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Electrolyte Imbalances: A Comprehensive Guide, Cheat Sheet of Medical Sciences

Ohio University (OU) - EasternMedical Sciences

A comprehensive overview of electrolyte imbalances, covering hypercalcemia, hypocalcemia, hypermagnesemia, hypomagnesemia, hyperkalemia, hypokalemia, hyperchloremia, hypochloremia, hyperphosphatemia, and hypophosphatemia. It outlines the normal ranges, causes, symptoms, and treatment options for each imbalance. Valuable for students and professionals in healthcare fields, offering a detailed and organized resource for understanding electrolyte imbalances.

Typology: Cheat Sheet

2024/2025

Uploaded on 03/21/2025

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Hypercalcemia
Normal range: 9 - 10.5 mg / dL
- Absorbed in GI system, excreted by kidneys
- Important in bones, nerves, muscles, & coagulation/clotting factors
- Regulated by PTH and vitamin D
- Has an inverse relationship with phosphorus
- Excessive intake of calcium
- Hyperparathyroidism
- Excessive Vitamin D intake
- Vitamin D toxicity
- Cancer of the bones
- Immobility
- Reduce dietary calcium intake
- Encourage PO hydration
- IV fluids - NS preferred
- Loop diuretics
- Calcium binders
- Dialysis
- Cardiac monitoring
Neuromuscular
- Weakness
- Flaccidity
- Decreased DTRs
Cardiovascular
- Bradycardia
- Cyanosis
- Deep vein thrombosis
Neurological
- Fatigue
- Decreased LOC
Gastrointestinal
- Decreased peristalsis
- Hypoactive bowel sounds
- Abdominal pain
- Nausea & vomiting
- Constipation
- Kidney stones
Calcium
Causes
Treatment
Signs & Symptoms
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Hypercalcemia

Normal range: 9 - 10.5 mg / dL

  • Absorbed in GI system, excreted by kidneys
  • Important in bones, nerves, muscles, & coagulation/clotting factors
  • Regulated by PTH and vitamin D
  • Has an inverse relationship with phosphorus
  • Excessive intake of calcium
  • Hyperparathyroidism
  • Excessive Vitamin D intake
  • Vitamin D toxicity
  • Cancer of the bones
  • Immobility
  • Reduce dietary calcium intake
  • Encourage PO hydration
  • IV fluids - NS preferred
  • Loop diuretics
  • Calcium binders
  • Dialysis
  • Cardiac monitoring Neuromuscular - Weakness - Flaccidity - Decreased DTRs Cardiovascular - Bradycardia - Cyanosis - Deep vein thrombosis Neurological
  • Fatigue
  • Decreased LOC Gastrointestinal
  • Decreased peristalsis
  • Hypoactive bowel sounds
  • Abdominal pain
  • Nausea & vomiting
  • Constipation
  • Kidney stones

Calcium

Causes

Treatment

Signs & Symptoms

Hypocalcemia

Normal range: 9 - 10.5 mg / dL

  • Absorbed in GI system, excreted by kidneys
  • Important in bones, nerves, muscles, & coagulation/clotting factors
  • Regulated by PTH and vitamin D
  • Has an inverse relationship with phosphorus
  • Renal failure
  • Acute pancreatitis
  • Malnutrition
  • Malabsorption
  • Celiac disease
  • Crohn’s disease
  • Alcoholism
  • Bulimia
  • Vitamin D deficiency
  • Hypoparathyroidism
  • Hyperphosphatemia
  • Glucocorticoids
  • PO calcium supplements
  • Administer with Vitamin D (increases absorption)
  • IV calcium supplements
  • Calcium rich diet Neuromuscular
  • Irritability
  • Hallucinations
  • Paresthesia
  • Tetany
  • Seizures
  • Muscle spasms **- Chvostek’s sign
  • Trousseau’s sign Gastrointestinal**
  • Hyperactive bowel sounds
  • Cramping
  • Diarrhea Misc.
  • Weak bones,↑risk of fractures
  • Weak/brittle nails

Calcium

Causes

Treatment

Signs & Symptoms

Hypomagnesemia

Normal range: 1.5 - 2.5 mEq / L

  • Stored in the bones & cartilage
  • Plays a major role in skeletal muscle contraction & ATP formation
  • Activates vitamins
  • Necessary for cellular growth
  • Mg is directly related to calcium because it is necessary for PTH production. With hypomagnesemia → also too little calcium.
  • Alcoholism
  • Malnutrition
  • Malabsorption
  • Hypoparathyroidism
  • Hypocalcemia
  • Diarrhea
  • Treat the cause
  • Monitor cardiac rhythm
  • Administer magnesium PO - Magnesium hydroxide IV - given very slowly

Neuromuscular

  • Numbness
  • Tingling
  • Cramping
  • Tetany
  • Seizures
  • Increased DTRs

Cardiovascular

  • Torsade De Points

(polyphasic V-tach)

Neuro

  • Psychosis
  • Confusion

Gastrointestinal

  • Nausea
  • Vomiting
  • Abdominal cramps
  • Anorexia

Magnesium

Causes

Treatment

Signs & Symptoms

  • Most abundant intracellular cation
  • Important in muscle contraction, nerve impulses, & acid-base imbalances

Hyperkalemia

Normal range: 3.5 - 5 mEq / L

  • Burns or tissue damage (potassium forced out of the damaged cells)
  • DKA
  • Renal failure
  • Excessive potassium intake
  • ACE inhibitors and ARBs
  • Potassium-sparing diuretics
  • Discontinue any IV or PO potassium supplements
  • Potassium-restricted diet (NO SALT substitutes as they are KCL)
  • IV Calcium gluconate or chloride if EKG changes present (protects heart)
  • Reduce total body potassium Kayexalate: PO or enema, causes↑sodium to be absorbed & potassium excreted Potassium wasting diuretics
  • Drive potassium into cells by giving: Bicarbonate: important in acidosis with hyperkalemia D5W + regular insulin Albuterol
  • Dialysis (for severe cases)
  • Muscle weakness, numbness
  • Shallow respirations → resp. failure
  • Cramping, hyperactive bowel sounds, diarrhea
  • Impaired contractility → decreased CO Weak pulses Bradycardia Hypotension
  • Metabolic acidosis
  • EKG CHANGES that can lead to heart blocks, v-fib, & cardiac arrest

Potassium

Causes

Treatment

Signs & Symptoms

  • Most abundant extracellular anion
  • Works with sodium to maintain fluid balance
  • Binds with hydrogen ions to form stomach acid - HCl
  • Inversely related to bicarbonate
  • Directly related to sodium and potassium Hyperchloremia

Normal range: 98 - 106 mEq / L

  • Fluid loss Dehydration Vomiting Sweating
  • Steroids Cushing’s disease Excess corticosteroid administration
  • Excess chloride administration NORMAL SALINE!
  • Treat the underlying cause (correct the imbalance) Bicarbonate administration Discontinue any sodium- containing meds No NS for IVFs - consider LR instead
  • Monitor all electrolytes - it’s usually not the only imbalance! Neurological
  • Restlessness
  • Agitation
  • Lethargy
  • Drowsiness
  • Stupor
  • Coma Cardiovascular
  • Fever
  • Hypovolemia: weak pulse, hypotension
  • Hypervolemia: bounding pulses, hypertension, edema Musculoskeletal
  • Twitching
  • Cramping
  • Weakness Misc :
  • Flushed skin
  • Decreased urinary output
  • Dry mouth

Chloride

Causes

Treatment

Signs & Symptoms

  • Most abundant extracellular anion
  • Works with sodium to maintain fluid balance
  • Binds with hydrogen ions to form stomach acid - HCl
  • Inversely related to bicarbonate
  • Directly related to sodium and potassium

Chloride

Hypochloremia

Normal range: 98 - 106 mEq / L

  • Volume overload
  • CHF
  • Water intoxication
  • Salt losses
  • Burns
  • Sweating
  • Vomiting
  • Diarrhea
  • Cystic Fibrosis
  • Addison’s Disease
  • Treat the underlying cause (correct the imbalance) Normal Saline - 0.9% NaCL
  • Monitor all electrolytes - it’s usually not the only imbalance
  • Foods with chloride are same as sodium Neurological
  • Seizures
  • Confusion
  • Lethargy
  • Stupor
  • Cerebral edema / increased ICP Cardiovascular - Hypovolemia: weak pulse, tachycardia, hypotension, dizziness
  • Hypervolemia: bounding pulses, hypertension Musculoskeletal
  • Weakness
  • Shallow respirations
  • Decreased DTRs
  • Muscle spasms
  • Orthostatic hypotension GI/GU - Loss of appetite
  • Hyperactive bowel sounds
  • Abdominal cramps

Treatment

Causes^ Signs & Symptoms

Normal range: 3 - 4.5 mEq / L

  • Malnutrition
  • Alcoholism
  • TPN
  • Hyperparathyroidism → hypercalcemia → hypophosphatemia
  • Treat the cause
  • Phosphorus replacement PO IV - give slowly
  • Phosphorus-rich diet
  • Diet low in calcium Neuromuscular
  • Weakness
  • Flaccidity
  • Decreased DTRs Cardiovascular
  • Bradycardia
  • Cyanosis
  • Deep vein thrombosis Neurological
  • Fatigue
  • Decreased LOC Gastrointestinal
  • Decreased peristalsis
  • Hypoactive bowel sounds
  • Abdominal pain
  • Nausea
  • Vomiting
  • Constipation
  • Kidney stones

Treatment

Causes Signs & Symptoms

Hypophosphatemia

  • Major role is in cellular metabolism and energy production (ATP)
  • Makes up the phospholipid bilayer of cell membranes
  • Large component of bones and teeth
  • Has an inverse relationship with calcium

Phosphorus

Hypernatremia

Normal range: 135 - 145 mEq / L

Euvolemic Hypernatremia Hypervolemic Hypernatremia Hypovolemic Hypernatremia Water in the body decreases, but sodium stays near normal. Causes:

- Diabetes insipidus

  • Increased insensible water loss from hyperventilation, sweating, and/or fever Treatment: - Give free water
  • Oral water intake is better than IV because client is euvolemic Water AND sodium increase, but sodium increases more. Causes: - Hypertonic IVF
  • Sodium bicarbonate
  • Increased sodium intake
  • Corticosteroids
  • Cushing’s disease
  • Hyperaldosteronism Treatment: - Find cause (3% saline or aldosterone) and discontinue
  • Give loop diuretics
  • Give free water Water and sodium are both lost, but more water is lost. Relative hypernatremia. Causes: - Vomiting
  • Diarrhea
  • Dehydration
  • Osmotic Diuretics
  • Burns
  • NPO Treatment: - Isotonic IV fluid
  • NS is relatively hypotonic to the hypernatremia
  • Most abundant extracellular cation
  • Water likes to crash sodium parties! It always moves to the area with high concentrations of electrolytes
  • Correct sodium imbalance slowly (0.5 mEq/hr) - changing too quickly can cause cerebral edema and↑ ICP

Sodium

Musculoskeletal

  • Weakness
  • Twitching
  • Cramps Misc.
  • Flushed skin
  • Decreased urine output
  • Dry mouth

Signs & Symptoms

Neurological

  • Restlessness & agitation
  • Lethargy & drowsiness
  • Stupor
  • Coma Cardiovascular - Fever
  • Hypovolemia: weak pulse, hypotension
  • Hypervolemia: bounding pulses, hypertension, edema