Electrolyte Imbalances and Their Effects

Introduction

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Potassium (K⁺)

Hyperkalemia (High Potassium)

• Levels: Above 5.0
• Cardiac:
  • Tight and contracted
  • Hyper heart: ST elevation, peaked T-waves, wide QRS
  • Severe: V-fib, cardiac standstill
  • Hypotension (low BP), bradycardia
• GI:
  • Tight and contracted
  • Diarrhea, hyperactive bowel sounds
• Neuromuscular:
  • Tight and contracted
  • Paralysis in extremities, paresthesia (numbness)
  • Increased DTRs (deep tendon reflexes), profound muscle weakness
• Test Tip: Words like “profound” and “severe” indicate priority patients

Hypokalemia (Low Potassium)

• Levels: Below 3.5 (notable below 3.0)
• Cardiac:
  • Low and slow
  • Flat T-waves, ST depression, prominent U-waves
• Muscular:
  • Low and slow
  • Decreased DTRs, paralysis of limbs
• GI:
  • Low and slow
  • Decreased motility, hypoactive bowel sounds, constipation, abdominal distension, paralytic ileus (risk for SBO)
• Test Tip: Both hyper and hypokalemia can cause confusion, weakness, and respiratory failure

Sodium (Na⁺)

Functions:

• Maintain blood pressure, blood volume, and pH balance

Hypernatremia (High Sodium)

• Appearance: Big and bloated, flushed, red, rosy cheeks, edema (Santa Claus appearance), low-grade fever
• Symptoms: Polydipsia (excessive thirst)
• Severe Signs:
  • Swollen dry tongue
  • Nausea, vomiting
  • Increased muscle tone
  • Important for tests

Hyponatremia (Low Sodium)

• Causes: Due to fluid imbalance
• Top 3 Priorities:
  • Neuro: seizures, coma
  • Heart: tachycardia, weak thready pulses
  • Respiratory arrest
• Symptoms: Neurological deficits (restlessness, fatigue), abdominal cramping

Chloride (Cl⁻)

Functions

• Mimics sodium: maintains blood volume, blood pressure, pH

Hyperchloremia

• Symptoms: Nausea, vomiting, swollen dry tongue, confusion

Hypochloremia

• Symptoms: Excessive diarrhea, vomiting, sweating, fever

Magnesium (Mg²⁺)

Functions

• Maintains muscle function, calming effect on heart, uterus, DTRs
• Required for calcium and Vitamin D absorption

Hypermagnesemia

• Organs: Calm and quiet
  • Heart: Heart blocks, prolonged PR intervals, bradycardia, hypotension
  • DTRs: Hyporeflexia
  • Lungs: Depressed, shallow respirations
  • GI: Hypoactive bowel sounds

Hypomagnesemia

• Organs: Buck wild
  • Heart: Torsades de Pointes, V-fib, tachycardia
  • EKG: ST depression, T-wave inversion
  • DTRs: Hyperreflexia
  • Eyes: Nystagmus
  • GI: Diarrhea
• Common Symptoms: Neurological confusion, irritability, shallow respiration

Calcium (Ca²⁺)

Functions

• Maintains bones, blood clotting, and heartbeats strong

Hypercalcemia (High Calcium)

• Appearance: Swollen, slow
  • Symptoms: Constipation, bone pain, kidney stones, decreased DTRs, severe muscle weakness

Hypocalcemia (Low Calcium)

• Symptoms:
  • Positive Trousseau's sign (arm torque with BP cuff)
  • Chvostek's sign (smile when stroking cheek)
  • Diarrhea, circumoral tingling
  • Weak bones (risk for fractures), bleeding (risk for bleeding), heart dysrhythmias

Phosphate (PO₄³⁻)

Function and Relation to Calcium

• Essential for bone and teeth formation
• Regulates calcium (inverse relationship)

Hyperphosphatemia (High Phosphate)

• Resulting Signs: Similar to low calcium (Trousseau's, Chvostek's, diarrhea, weak bones, risk for fractures, weak blood, risk for bleeding, heart dysrhythmias)

Hypophosphatemia (Low Phosphate)

• Resulting Signs: Similar to high calcium (constipation, decreased DTRs, severe muscle weakness, decreased heart and respiratory rate, kidney stones)