Question

4.) Explain the difference between Hyper and Hypo-natremia, and describe symptoms of both conditions. Are these conditions considered “osmolality or electrolyte” imbalances?

5.) Explain the difference between Hyper and Hypo-calcemia, and describe symptoms of both conditions. Give an example of why each condition might occur (i.e. disease or diet issue, etc.).

Answer 1

4, In hypernatremia, high blood sodium levels draw water out of the brain cells, causing dehydration and shrinkage. Whereas inhyponatremia, low concentrations of plasma sodium drive water into brain cells, making them swell, causing edema.

What is the difference between hypernatremia and hyponatremia?
A normal blood sodium level is kept between 135 and 145 mmol/L. Hyponatremia occurs when blood sodium falls below 135, while hypernatremia is when it exceeds 145. ... Whereas in hyponatremia, low concentrations of plasma sodium drive water into brain cells, making them swell, causing edema.

Symptoms
Hyponatremia signs and symptoms may include:

Nausea and vomiting
Headache
Confusion
Loss of energy, drowsiness and fatigue
Restlessness and irritability
Muscle weakness, spasms or cramps
Seizures ,Coma

Symptoms
The main symptom of hypernatremia is excessive thirst. Other symptoms are lethargy, which is extreme fatigue and lack of energy, and possibly confusion.

Advanced cases may also cause muscle twitching or spasms. That’s because sodium is important for how muscles and nerves work. With severe elevations of sodium, seizures and coma may occur.

Severe symptoms are rare and usually found only with rapid and large rises of sodium in the blood plasma.

Hyponatremia and hypernatremia are common electrolyte disorders resulting from disorders in water homeostasis. Hyponatremia usually results from defects in free water excretion, although increased intake may also contribute. The treatment of hyponatremia has been controversial because of the high associated morbidity and mortality and the observation that rapid correction of hyponatremia is associated with the development of central pontine myelinolysis. Mild hyponatremia should be treated with water restriction alone, whereas severe acute or symptomatic hyponatremia should initially be corrected rapidly until symptoms resolve followed by more gradual correction. In all cases, treatment should be individualized on the basis of severity, cause, and duration of the hyponatremia. Hypernatremia results from impaired water ingestion, although increased water losses are often contributory. Hospital-acquired hypernatremia is usually iatrogenic because of inadequate water prescription and is therefore preventable. Hypernatremia is also associated with high morbidity and mortality, both as a result of the underlying disease and inadequate treatment. The primary treatment of hypernatremia is water replacement-repleting water deficits and replacing ongoing losses. Additional treatment should be directed at eliminating excess water losses.

5,Calcium is an important divalent cation required for many enzymatic and cellular functions. It is a critical component of bone ossification, and as one would expect, about 99% of total body calcium resides in skeletal tissue. Of the fraction found in plasma, about 40% of it is bound to protein, and 10% is complexed with anions. The remaining serum calcium is ionized and unbound. While serum ionized calcium represents only a very small fraction of total body calcium, it is also the most physiologically important form of calcium circulating in the body. Depending on age, normal serum ionized calcium levels range between 0.95 and 1.5 mmol/L (3.7 and 6mg/dL).
Several organ systems can be impacted by derangements of calcium homeostasis. Among its many functions, calcium plays a key role in cardiac pacemaking, muscle contraction, neuronal function, vascular tone, and hemostasis. Derangements in calcium homeostasis can cause both acute findings related to changes in serum ionized calcium levels as well as chronic findings related to prolonged calcium imbalances.

Calcium is an important divalent cation required for many enzymatic and cellular functions. It is a critical component of bone ossification, and as one would expect, about 99% of total body calcium resides in skeletal tissue. Of the fraction found in plasma, about 40% of it is bound to protein, and 10% is complexed with anions. The remaining serum calcium is ionized and unbound. While serum ionized calcium represents only a very small fraction of total body calcium, it is also the most physiologically important form of calcium circulating in the body. Depending on age, normal serum ionized calcium levels range between 0.95 and 1.5 mmol/L (3.7 and 6mg/dL).
Several organ systems can be impacted by derangements of calcium homeostasis. Among its many functions, calcium plays a key role in cardiac pacemaking, muscle contraction, neuronal function, vascular tone, and hemostasis. Derangements in calcium homeostasis can cause both acute findings related to changes in serum ionized calcium levels as well as chronic findings related to prolonged calcium imbalances.

Hypocalcemia:

Typical findings in mild to moderate hypocalcemia can include:

-Fatigue

-Cramping

-Weakness

-Paresthesias, especially in the perioral area and distal extremities

-Myoclonic jerks

In more severe cases of hypocalcemia, findings can include:

-Laryngospasm and stridor

-Tetany

-Altered mental status

-Apnea

-Seizures

-Hypotension

-Decreased myocardial contractility

-Prolonged QT interval

-Nonspecific ST and T wave changes

-Arrhythmias

With prolonged hypocalcemia, findings can include:

-Dry and coarse skin

-Eczematous dermatitis

-Alopecia and brittle hair

-Brittle nails

-Dental enamel hypoplasia

-Radiographic and clinical findings of Rickets (rachitic rosary, epiphyseal widening, genu varum, osteopenia)

On physical exam, there are two specific findings commonly reported with clinically significant hypocalcemia:

-Chvostek sign: facial muscle contraction with tapping of facial nerve below zygomatic arch.

-Trousseau sign: carpopedal spasms with compression of arms or legs by blood pressure cuff.

Hypercalcemia:

Typical findings in hypercalcemia can include:

-Poor feeding

-Vomiting

-Constipation

-Abdominal Pain

-Hypertension

-Altered mental status

In more severe cases of hypercalcemia, findings can include:

-Hypotonia

-Hyporeflexia

-Paresis

-Psychosis

-Hallucinations

-Lethargy and coma

-QT interval shortening

-Ventricular dysrhythmias

-Nephrogenic DI

With prolonged hypercalcemia, findings can include:

-Failure to thrive and anorexia

-Nephrolithiasis

-Peptic ulcer disease

-Calcium deposition in soft tissues

Hypercalcemia is usually a result of overactive parathyroid glands. These four tiny glands are situated in the neck, near the thyroid gland. Other causes of hypercalcemia include cancer, certain other medical disorders, some medications, and taking too much of calcium and vitamin D supplements.

Hypocalcemia include hypoparathyroidism, pseudohypoparathyroidism, vitamin D deficiency, and renal failure. Mild hypocalcemia may be asymptomatic or cause muscle cramps.