Electrolyte imbalance

Electrolytes are electrically conductive substances containing free ions. The body requires a balance between the electrolytes inside and outside of cells (intracellular and extracellular ions). These electrolytes include Magnesium (Mg ), Sodium (Na ), Potassium (K ) and Calcium (Ca +). Imbalances in these electrolytes can cause serious physiological problems, so all electrolyte imbalances should be identified and treated promptly. 

The online version of this chapter (doi 10.1007/978-f-4471-4962-0 9) contains supplementary material, which is available to authorized users. 

Please note some of the figures within this chapter have been reproduced in full size online at Extra Materials (extras.springer.com) for ease of viewing 

Tall peaked T waves Prolonged PR interval Broad QRS complexes 

Flat (low amplitude) P waves Wide P waves Ventricular arrhythmias 

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Seizure disorders are generally categorized as idiopathic or acquired. Idiopathic seizures have no known cause acquired seizure disorders have a known cause, including high fever, electrolyte imbalances, uremia, hypoglycemia, hypoxia, brain tumors, and some drug withdrawal reactions. Once the cause is removed (if it can be removed), the seizures theoretically cease. 

As part of the preadministration assessment for a patient receiving a drug for nausea and vomiting, the nurse documents the number of times the patient has vomited and the approximate amount of fluid lost. Before starting therapy, the nurse takes vital signs and assesses for signs of fluid and electrolyte imbalances (see Chap. 58). 

If vomiting is severe the nurse observes the patient for signs and symptoms of electrolyte imbalance. The nurse monitors the blood pressure, pulse, and respiratory rate every 2 to 4 hours or as ordered by the primary health care provider. The nurse carefully measures the intake and output (urine, emesis) until vomiting ceases and the patient is able to take oral fluids in sufficient quantity. The nurse documents in the patient s chart each time the patient has an emesis. The nurse notifies the primary health care provider if there is blood in the emesis or if vomiting suddenly becomes more severe... 

No evidence of a fluid volume deficit or electrolyte imbalance is seen. 

An arrhythmia may occur as a result of heart disease or from a disorder that affects cardiovascular function. Conditions such as emotional stress, hypoxia, and electrolyte imbalance also may trigger an arrhythmia An electrocardiogram (ECG) provides a record of the electrical activity of the heart. Careful interpretation of the ECG along with a thorough physical assessment is necessary to determine the cause and type of arrhythmia The goal of antiarrhythmic drug therapy is to restore normal cardiac function and to prevent life-threatening arrhythmias. 

MANAGING FLUID VOLUM E DEFICIT. The patient receiving a diuretic is observed for dehydration and electrolyte imbalances. A fluid volume deficit is most likely to occur if the patient fails to drink a sufficient amount of fluid. This is especially true in the elderly or confused patient. To prevent a fluid volume deficit, the nurse encourages patients to drink adequate oral fluids (up to 3000 mL/d, unless contraindicated). 

Electrolyte imbalances that may be seen during therapy with a diuretic include hyponatremia (low blood sodium) and hypokalemia (low blood potassium), although other imbalances may also be seen. See Chapter 58 and Display 58-2 for the signs and symptoms of electrolyte imbalances. The primary care provider is notified if any signs or symptoms of an electrolyte imbalance occur. 

Electrolyte imbalances, anorexia, nausea, vomiting, dizziness, rash, photosensitivity reactions, postural or orthostatic hypotension, glycosuria Electrolyte imbalances, anorexia, nausea, vomiting, fever, chills, anxiety, confusion, hematologic changes me as bumetanide... 

Edema, fluid and electrolyte imbalance, headache, blurred vision, nausea, vomiting, diarrhea, urinary retention Headache, nausea, vomiting, fluid and electrolyte imbalance, syncope... 

The osmotic diuretics urea and mannitol are administered intravenously (IV), whereas glycerin and isosorbide are administered orally Administration by the IV route may result in a rapid fluid and electrolyte imbalance, especially when these drugs are administered before surgery with the patient in a fasting state ... 

The carbonic anhydrase inhibitors are contraindicated in patients with known hypersensitivity to the dru , electrolyte imbalances, severe kidney or liver dysfunction, or anuria, and for long-term use in chronic non-congestive angle-closure glaucoma (may mask worsening glaucoma). 

The osmotic diuretics are contraindicated in patients with known hypersensitivity to the drags, electrolyte imbalances, severe dehydration, or anuria and those who experience progressive renal damage after instituting therapy (mannitol). Mannitol is contraindicated in patients with active intracranial bleeding (except during craniotomy). 

The thiazide diuretics are contraindicated in patients with known hypersensitivity to the thiazides or related diuretics, electrolyte imbalances, renal decompensation, hepatic coma, or anuria. A cross-sensitivity reaction may occur with the thiazides and sulfonamides. Some of the thiazide diuretics contain tartrazine, which may cause allergic-type reactions or bronchial asthma in individuals sensitive to tartrazine. 

TH E PATIEN T WITH ED EM A. Fhtients with edema caused by heart failure or other causes are weighed daily or as ordered by the primary health care provider. A daily weight is taken to monitor fluid loss. Weight loss of about 2 lb/d is desirable to prevent dehydration and electrolyte imbalances. The nurse carefully measures and records the fluid intake and output every 8 hours. The critically ill patient or the patient with renal disease may require more frequent measurements of urinary output. The nurse obtains the blood pressure, pulse, and respiratory rate every 4 hours or as ordered by the primary health care provider. An acutely ill patient may require more frequent monitoring of the vital signs. 

ELECTROLYTE IMBALANCE The most common adverse reaction associated with the administration of a diuretic is the loss of fluid and electrolytes (see Display 46-1), especially during initial therapy with the drug. In some patients, the diuretic effect is moderate, whereas in others a large volume of fluid is lost. Regardless of the amount of fluid lost, there is always the possibility of excessive electrolyte loss, which is potentially serious. 

DISPLAY 46-1 Signs and Symptoms of Cbmmon Fluid and Electrolyte Imbalances Associated With Diuretic Therapy... 

Whether a fluid or electrolyte imbalance occurs depends on the amount of fluid and electrolytes lost and the ability of the individual to replace them. For example, if a patient receiving a diuretic eats poorly and does not drink extra fluids, an electrolyte and water imbalance is likely to occur, especially during initial therapy with the drug. However, even when a patient drinks adequate amounts of fluid and eats a balanced diet, an electrolyte imbalance may still occur and require electrolyte replacement (see Chapter 58 and Display 58-2 for additional discussion of fluid and electrolyte imbalances). 

Older adults are particularly prone to fluid volume deficit and electrolyte imbalances (see Display 46-1) while taking a diuretic. The older adult is carefully monitored for hypokalemia (when taking the loop or thiazide diuretic and hyperkalemia (with the potassium-sparing diuretics... 

To prevent a fluid volume deficit, the nurse encourages oral fluids at frequent intervals during waking hours. A balanced diet may help prevent electrolyte imbalances. The nurse encourages patients to eat and drink all food and fluids served at mealtime The nurse encourages all patients, especially the elderly, to eat or drink between meals and in the evening (when allowed). The nurse monitors the fluid intake and output and notifies the primary health care provider if the patient fails to drink an adequate amount of fluid, if the urinary output is low, if the urine appears concentrated, if tiie patient appears dehydrated, or if signs and symptoms of an electrolyte imbalance are apparent. 

Warning sgns of a fluid and electrolyte imbalance include dry mouth, thirst, weakness lethargy, drowsiness restlessness muscle pains or cramps confuson, gastrointestinal disturbances hypotenson, oliguria, tachycardia, and seizures... 

The nurse must closely observe patients receiving a potassium-sparing diuretic for signs of hyperkalemia (see Display 46-1), a serious and potentially fatal electrolyte imbalance The patient is closely monitored for hypokalemia during loop or thiazide diuretic therapy. A supplemental potassium supplement may be prescribed to prevent hypokalemia. The primary health care provider may also encourage the patient to include... 

When administering spironolactone (Aldactone), die nurse monitors die patient closely for which of die following electrolyte imbalances ... 

Which electrolyte imbalance would the patient receiving a loop or thiazide diuretic most likely develop ... 

MANAGING FLUID AND ELECTROLYTE IMBALANCES. Fluid and electrolyte imbalances, particularly excess fluid volume, are common with corticosteroid therapy. The nurse checks the patient for visible edema, keeps... 

In men, administration of an androgen may result in breast enlargement (gynecomastia), testicular atrophy, inhibition of testicular function, impotence, enlargement of the penis, nausea, jaundice, headache, anxiety, male pattern baldness, acne, and depression. Fluid and electrolyte imbalances, which include sodium, water, chloride, potassium, calcium, and phosphate retention, may also be seen. 

Virilization in the woman is the most common reaction associated with anabolic steroids, especially when higher doses are used. Acne occurs frequently in all age groups and both sexes. Nausea, vomiting, diarrhea, fluid and electrolyte imbalances (the same as for the androgens, discussed previously), testicular atrophy,... 

ANDROGENS In most instances, androgens are administered to the man on an outpatient basis. Before and during therapy, the primary health care provider may order electrolyte studies because use of these drugs can result in fluid and electrolyte imbalances. 

The nurse observes the patient each day for adverse drug reactions especially signs of fluid and electrolyte imbalance, jaundice (which may indicate hepatotoxicity), and virilization. The primary health care provider must be alerted to any sgns of fluid and electrolyte imbalance or jaundice. 

Sodium and water retention may also occur with androgen or anabolic steroid administration, causing die patient to become edematous, hi addition, otiier electrolyte imbalances, such as hypercalcemia, may occur. The nurse monitors the patient for fluid and electrolyte disturbances (see Chap. 58 for signs and symptoms of electrolyte disturbance). 

Discuss the more common signs and symptoms of electrolyte imbalance. 

Along with a disturbance in fluid volume (eg, loss of plasma, blood, or water) or a need for providing parenteral nutrition with the previously discussed solutions, an electrolyte imbalance may exist. An electrolyte is an electrically charged substance essential to the normal functioning of all cells. Electrolytes circulate in the blood at specific levels where they are available for use when needed by the cells. An electrolyte imbalance occurs when the concentration of an electrolyte in the blood is either too high or too low. In some instances, an electrolyte imbalance may be present without an appreciable disturbance in fluid balance For example, a patient taking a diuretic is able to maintain fluid balance by an adequate oral intake of water, which... 

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