Electrolyte Imbalances: Sodium, Potassium, and Chloride.

Andrew Jo, RSN; Brandi Johnson, RSN; Jasmine Jones, RSN

Professional Nursing I (NUR2349) - Melissa McGarry.

DISEASE LABORATORY VALUES MEDICATIONS

Hypokalemia: Potassium < 3.5 mEq/L Captopril (Capoten): ACE Inhibitor -
Sodium imbalance Prevents vasoconstriction, enabling
Hyperkalemia: Potassium > 5.0 meq/L increased circulation of fluids.
Hyponatremia
Hyponatremia: Sodium < 135 mEq/L Furosemide (Lasix): Loop Diuretic
Hypernatremia Reduces excess fluid, which can help
Potassium imbalance Hyponatremia: Sodium > 145 mEq/L rebalance sodium and water, and is COMMUNITY RESOURCES
potassium-wasting.
Hypokalemia Hypochloremia: Chloride < 95 mEq/L Sodium Chloride: IV fluid/supplement
**For serious emergencies, call 911 or go to the
Hyperkalemia Hyperchloremia: Chloride > 105 mEq/L Functions to replace deficits when Emergency Department of any local hospital.**
needed.
Chloride imbalance Potassium Chloride: IV fluid/supplement Marion County Health Department (Ocala)
INTERVENTIONS - Functions to replace deficits when 1801 SE 32nd Ave.
Hypochloremia Ocala, FL 34471.
Hyponatremia needed. 352-629-0137
Hyperchloremia Tolvaptan (Samsca): Vasopressin
Monitor I & Os & Na + levels. Antagonist Increases renal water Alachua County Health Department (Gainesville)
KEY POINTS Increase intake of sodium excretion and increased serum sodium.
224 SE 24th St.
Gainesville, FL 32641.
Potassium is a key electrolyte in (PO/IV). 352-334-7900
cellular metabolism NURSING DIAGNOSES
Skin care may be needed; at risk
Potassium regulates conduction of
for dehydration. Electrolyte Imbalance
cardiac rhythm QSEN
Hypernatremia Risk for dysrhythmias
Potassium transmits electrical
Fatigue Safety - strict monitoring of fluids
impulses in multiple body systems Monitor I & Os & Na+ levels.
Risk for injury and electrolyte levels can prevent
Potassium assist with acid-base Monitor vital signs & level of serious complications.
imbalance Risk for confusion
consciousness Patient-centered care -
Sodium interacts with calcium to Risk for knowledge deficit
Restrict sodium in diet integration of nursing
maintain muscle contraction
Increase water intake DIAGNOSTIC interventions per each imbalance
Sodium stimulates conduction of with patients health and well-
nerve impulses Hypokalemia Osmolality blood/urine test to check waters balance.
Helps diagnose electrolyte imbalance. being in mind.
Sodium primary function is to Monitor I & Os & K+ levels. Comprehensive Metabolic Panel (CMP) blood test that
regulate fluid volume
measures chemical imbalance. Differentials (%) could be Informatics - Laboratory ranges
If the client is taking Digoxin determined as well.
of each electrolyte in nursing
When sodium is reabsorbed in the monitor pulse & observe for Urine Test Urine sample that can determine the cause of
an abnormal electrolyte blood levels (whether or not the informatics.
kidneys, water and potassium are toxicity
kidneys are removing sodium from the body).

also reabsorbed, maintaining ECF
volume
When hyponatremic, client is at risk
for dehydration.
Chloride works with sodium to
maintain osmotic pressure between
fluid compartments
Chloride is essential for production
of HCl for gastric secretions
Chloride assists with acid-base
balance
(Treas & Wilkinson, 2014, p. 1387-1391).
Encourage the intake of foods
high in potassium.
COMPLICATIONS/EDUCATIO
Hyperkalemia
Hypernatremia: Thirst, weakness,
Monitor I & Os & K+ levels.
Caution about potassium rich food
intake in patients with
elevated creatinine.
(Gulanick, 2017)
(Gulanick, 2017). EBP - Electrolyte imbalances can
cause further complications in the
healing process (cardiac
dysrhythmias and dehydration).
N nausea, confusion,
muscle twitching, hemorrhage in brain.
Avoid food high in sodium (canned veggies, processed
Quality Improvement - We are
food, snacks and condiments). always able to enhance the
Increase fluid intake.
Hyponatremia: Brain swelling, gait instability, adrenal patients healing process by
insufficiency, CHF, attention deficit.
Encourage intake of food/fluids high in sodium.
personalizing their care to their
Skin care may be needed with dehydration (Gulanick, needs.
2017).
Hyperchloremia: dyspnea, tachycardia, edema, LOC,
cognitive changes, weakness, muscle spasms, hyperflexia, Teamwork - Interdisciplinary:
mood, and patient level of education on medications, injury, or
disease process. dietician, physician, nutritionist,
Hypochloremia: tremors/twitching, respiratory exacerbation,
drop in BP, heart rate and rhythm, assess LOC.
pharmacy, etc.
REFERENCES
Hyperkalemia: Ventricular fibrillation, shortness of breath, Gulanick, M., & Myers, J. L. (2017). Nursing Care Plans: Diagnoses, Interventions, & Outcomes (9th ed.). St.
death. Louis, MI: Elsevier.

Hypokalemia: Weakness, cardiac arrhythmias, cardiac Treas, L. S., & Wilkinson, J. M., (2013). Basic nursing: Concepts, skills & reasoning. [Bookshelf Online].
Retrieved from https://online.vitalsource.com/#/books/9780803640542/
arrest, myopathy, paralysis.