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Test
Sodium
Adult Normals:
135-145 mEq/L
Critical Values:
<120 or >160
Potassium
Adult Normals:
3.6-5.1 mEq/L
Critical Values:
<2.5 or >6.5
Chloride
Adult Normals:
101-111 mEq/L
Critical Values:
<80 or >115
General Information
Measured in serum. Sodium is
major cation in extracellular
space and is the major
determinant of extracellular
osmolality. Sodium content is
the result of a balance between
dietary sodium intake and renal
excretion.
Causes of Imbalances
Hypernatremia: increased sodium
intake, decreased sodium loss
(Cushings syndrome,
Hyperaldosteronism), excessive free
body water loss (GI loss, excessive
sweating, extensive thermal burns,
diabetes insipidus, osmotic diuresis)
Hyponatremia: decreased sodium
intake, increased sodium loss
(Addisons disease, diarrhea, vomiting,
NG aspiration, ileus, bowel
obstruction, diuretics, chronic renal
insufficiency, large volume para- or
thoracentesis), increased free body
water (excessive po intake,
hyperglycemia, IV fluid overload, CHF,
ascites, edema).
Hyperkalemia: excessive dietary
intake, excessive IV intake, acute or
chronic renal failure, Addisons
disease, hypoaldosteronism,
Aldosterone inhibiting diuretics, crush
injuries to tissue, hemolysis, infection,
acidosis, dehydration.
Hypokalemia: deficient dietary
intake, deficient IV intake, burns, GI
disorders, diuretics,
hyperaldosteronism, Cushings
syndrome, alkalosis, insulin
administration, ascites, renal artery
stenosis, trauma.
Symptoms of Imbalances
Hypernatremia: dry mucous
membranes, thirst, agitation,
restlessness, hyperreflexia, mania
and convulsions.
Hyperchloremia: dehydration,
excessive infusion of NS, metabolic
acidosis, Cushings syndrome, kidney
dysfunction, hyperparathyroidism,
eclampsia, respiratory alkalosis.
Hypochloremia: over hydration,
SIADH, CHF, vomiting, prolonged
gastric suction, chronic diarrhea,
chronic respiratory acidosis, metabolic
Hyperchloremia: lethargy,
weakness, deep breathing.
Hyponatremia: weakness,
confusion, lethargy, stupor, and
coma.
Hyperkalemia: irritability,
nausea, vomiting, intestinal colic,
diarrhea.
Hypokalemia: weakness,
paralysis, hyporeflexia, ileus,
increased cardiac sensitivity to
digoxin, cardiac arrhythmias, and
EKG changes as a result of
decreased contractility of smooth,
skeletal and cardiac muscles.
Hypochloremia: hyperexcitability
of nervous system and muscles,
shallow breathing, hypotension,
tetany.
General Information
Causes of Imbalances
alkalosis, Addisons disease, diuretic
therapy, hypokalemia, burns.
Symptoms of Imbalances
Glucose
Adult Normals:
65-100 mg/dl
General Information
Measure of H2CO3, dissolved
CO2 and the bicarbonate ion
(HCO3) that exists in serum.
Important in electrical
neutrality and plays a major
role in acid base balance.
Regulated by kidneys.
Calculated based on cations
and anions (see next table)
Critical Values:
<40 or >400
Causes of Imbalances
Alkalosis (increased levels): severe
vomiting, high volume gastric
suctioning, Aldosteronism, use of
mecurial diuretics, COPD, metabolic
alkalosis.
Acidosis (decreased levels):
chronic diarrhea, chronic use of loop
diuretics, renal failure, DKA,
starvation, metabolic acidosis, shock.
Increased levels: Lactic, Diabetic
and alcoholic acidosis, starvation,
renal failure, increased GI losses,
hyperaldosteronism.
Decreased levels: excessive alkali
ingestion (antacids) multiple
myeloma, chronic vomiting or gastric
suction, hyperaldosteronism.
Hyperglycemia: Diabetes mellitus,
acute stress response, Cushings
syndrome, pheochromocytoma,
chronic renal failure, glucagonoma,
acute pancreatitis, diuretic therapy,
corticosteroid therapy, acromegaly.
Hypoglycemia: insulinomia,
hypothyroidism, hypopituitarism,
Addisons disease, extensive liver
disease, insulin overdose, starvation.
BUN
Adult Normals:
6-22 mg/dl
Critical Values:
>100
Symptoms of Imbalances
Alkalosis: Confusion, Muscle
twitching, Hand tremor, tetany,
Nausea, vomiting, Numbness or
tingling in the face or extremities,
Light-headedness Acidosis: Rapid
breathing, confuion, lethargy.
Hyperglycemia: polydypsia,
polyphagia, polyuria, dry mouth,
poor skin turgor, nausea, vomiting,
abdominal pain, weakness,
confusion, blurred vision,
headache, Kussmauls respirations,
acetone breath, coma.
Hypoglycemia: diaphoresis,
tachycardia, anxiety, shakiness,
weakness, hunger, nausea,
headache, irritability, confusion,
behavioral changes, tremors,
seizures, coma.
General Information
for excretion).
Causes of Imbalances
Symptoms of Imbalances
General Information
Measured in serum. Creatinine
is a catabolic product of
creatinine phosphate used in
skeletal muscle contraction and
is excreted entirely by the
kidneys.
144 mEq
Total
130 mEq
Causes of Imbalances
Increased levels:
glomerulonephritis, pyelonephritis,
urinary tract obstruction, reduced
renal blood flow, diabetic
nephropathy, nephritis,
rhabdomyolysis, acromegaly,
gigantism.
Decreased levels: debilitation,
decreased muscle mass.
Unmeasured Anions
Phosphates
Sulfates
Organic acids
(gap of 14 mEq)
Symptoms of Imbalances
References:
Corbett, J.V. (2004) Laboratory Tests and
Diagnostic Procedures with Nursing
Diagnoses, 6th ed., Upper Saddle River, New
Jersey: Prentice Hall.
Pagana, K.D. and Pagana, T.J. (2002)
Mosbys Manual of Diagnostic and
Laboratory Tests, 2nd ed., St. Louis: Mosby.