low sodium may lead to dizziness, muscle weakness or even seizures in extreme cases, according to Merck.[livestrong.com]
Muscle Twitch
  • twitching, abdominal cramps, elevated BP and HR, hyponatremia side effects of hypervolemia _________ for overhydration increases excretion of water and sodium restore normal fluid balance, prevent further overload drug therapy- diuretics diet therapy[quizlet.com]
  • Symptoms of hypernatremia include: thirst orthostatic hypotension dry mouth and mucous membranes dark, concentrated urine loss of elasticity in the skin irregular heartbeat (tachycardia) irritability fatigue lethargy heavy, labored breathing muscle twitching[medical-dictionary.thefreedictionary.com]
  • Monitoring how much sodium you consume helps keep symptoms at bay, including bloating, lethargy, dehydration, weakness, irritability and muscle twitching. Drinking water and eating mostly whole foods (not the kinds that come in packages!)[draxe.com]
Knee Pain
  • Upon further questioning, she had been taking high-dose NSAIDs for her chronic knee pain. Her renal function improved mildly by withholding NSAIDs, and she was discharged with appropriate nephrology follow-up.[the-hospitalist.org]
Confusion
  • […] spaces decreased HgB, decreased Hct, decreased serum osmolarity, decreased glucose, decreased protein, decreased electrolytes laboratory assessment hypervolemia excess water is retained and other substances remain unchanged resulting in ___________ confusion[quizlet.com]
  • Her daughter states that she has been mildly confused over the past 2 days. She reports that her primary-care physician prescribed hydrochlorothiazide for elevated BP 2 weeks ago.[clinicalgate.com]
  • Other electrolyte disorders cause confusion, weakness, cramping, and muscle spasms. Some can cause difficulty breathing, dizziness, and a rapid heart rate.[nyulangone.org]
  • Clinical features of hypernatraemia may include fever, irritability, drowsiness, irritability, lethargy and confusion.[ausmed.com]
Dizziness
  • Low calcium may also result in numbness in the extremities as well as confusion and dizziness.[livestrong.com]
  • The doctor asks if your child has been ill recently and whether he or she has had any unusual symptoms, such as muscle cramps, dizziness, rapid heart rate, or confusion.[nyulangone.org]
  • Confusion, Dizziness and Irritability : When your sodium levels rise too drastically (called hypernatremia), you can become dizzy and weak. When this worsens, it’s possible to become even more delirious and even experience a seizure or coma.[draxe.com]
  • If left untreated, electrolyte imbalance can lead to dizziness, cramps, irregular heartbeat, and possibly death.[labtestsonline.org.uk]
Paresthesia
  • Vitamin D deficiency, end stage renal disease diarrhea, paresthesia of extremities, laryngeal spasm, muscle spasms in calf or foot during sleep or rest, tetany, convulsions, positive Trousseau's and Chvotek's signs Heart rate and EKG changes, osteoporosis[quizlet.com]
  • Patients with significant deficiency may complain of muscle cramps, tetany, and paresthesias of the lips and extremities. Severe hypocalcemia may cause lethargy, confusion, laryngospasm, or seizures.[musculoskeletalkey.com]
  • […] inflating blood pressure cuff on arm for 3 minutes to systolic blood pressure will cause spasm of hand Chvostek sign – tapping on facial nerve near temporal mandibular joint will cause grimace and spasm of facial muscles Seizures Circumoral numbness Paresthesias[arupconsult.com]
  • Neuromuscular irritability is seen with hypocalcemia and may present as tetany or paresthesia. Hypermagnesemia causes neuromuscular depression with weakness and loss of reflexes.[emedicine.medscape.com]
  • Hypercalcemia is characterized with thirst, renal stones, anorexia, paresthesia, urinary frequency, bone pain, muscular weakness, confusion, abdominal pain, depression, fatigue, lethargy, constipation, nausea and vomiting.[registerednursing.org]
Altered Mental Status
  • mental status, and (3) iatrogenic causes such as administration of hypertonic saline.[musculoskeletalkey.com]
  • mental status increase dietary potassium, administer potassium, supplement (IV & PO) - potassium chloride, monitor I&O and serum potassium level, may place patient on telemetry.[quizlet.com]
  • Hypernatremia may cause neurologic symptoms such as altered mental status, weakness, irritability, focal neurologic deficits, and even coma or seizures.[circ.ahajournals.org]
Flaccid Paralysis
  • Monitor IV site hourly cardiac changes are most severe problems and most common cause of death in these clients paresthesia, muscle weakness, flaccid paralysis, dysrhythmias, N/V, watery diarrhea decrease dietary potassium, discontinue potassium containing[quizlet.com]
  • Severe hypokalemia can lead to flaccid paralysis, respiratory failure, arrhythmias, rhabdomyolysis, and nephrogenic DI. Dx The source of potassium loss is very often evident upon careful history.[musculoskeletalkey.com]

Workup

  • . • TSH and cortisol levels can exclude hypothyroidism and adrenal insufficiency, respectively, as causes of hyponatremia. 24, 23 • In potassium disorders, determination of acid-base status can aid in the workup. • Radiologic tests (e.g., chest radiograph[clinicalgate.com]
Albuminuria
  • […] to renal causes of the normal anion gap metabolic acidosis, whereas a negative UAG points to extrarenal causes such as bicarbonate losses in the GI tract. 9 Additional considerations Urine studies can also be useful for assessment of proteinuria and albuminuria[the-hospitalist.org]
Thrombocytosis
  • Pseudohyperkalemia secondary to thrombocytosis, erythrocytosis, or activated platelets should be considered and evaluated.[the-hospitalist.org]
  • Pseudo-hyperkalemia is a factitious elevation of serum potassium often seen in patients with hemolysis, thrombocytosis (platelet count 1 million/μL), or leukocytosis (WBC count over 100,000/μL).[musculoskeletalkey.com]
Erythrocytosis
  • Pseudohyperkalemia secondary to thrombocytosis, erythrocytosis, or activated platelets should be considered and evaluated.[the-hospitalist.org]
Wide QRS Complex
  • The ECG below shows large T waves and wide QRS complex. The tracing shows a wide QRS and very large T waves.[emedicine.medscape.com]
Prominent U Wave
  • Electrocardiographic (ECG) changes can occur and include flattening or inversion of T waves, prominent U waves, and ST-segment depression and arrhythmias.[musculoskeletalkey.com]
  • EKG changes can include increased amplitude and width of P wave, T wave flattening and inversion, prominent U waves and apparent long QT intervals due to merging of the T and U wave. The U-wave is a deflection following the T wave.[cdemcurriculum.com]

Treatment

  • Tx The goals of treatment are (1) to stop ongoing loss of water and (2) to replace the water deficit.[musculoskeletalkey.com]
  • Since these disorders are accompanied by significant morbidity and mortality, appropriate diagnosis and treatment are essential.[clinicalgate.com]
  • Currently the goal of treatment is to return her hormone levels to normal. This is done by taking a form of cortisol every day. I hope that your child and you will avoid facing yourself with this.[steadyhealth.com]
  • Treatment of Hyperkalemia The treatment of hyperkalemia is determined by its severity and the patient’s clinical condition.[circ.ahajournals.org]
  • Electrolyte abnormalities may also be a consequence of drug treatment. Knowing which electrolytes are out of balance can help your doctor determine the cause and treatment to restore proper balance.[labtestsonline.org.uk]

Prognosis

  • In general, the short-term prognosis for seizure control and neurologic recovery is related to the correction of the specific metabolic derangements; the long-term prognosis depends on correction of the underlying condition.[epilepsy.com]
  • Prognosis A patient's long-term prognosis depends upon the root cause of the electrolyte disorder. However, when treated quickly and appropriately, electrolyte imbalances in and of themselves are usually effectively reversed.[medical-dictionary.thefreedictionary.com]
  • ., borderline, narcissistic, and antisocial disorders) have a worse prognosis. Although most bulimics purge by vomiting, abuse of laxatives or diuretics also occurs.[aafp.org]
  • Hence electrolytes should be repeatedly done in patients with decompensated liver disease and hypokalaemia should be corrected immediately which may improve the prognosis. References 1.[jpma.org.pk]

Etiology

  • Overall, the FENa and FEUrea can be helpful to determine the etiology of AKI, but only in certain clinical scenarios.[the-hospitalist.org]
  • Once the specific electrolyte abnormality has been diagnosed, additional tests can be done to aid in determining the etiology. • TSH and cortisol levels can exclude hypothyroidism and adrenal insufficiency, respectively, as causes of hyponatremia. 24,[clinicalgate.com]
  • […] hand Chvostek sign – tapping on facial nerve near temporal mandibular joint will cause grimace and spasm of facial muscles Seizures Circumoral numbness Paresthesias Carpopedal spasm Electrocardiogram (ECG) – prolonged QT interval, Torsades de Pointes Etiologies[arupconsult.com]
  • Dx In most cases the etiology of the hypernatremia can be determined based on history and physical. Laboratory tests such as urine osmolality, urine sodium concentration, and blood glucose can provide further diagnostic clues.[musculoskeletalkey.com]
  • Calcium Hypercalcaemia Etiology of hypercalcaemia Primary hyperparathyroidism and malignancies cause 90% of all cases of hypercalcaemia.[ecgwaves.com]

Epidemiology

  • Hyponatremia: Study of its epidemiology and mortality. Rev Hosp Clin Fac Med 1989; 44: 307-311. Singhi S, Murudkar A. Hypokalemia in a pediatric intensive care unit. Indian Pediatr 1996; 33: 9-14. Singhi S, Dhawan A.[indianpediatrics.net]
  • Epidemiology, pathophysiology, and management of hyponatremic encephalopathy. Am J Med . 1997 ; 102 : 67 –77. Laureno R, Karp BI. Myelinolysis after correction of hyponatremia. Ann Intern Med . 1997 ; 126 : 57 –62.[circ.ahajournals.org]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of electrolyte abnormalities in this patient group is briefly reviewed.[ncbi.nlm.nih.gov]
  • In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills for fluis and electrolyte imbalances in order to: Identify signs and symptoms of client fluid and/or electrolyte imbalance Apply knowledge of pathophysiology[registerednursing.org]
  • Hyponatremia is common even though the kidneys may avidly retain sodium (see Ascites : Pathophysiology ); it usually occurs with advanced hepatocellular disease and is difficult to correct.[msdmanuals.com]
  • The pathophysiology of takotsubo cardiomyopathy remains to be elucidated but is thought to involve catecholamine excess leading to myocardial stunning.[nutritionj.biomedcentral.com]
  • The improvements in surviv al have been attributed, among other things, to a better understanding of the pathophysiological nature of thermal injuries.[medbc.com]

Prevention

  • […] unchanged resulting in ___________ confusion, headache, muscle twitching, abdominal cramps, elevated BP and HR, hyponatremia side effects of hypervolemia _________ for overhydration increases excretion of water and sodium restore normal fluid balance, prevent[quizlet.com]
  • The initial treatment is aimed at stabilizing the cardiac cell membrane to prevent cardiac death by giving intravenous calcium gluconate.[musculoskeletalkey.com]
  • Low levels of any of these minerals can allow the muscle to contract, but prevent it from relaxing.[eletewater.co.uk]
  • The nurse can then prevent serous clinical complications from occurring. Prevention is a prime nursing responsibility when caring for a patient with cardiovascular disease.[nurseslearning.com]
  • Following a well-balanced diet can also help prevent cardiac arrhythmias.[healthyeating.sfgate.com]

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