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Electrolytes Imbalance | Questions with Explanations of Answers | latest upate 2024
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Electrolytes ImbalanceK++ Hypokalemia Hyperkalemia
Hyperkalemia is a serum potassium level that
exceeds 5.0 mEq/L (5.0 mmol/L)
Hypokalemia is a serum potassium level
Pseudohyperkalemia: a condition that can
Description lower than 3.5 mEq/L (3.5 mmol/L)
occur due to methods of blood specimen
collection and cell lysis; if an increased serum
value is obtained in the absence of clinical
symptoms, the specimen should be redrawn
and evaluated.
1. Actual total body potassium 1. Excessive potassium intake
loss: a. Over ingestion of potassium-
a. Excessive use of medications containing foods or medications, such as
such as diuretics or corticosteroids potassium chloride or salt substitutes
b. Increased secretion of b. Rapid infusion of potassium-
aldosterone, such as in Cushing’s containing IV solutions
syndrome
c. Vomiting, diarrhea 2. Decreased potassium excretion
d. Wound drainage, particularly a. Potassium-sparing (retaining)
gastrointestinal diuretics
e. Prolonged nasogastric suction b. Kidney disease
f. Excessive diaphoresis c. Adrenal insufficiency, such as in
g. Kidney disease impairing Addison’s disease
Causes reabsorption of potassium
3. Movement of potassium from the
2. Inadequate potassium intake: intracellular fluid to the extracellular
Fasting; nothing by mouth status fluid
3. Movement of potassium from a. Tissue damage
the extracellular fluid to the b. Acidosis
intracellular fluid: c. Hyperuricemia
a. Alkalosis d. Hyper catabolism
b. Hyperinsulinism
4. Dilution of serum potassium
a. Water intoxication
b. IV therapy with potassium-
deficient solutions
1|22
, Electrolytes Imbalance
K++ Hypokalemia Hyperkalemia
1-Tall peaked T waves
ECG 1-ST depression
2-Flat P waves
2-Shallow, flat, or inverted T wave
Changes 3-Widened QRS complexes
3-Prominent U wave
4-Prolonged PR interval
Cardiovascular: Cardiovascular:
1-thready weak irregular pulse 1-slow weak irregular heart rate
2-weak peripheral pulse 2-decrease blood pressure
3-orthostatichypotension 3-dysthrythmias
4-dysthrythmias
Respiratory:
Respiratory: 1-profound weakness of skeletal
1-shallow ineffective respiration muscles leading to respiratory failure
that result from profound
weakness of skeletal muscles of Neuromuscular:
respiration Early: muscle twitches, cramps,
2-diminished breath sound paresthesia’s, tingling and burning
followed by numbness in hands and feet
Neuromuscular: and around mouth
Assessment 1-anxiety, lethargy, confusion, Late: profound weakness ascending
coma flaccid paralysis in the arms and legs
2-skeletal muscle weakness, leg (trunk, head and respiratory muscles
cramps become affected when serum k level
3-loss of tactile discrimination reaches a lethal level)
4-parethesia
5-deep tendon hypo-reflexia Gastrointestinal:
1-increase motility, hyperactive bowel
Gastrointestinal: sounds
1-decrease motility, hypo activing 2-diarrhea
to absent bowel sounds
2-nausea, vomiting, constipation,
abdominal distention
3-paralytic ileus
2|22
, Electrolytes Imbalance
1. Monitor electrolyte values. 1. Discontinue IV potassium (keep the IV
2. Administer potassium catheter patent) and withhold oral
supplements orally or potassium supplements.
intravenously, as prescribed. 2. Initiate a potassium-restricted diet.
3. Oral potassium supplements 3. Prepare to administer potassium-
a. Oral potassium supplements excreting diuretics if renal function is
may cause nausea and vomiting not impaired.
and should not be taken on an 4. If renal function is impaired, prepare
empty stomach; if the client to administer sodium polystyrene
complains of abdominal pain, sulfonate (oral or rectal route), a
distention, nausea, vomiting, cation-exchange resin that promotes
diarrhea, or gastrointestinal gastrointestinal sodium absorption and
bleeding, the supplement may potassium excretion.
need to be discontinued. 5. Prepare the client for dialysis if
b. Liquid potassium chloride has an potassium levels are critically high.
unpleasant taste and should be 6. Prepare for the administration of IV
taken with juice or another liquid. calcium if hyperkalemia is severe, to
4. Intravenously administered avert myocardial excitability.
Treatment potassium (Box 8-2) 7. Prepare for the IV administration of
5. Institute safety measures for hypertonic glucose with regular insulin
the client experiencing muscle to move excess potassium into the cells.
weakness. 8. When blood transfusions are
6. If the client is taking a prescribed for a client with a potassium
potassium-losing diuretic, it may imbalance, the client should receive
be discontinued; a potassium- fresh blood, if possible; transfusions of
sparing (retaining) diuretic may be stored blood may elevate the potassium
prescribed. level because the breakdown of older
7. Instruct the client about foods blood cells releases potassium.
that are high in potassium 9. Teach the client to avoid foods high in
content. potassium.
Potassium is never administered 10. Instruct the client to avoid the use of
by IV push, intramuscular, or salt substitutes or other potassium-
Subcutaneous routes. containing substances.
IV potassium is always diluted and 11. Monitor the serum potassium level
administered using an infusion closely when a client is receiving a
device! potassium-sparing (retaining) diuretic.
3|22
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