Electrolyte imbalance, S&S

[jothomas]

I am trying to find a way to remember the signs and symptoms of the electrolyte imbalnce. Different books says diff things and my insturctor says somethingelse. Is there a cheat sheet (may be based on etiology)for this? I co-relate:

Sodium to fluid;

potassium to heart;

calcium to muscle;

Am I right? Not sure about the rest. Then there is hypo and hyper, very confusing.

Thanks in advance for any help.

[Daytonite, BSN, RN]

They are very confusing. I had a very difficult time with them. In fact, when I was working toward getting my national certification in IV therapy many years ago it was the electrolytes part of the exam that was the problem for me and I failed the test by 2 points the first time I took it and it was in the electrolytes portion that I bombed.

There are 6 major electrolytes. Sodium, potassium, calcium, chloride, magnesium and phosphorus. It is primarily potassium, calcium and sodium that will cause problems when they are out of whack. Rather than listing the signs and symptoms of too much or too little potassium, I'd go by the medical conditions which are:

• hypokalemia
  
• hyperkalemia
  
• hypocalcemia
  
• hypercalcemia
  
• hyponatremia
  
• hypernatremia
  

I know you said those were confusing, but when someone posts questions about an electrolyte problem this is how I find the information in my medical disease references here at home. All of the 6 electrolytes are listed in my disease reference by the hypo- and hyper- names along with the pathophysiology, causes, signs and symptoms and complications. When you start comparing them is when you start to see similarities and get confused. Like diseases, you have to consider each one individually and as its own entity. Because they are so closely the same, there will be subtle similarities when you try to compare the signs and symptoms, so don't do that.

I think you did make some good generalities though. Sodium does affect fluid. In fact, they say sodium always follows water. You will see a lot of people with edema related hypernatremia; and you will see a lot of dehydration related to sodium and chloride losses. Potassium tends to affect the heart and in the clinical area you will see dramatic instances of people with hypokalemia and hyperkalemia. Calcium affects the muscles and is not as commonly seen clinically because it is detected because of lab testing.

• Sodium - body water balance
  
• Potassium - contraction of skeletal and smooth muscle and nerve impulse conduction
  
• Calcium - formation and structure of bones and teeth, cell structure and function, cell membrane permeability and impulse transmission, the contraction of all muscle types and is necessary in the blood clotting process
  
• Chloride - important in the digestive acids; closely linked to sodium
  
• Magnesium - affects nerve and muscle action by affecting calcium usage, activates enzymes involved in carbohydrate and protein metabolism, helps in the transport of sodium and potassium across cell membranes, and influences the levels of sodium, potassium, calcium and some body hormones (parathyroid hormone)
  
• Phosphorus - formation and structure of bones and teeth, this electrolyte is needed in the following activities: utilization of B vitamins, acid base homeostasis, bone formation, nerve and muscle activity, cell division, the transmission of hereditary traits, metabolism of carbohydrates, proteins and fats
  

[jothomas]

Thank you so..... much Daytonite. The information was very helpful. But as you mentioned, it get confused when you try to compare them. Hopefully, I get a hold of it, once I finish my med surg class.

[HersNurse2B]

Jothomas,

Electrolytes is a topic I struggle with as well. I don't know if you've taken a look at it yet, but my pharm instructor strongly recommended a book to help understand it better. It's "Fluids and Electrolytes Made Incredibly Easy". I found an older, slightly used edition on Amazon for about $10...fyi. I just got it in the mail a week ago and haven't had a chance to look at it yet, but that will be some "light reading" for me to do this summer. LOL. Maybe go to B&N and flip through it. That's my (2 cents). :)

Hope that helps.

[nminodob]

I too was very confused, and basically memorized as much as I could for exams - but the 2 very broad things I remember are : When there is a sodium imbalance quite often there will be changes in mental status - confusion, delirium, etc. Often seen with traumatic brain injury where diabetes insipidus (pathological voiding of large amounts of dilute urine) and its opposite SIADH (syndrome of inappropriate antidiuretic hormone - minimal urine output but very concentrated) may occur. Sodium imbalances are also seen with dehydration in some patients (elderly, burn victims, many others) and the blood levels will go up. Very rarely, sodium levels in the blood will go down because of consuming large quantities of fluids.

The other main electrolyte imbalance seen is when potassium is out of whack, and its most serious consequence is cardiac problems that can be life-threatening (you will see T wave changes: depression with hypokalemia, elevation with hyperkalemia, among other changes in the EKG like QRS interval changes).

So for these 2 main electrolyte imbalances I always remember: Sodium equals mentation, and Potassium equals cardiac. Also, I remember Potassium is used in death sentence cases where they adminsiter a lethal injection of Potassium to stop the heart! Hang in there, you will get better at it - and try to think in broad terms because there is no way you can just remember a bunch of unrelated facts.

[fredrick90005]

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[fredrick90005]

This is exactly what im doing...right now..this minute. Daytonite is right DO NOT COMPARE the S/S for each or else you will get confuse. This is how i did it. First try understand what they regulate and then associate the S/S. For example:

Sodium: water balance, nerve impulse transmission, regulation of acid-base balance and participation in cellular chemical reactions.

Hyponatremia

S/S: nerve impulse transmission : convulsion, coma, personality change

water balance: vomiting, nausea, diarrhea

Hypernatremia (think of it as dehydration)

S/S: water balance: dry, flushed skin; extreme thirst; dry mucous membranes

Nerve impulses: convulsion, agitaion, irritability

and So on.....hope it helps

[snaz101]

Hey I am currently in a ABSN program in MED.Surg. and we are working on this unit and I really found these comments helpful

Thanks so much!