Question

Answer the following questions related to the topic of fluids and electrolytes:

1. Describe each of the following disorders including its signs and symptoms and treatment:
• Hypo / Hypernatremia
• Hypo / Hyperkalemia
• Hypo / Hypercalcemia
• Hypo / Hypermagnesemia
• Hypo / Hyperphosphatemia
• Hypo / Hyperchloremia

Answer 1

AnsI. Hyponatremia-

Hypo= Low of something, Natremia= sodium level in the blood

A condition that occours when the level of sodium in the blood gets too low. As in this condition the body holds onto too much water which dilutes the amount of sodium in the blood and causes levels to low. Normal serum sodium value is 135-145mEq/L. And this case value gets below 135mEq/L

Sign and symptoms--

could be asymptomatic in mild cases with little lethargy.

In extremist the signs and symptoms are as follows--

1]Headache

2] Lethargy and fatigue

3]Nausea

4] Seizures and covulsions

5]Coma

6]Confusion

7]Low blood pressure

8]Faintness and dizziness

Treatment--

Depends upon the cause. In case of Hypovolemia-- IV saline hydration, If the patient is euvolemic( no oedema) treat underline cause, in case of hypervolemia management of heart failure and chronic kidney diseases. In case of chronic hyponatremia: fluid restriction, intravenous saline hydration, pharmacotherapy to increase serum sodium.

Hypernatremia --- Hyper= Excess, Natremia= sodium in blood

It is an electrolyte imbalance, in which serum sodium value gets increased and leads to decrease in total body water relative to electrolyte content. Normal serum sodium is 135-145mEq/L and in this case it gets exceed from 145mEq/L.

Sodium helps in balancing water balance, blood pressure, blood volume. The cell initially responds to extracellular hypertonicity through passive osmosis of water extracellularly, resulting in cell shrinkage.

Signs and Symptoms---

Fever, thirst, dry mouth, flushed skin, restless, agitated, increased fluid retention, oedema, extreme confusion, decreased urine output.

Treatment--

Slow administration of Hypotonic and isotonic saline, sodium intake cut down related to sodium serum value, rehydrate, administration of IV fluids.

Ans II. Hypokalemia --

Hypokalemia means blood level having below normal potassium level that is less than 3.5mEq/L. Total body potassium divided into two components -- Intracellular and extracellular. Vast majority around 98% of all of the body's potassium is intracellular and is responsible for contraction, nerve transmission and muscle reactions and is naturally regulated by kidneys and hormones.

sign and symptoms--

Vomiting, diarrhea, diuresis, muscle weakness, slow respiratory rate, bradycardia, respiratory alkalosis, lethargy, muscle cramps.

Treatment--

Medications, potassium supplements, normalize pottasium level by treating underlying causes like vomiting and diarrhea, diuretic therapy , administration of 10neq/hr by peripheral lines, 20 neq/hr via central lines.

Hyperkalemia--

Blood having higher than normal potassium in blood which is  generally over 5.5mEq/L.

signs and symptoms--

Heart is going to be tight and contracted which leads to irregular heartbeat, hypotension, bradycardia, respiratory failure, diarrhea, confusion, profound weakness, muscle cramping, increased DTR, tingling burning sensations around feet, hand and mouth.

Treatment--

Monitoring EKG, no fruits or greenleafy vegetables as it can increase bowel movement and have high K level in it, administration of I-IV sodium bicarb to correct acidosis and IV calcium gluconate to decrease muscular irritability, insulin and albuterol administration, diurectics and dialysis.

Ans III. Hypocalcemia-- A condition in which blood has too little calcium typically less than 9.0mg/dl. It can be because of lack of vitamin D or due to the condition of the parathyroid gland, kidneys or the pancreas. Level is regulated by 3 hormones: Parathyroid, calcitonin, calcitriol. Calcium is most abundant metal in our body and 99% presents in bone

Signs and symptoms --

Weak bones and very much prone to fractures, clotting of blood decreased and high risk of bleeding, dysrhythmias, ventricular tachycardia, narrowing of wind pipe, difficulty in breathing and heard crackles with heart failure, intestinal cramping, diarrhea, seizures, confusion, dementia.

Treatment--

By giving Vit. D supplements, using formulation like calcium gluconate, food high in calcium like green vegetables, milk, eggs,cheese, administration of Ca acetate, IV calcium, safety to fall and risk of fractures.

Hypercalcemia ---

High calcium levels in blood, more than 10.5 mg/dl. When Ca gets low phosphate gets increase in blood and magnesium also gets low accordingly.

sign and symptoms--

Decreased heart rate, decreased respiratory rate, decreased blood pressure, shortness of breath, nausea, vomiting, constipation, renal calculi, loss of consciousness, decreased deep tendon reflexes, decreased muscle excitability, severe muscle weakness, bone pain.

Treatment--

IV phosphate administration, loop diuretic, normal salines, avoid high calcium food, dialysis, calcium reabsorption inhibitors administration, biphosphate is also given.

Ans IV. Hypomagnesemia --

Electrolyte disturbance caused due to low magnesium level less than 1.8mg/dL in blood. Magnesium maintain the muscles by calming the hyper activities. Mainly in heart and uterus.

Signs and symptoms--

Tachycardia, cardiac dysrhythmias, ventricular fibrillation, dyspnea, rapid shallow breathing, diarrhea, insomnia, nausea, confusion, increased DTR, muscle twitching and numbness, increased muscle tone.

Treatment-- IV mag sulfate is administered, safety with swallowing

Hypermagnesemia--

Elevated magnesium level more than 4 mEq/L in blood.

sign and symptoms--

Bradycardia, hypotension, cardiac dysrhythmias, depressed respiration, slow bowel movement, drowsiness, lethargy, coma, weakness, diminished DTR, twitching, tight muscles, vasodilation.

Treatment--

Hemodialysis, IV calcium gluconate which will decrease muscle tension, avoid Mg rich food