Electrolyte Imbalances

Electrolyte Imbalances

Imbalance	Signs and Symptoms	Common Causes
Hypercalcemia Serum calcium level > 10.5 mg/dL	Weakness, fatigue, anorexia, nausea, vomiting, constipation, polyuria, tingling lips, muscle cramps, confusion, hypoactive bowel tones	Hyperparathyroidism or malignancies, thiazide diuretics, lithium, renal failure, immobilization, metabolic acidosis
Hypocalcemia Serum calcium level < 8.5 mg/dL	Anxiety, irritability, twitching around the mouth, convulsions, tingling/numbness of fingers, diarrhea, abdominal/muscle cramps, arrhythmias	Low albumin level is most common, renal failure, hyperthyroid, ↑Mg, acute pancreatitis, Crohn’s disease
Hyperkalemia Serum potassium level > 5.0 mEq/L	Weakness, nausea, diarrhea, hyperactive GI, muscle weakness and paralysis, arrhythmias, dizziness, postural hypotension, oliguria	K-sparing diuretics, NSAIDS, renal failure, multiple transfusions, ↓ renal steroids, OD of K-supplements
Hypokalemia Serum potassium level < 3.5 mEq/L	Anorexia, nausea, vomiting, fatigue, ↓ LOC, leg cramps, muscle weakness, anxiety, irritability, arrhythmias, postural hypotension, coma	Anorexia, fad diets, prolonged NPO status, alkalosis, transfusion of frozen RBCs, prolonged NGT suctioning
Hypermagnesemia Serum magnesium level > 2.7 mg/dL	Muscle weakness and fatigue are most common, nausea, vomiting, flushed skin, diaphoresis, thirst, arrhythmias, palpitations, dizziness	↑ Mg intake, chronic renal disease, pregnant women on parenteral Mg for preeclampsia, Addison’s disease
Hypomagnesemia Serum magnesium level < 1.7 mg/dL	Diarrhea, anorexia, arrhythmias, lethargy, muscle weakness, tremors, nausea, dizziness, seizures, irritability, confusion, psychosis, ↓BP, ↑ HR	Prolonged NGT suctioning, diarrhea, laxative abuse, malnutrition, alcoholic, prolonged diuretic use, DKA, digoxin
Hypernatremia Serum sodium level > 145 mEq/L	Confusion if severe, fever, tachycardia, low BP, postural hypotension, dehydration, poor skin turgor, dry mucous membranes/tongue, flushed	Fever, vomiting, diarrhea, ventilated Pts, severe burns, profuse sweating, diabetes insipidus, diuresis
Hyponatremia Serum sodium level < 135 mEq/L	Nausea, vomiting, abdominal cramps, diarrhea, HA, dizziness, confusion, flat affect, ↓ DBP, ↑ HR, postural hypotension, ↓ deep tendon reflex	Diuretic use, vomiting, diarrhea, burns, hemorrhage, fever, diaphoresis, CHF, renal failure, hyperglycemia, ↑ ADH