Serum level
Sodium

Critically Low Limit:
Sodium

Critically High Limit:
Sodium

Serum level
Potassium

Serum level:
Calcium

Serum level:
Magnesium

Serum level:
Phosphorus

Critical Low:
Potassium

Critical Low:
Calcium

Critical Low:
Magnesium

Critical Low:
Phosphorus

Critical High:
Potassium

Critical High:
Calcium

Critical High:
Magnesium

Critical High:
Phosphorus

S/S:
cerebral edema and increased ICP, mental status changes, decreased LOC, lethargy, confusion, muscle twitching, weakness, hyperreflexia, headache, personality change, hemiparesis, seizures, muscle cramps, exhaustion, anorexia

S/S:
thirst, altered neuro-function, restlessness, weakness, disorientation, lethargy, delusions, stupor, convulsions, coma, dry swollen tongue, increased temp, increased excitability/conductivity of nerve cells, muscle irritability and twitching, peripheral/pulmonary edema or postural hypotension

S/S:
fatigue, muscle weakness, leg cramps, paresthesia, confusion, slowed GI motility, N/V, anorexia, flat T waves, depressed ST, elevated U wave, dig. toxicity, cardiac/respiratory arrest

peaked narrow T waves, prolonged PR, widened QRS may progress to atrial systole, dysrhythmias, heightened neuromuscular activity, speeds up GI: diarrhea, abdominal cramping, anxiety irritability, paresthesia, muscle tremor, twitching muscle weakness, flaccid paralysis, respiratory paralysis

tetany, convulsions, tingling numbness, hyperactive reflexes, positive Chvostek's and Trousseau's signs, bronchospasms, abd. pain, laryngospasm, respiratory arrest, impaired memory, confusion, delirium, depression, prolonged QT and ST, V-tach

muscle weakness, incoordination, anorexia, constipation, abd. pain, bone pain, abd. distention and paralytic ileus, confusion, impaired memory, slurred speech, lethargy, acute psychotic behavior, coma, short QT and ST, renal calculi

hyperexcitable muscles with weakness, tremor, tetany, seizures, laryngeal spasms, positive Chvostek's and Trousseau's, dysrhythmias, mood alterations, apathy, depression, apprehension, agitation, dizziness, insomnia, confusion, paresthesia, dysphagia

CNS depression, peripheral vasodilation, low BP, N/V, soft tissue calcification, facial flushing, feeling warm --> increases to lethargy, difficulty speaking, drowsiness, decreased/absent DTR, muscle weakness --> >10mEq coma, A/V block, cardiac arrest

irritability, fatigue, paresthesia, confusion, seizures, apprehension, weakness, numbness, coma, muscle damage weakness and pain, impaired ventilation due to respiratory muscle weakness, platelet dysfunction (bruising/bleeding), altered granulocyte function, anorexia, dysphagia, N/V decreased motility of GI

tetany, hypocalcemia, anorexia, N/V, muscle weakness, hyperreflexia, tachycardia

Caused by:
vomiting, diarrhea, fistulas, excess sweating, diuretics, aldosterone deficiency, excessive water: water intoxication, GI irrigation, electrolyte poor fluids,tap water enemas

causes:
hypertonic enteral formulas and IV solution, salty foods, medications, drowning in salt water, water loss: altered thirst mechanism, NPO/elderly water deprivation, watery diarrhea, burns, diaphoresis, fevers, hyperfunction of aldosterone, diabetes insipidus, osmotic diuresis (Hyperglycemia)

Causes:
diuretics, sodium-antibiotics, penicillin, glucocorticoids, osmotic diuresis, DM, hyperaldosteronism (CHF, renal disease, cirrhosis, adrenal adenomas), vomiting, diarrhea, laxative overuse, excessive ileostomy drainage, suction, extended therapy without X - replacement, alkalosis, burns, trauma, starvation, high insulin

high x intake, decreased excretion by kidneys (renal disease x-sparing meds, hypovolemia, adrenal insufficiency, rapid infusion of blood, metabolic acidosis, hyperglycemia, crush injuries, burns, trauma, severe infection, chemo

Causes:
large transfusion of citrated blood, decreased PTH, alkalosis, rapid infusion of IV phosphate, cimetidine, phenytoin, heparin, loop diuretics, MgSO4, gentamicin, decreased absorption due to bowel disease, deficient vit D/sunlight, acute pancreatitis, hypoparathyroidism, bed rest/decreased mobility

Causes:
hyperparathyroidism, malignancies of the bone, lack of stress on bone, paget's disease, multiple fractures, addison's disease, overuse of antacids, excess milk intake, IV od, thiazide diuretics

Causes:
alcoholism, esp with withdrawal, GI tract, NG suction, diarrhea, fistulas, IBD, disruption of bowel function, starvation, aminoglycosides, cyclosporin, diuretics, digitalis, rapid infusion of citrated blood, DKA, sepsis, burns, hypothermia

renal failure, excessive antacid use or laxative use, excessive Mg, adrenocortical insufficiency, addison's disease, hypothermia

TPN with insufficient x, severe protein-cal malnutrition, aloholism, anorexia nervosa, prolonged intense hyperventilation, DKA, major burns, metabolic or respiratory acidosis, antacids, excess calcium, vomiting/diarrhea, decreased absorption, increased renal excretion, glycosuria, polyuria, diuretics

Causes:
Renal failure, chemo, hypoparathyroidism and decreased calcium, respiratory acidosis, DKA, increased intake, muscle necrosis, hyperthyroidism

Tx:
increase intake, if hypovolemia - isotonic LR or NS, GRADUAL increase!
If VERY low - hypertonic NS, ICU care, and if hypervolemic - loop diuretics

Tx:
gradually decrease, hypotonic IV solution, diuretics, restrict intake

replace with oral supplement, salt substitutes, IV supplement, KCL (NEVER BOLUS)

Restrict x, calcium gluconate, monitor EKG, IV sodium bicarbonate, hypertonic dextrose and insulin for temporary shift, beta2agonist, kayexalate, dialysis

oral supplement, or IV calcium gluconnate, but gradually as rapid infusion could cause bradycardia and cardiac arrest, may cause dig. toxicity

Tx:
treat cause, IV fluids to promote excretion, restrict in diet, give IV phosphorus, lop diuretics, calcitonin IM, mithramycin

Tx:
diet (peanut butter, chocolate, green leafy veggies, nuts) x salts - be careful they may cause diarrhea in excess, IV

restrict intake, DC antacids/laxatives, give calcium to antagonize, resp. support, loop diuretics and hypotonic saline

Tx:
replace orally of if <1mg/dl give IV

Tx:
treat underlying cause, restrict x-rich foods (cheese, cream, nuts, whole grains, dried fruits), restrict meds, increase GI/urinary elimination