Hypercalcemia

 
Hypercalcemia:
Risk Factors:

• Hyperparathyroidism
• Malignant disease
• Prolonged immobilization
• Vitamin D excess
• Thiazide diuretics
• Lithium

Manifestations:

• Ca++ > 10 mg/dL
• Muscle weakness
• Decreased DTRs
• Hypercalciuria/renal stones
• Dysrhythmias
• Confusion
• Anxiety
• Lethargy/coma

Interventions:

• Increase mobility
• Isotonic IVF
• Furosemide
• Calcitonin
• Glucocorticoids
• Biophosphonates
• NOTE: increased risk of fractures

Hypophosphatemia & Hyperphosphatemia

 
Hypophosphatemia:
Risk Factors:

• Alcoholism
• Chronic diarrhea
• Starvation
• Vitamin D deficiency

Manifestations:

• Phosphorus < 2.5 mg/dL
• Muscle weakness
• Decreased DTRs
• Hypercalciuria/renal stones
• Dysrhythmias
• Confusion
• Anxiety
• Lethargy/coma 

Interventions:

• Correct etiology
• Oral phosphate replacement
• Vitamin D
• Decrease calcium level
  
  Hyperphosphatemia:
  Risk Factors:
  
• Renal failure
• Chemotherapy
• High vitamin D
• High phosphorus intake
• Excessive enema use [Fleet’s]

Manifestations:

• Phosphorus > 4.5 mg/dL
• Tetany, cramps
• Paresthesias
• Dysrhythmias
• Trousseau’s sign
• Chvostek’s sign
• Seizures

Interventions:

• Aluminum hydroxide [with meals]
• Decrease dialysis

Hypomagnesemia

Hypomagnesemia:
Risk Factors:

• GI loss
• Alcoholism
• Diuretics
• Pancreatitis
• Hypocalcemia
• Hypokalemia
• Insulin resistance
• DKA

Manifestations:

• Magnesium < 1.8 mEq/L
• Tetany, cramps
• Increased DTRs
• Paresthesia
• Dysrhythmias
• Trousseau’s sign
• Chvostek’s sign
• Agitation, confusion

Interventions:

• Seizure precautions
• Assess for difficulty swallowing
• Correct underlying cause
• IV magnesium
• Teach food sources
• NOTE: monitor for signs of magnesium toxicity with IV replacement and treat with calcium gluconate

Hypermagnesemia

 
Hypermagnesemia:
Risk Factors:

• Renal failure
• Excessive Mg++ therapy
• Adrenal insufficiency
• Laxative abuse

Manifestations:

• Magnesium > 3.0 mEq/L
• Hypotension
• Drowsiness
• Decreased DTRs
• Bradycardia
• Bradypnea
• Coma
• Cardiac arrest

Interventions:

• Decrease intake
• IV calcium gluconate
• Mechanical ventilation
• Temporary pacemaker

Hyponatremia

 
Hyponatremia:
Risk Factors:

• GI loss
• SIADH
• Adrenal insufficiency
• Diuretics
• Water intoxication
• Decreased intake

Manifestations:

• Na+ < 135 mEq/L
• Weakness
• Lethargy
• Confusion
• Seizures
• Coma

Interventions:

• Daily weight
• Assess CNS changes
• I/O
• Administer IVF [hypertonic (acute); isotonic (restore volume)]
• Seizure precautions
• Teach sodium-rich food
• If etiology is FVE, restrict fluids
• NOTE: risk for hypertonic solutions is cerebral edema

Hypernatremia

Hypernatremia:
Risk Factors:

• Water deficit
• GI loss
• DI
• increased intake

Manifestations:

• Na+ > 145 mEq/L
• Thirst, dry mucous membranes
• Restless, weak
• Orthostatic hypotension
• Muscle irritability, seizures
• Coma

Interventions:

• Daily weight
• Assess CNS changes
• I/O
• Administer IVF: isotonic [restore volume]
• Seizure precautions
• Teach Na+ food sources

Metabolic Acidosis

Metabolic Acidosis:

Risk Factors:

• Diarrhea
• Fever
• Hypoxia
• Starvation
• Seizure
• Overdose: salicylates or ethanol
• Renal failure

Manifestations:

• pH < 7.35
• HCO3 < 22 mEq/L
• VS: Bradycardia, weak pulses, hypotension, tachypnea
• Flaccid paralysis
• Confusion

Interventions:

• Treat underlying cause
• Administer fluids, electrolyte