Electrolyte Imbalances

Causes: Signs & Symptoms:

Physical Exam: Lab findings:

Hyponatremia
Kidney Disease resulting Apprehension Serum Sodium
in salt wasting Personality Change level <135 mEq/L
Postural Hypotension Urine Specific
Adrenal insufficiency Postural Dizziness gravity <1.010
Abdominal Cramping
GI losses Nausea and Vomiting
Diarrhea
Increased sweating Tachycardia
Convulsions & Coma
Use of Diuretics, especially Fingerprints remaining on sternum
when combined with a low after palpation
sodium diet

Psychogenic polydipsia
(excessive thirst)

Syndrome of Inappropriate
ADH (SIADH)

Hypernatremia
Ingestion of large amounts of Thirst Serum Sodium
concentrated salt solutions Dry and flushed skin level >145 mEq/L
Dry and sticky tongue & mucous Urine Specific
Iatrogenic administration of membranes gravity >1.030
hypertonic saline solution Fever
parenterally Agitation
Convulsions
Excess Aldosterone Secretion restlessness
Irritability
Diabetes Insipidus

Increased Sensible & Insensible

Water loss

Water deprivation
Electrolyte Imbalances p.2

Causes: Signs & Symptoms:

Physical Exam: Lab findings:

Hypokalemia
Use of potassium-wasting Weakness & Fatigue Serum Potassium
diuretics Decreased Muscle tone level <3.5 mEq/L
Intestinal distention
Diarrhea, vomiting, or other Decreased Bowel Sounds
GI losses Ventricular Dysrhythmias
Paresthesias
Alkalosis Weak, irregular pulse

Excess Aldosterone secretions

Polyuria

Extreme Sweating

Excessive use of Potassium-free

Intravenous (IV) solutions

Treatment of diabetic ketoacidosis

with insulin

Hyperkalemia
Renal Failure Anxiety Serum Potassium
Dysrhythmias level >5.3 mEq/L
Fluid Volume Deficit Paresthesias
Weakness
Massive cellular damage such as Abdominal cramps
from burns & trauma Diarrhea

Iatrogenic administration of large

amounts of potassium
intravenously

Adrenal Insufficiency

Acidosis, especially diabetic ketoacidosis

Rapid infusion of stored blood

Use of K+ sparing diuretics

Electrolyte Imbalances p. 3

Causes: Signs & Symptoms:

Physical Exam: Lab Findings:
Hypocalcemia:
Rapid administration of blood Numbness & Tingling of Serum Calcium level
transfusions containing citrate fingers & circumoral <4.0 mEq/L
region. (encircling the
Hypoalbuminemia mouth)
Hyperactive reflexes
Hypoparathyroidism Positive Trousseau’s sign
(carpopedal spasm with
Vitamin D deficiency hypoxia)
Tetany
Pancreatitis Muscle cramps
Pathological fractures
Alkalosis (chronic hypocalcemia)

Hypercalcemia:
Hyperparathyroidism Anorexia Serum Calcium level
Nausea & Vomiting >5 mEq/L
Malignant Neoplastic Disease Weakness
Lethargy
Paget’s Disease Low Back Pain (from
Kidney Stones)
Osteoporosis Decreased level of Consciousness
Personality Changes
Prolonged immobilization Cardiac Arrest

Acidosis
Electrolyte Imbalances p. 4

Causes: Signs and Symptoms:

Physical Exam: Lab Findings:
Hypomagnesemia
Inadequate intake Muscular tremors Serum Mg+ level
Hyperactive deep tendon <1.5 mEq/L
Malnutrition & Alcoholism reflexes
Confusion & disorientation
Inadequate absorption: diarrhea, Dysrhythmias
Vomiting, nasogastric drainage, Positive Chvostek’s sign
Fistulas, diseases of the small & Trousseau’s sign
Intestines

Excessive loss resulting from thiazide

Diuretics

Aldosterone excess

Polyuria

Hypermagnesemia
Renal failure physical findings that are more Serum Mg+ level
Frequent in acute elevations in >2.5 mEq/L
Excess oral or Parenteral intake magnesium levels:
of magnesium Hypoactive deep tendon reflexes
Decreased depth & rate of
Respirations
Hypotension
Flushing