Hospitalized patients are at an increased risk of electrolyte imbalance meaning simply they are more susceptible to changes in their electrolyte levels that could potentially compromise their health. Electrolytes are a vital part of normal body function. The electrolytes help maintain electrical neutrality in cells. Likewise, they help to generate and conduct action potentials in the body’s nerves and muscles. When these levels are abnormal patients may experience abnormal bodily functions and at times these abnormalities can cause life-threatening situations.
Causes
Several factors can contribute to electrolyte abnormalities. Some of the potential causes include:
- Vomiting
- Diarrhea
- Excessive or insufficient fluid volume
- Other medical conditions (i.e. renal failure, congestive heart failure, hypothyroidism)
- Medications (i.e. diuretics)
Signs and Symptoms
Hypernatremia
Hyponatremia
Hyperkalemia
Hyperkalemia – serum potassium level > 5.0 mEq/L (5.0 mmol/L)
- Muscle weakness
- Nausea
- Life threatening cardiac dysrhythmias
Hypokalemia
Hypokalemia – serum potassium level < 3.5 mEq/L (3.5 mmol/L)
- Muscle weakness and muscle spasms
- Tingling, numbness
- Fatigue
- Light-headedness
- Palpitations
- Constipation
- Bradycardia
- Severe cases can cause cardiac arrest
Hypercalcemia
- Thirst
- Renal stones
- Anorexia
- Urinary frequency
- Confusion
- Abdominal pain
- Fatigue
- Lethargy
- Nausea and vomiting
Read more on hypercalcemia.
Hypocalcemia (can be very mild to severe)
- Muscle pains
- Bronchospasm
- Life threatening cardiac arrhythmias
Read more on hypocalcemia.
Hypermagnesemia
- Nausea and vomiting
- Respiratory distress
- Muscle weakness
- Cardiac arrhythmias
- Hypotension
Hypomagnesemia
- Muscle weakness and spasms
- Cramps
- Fatigue
Hyperphosphatemia
- Muscle spasms and cramping
- Weakness
- Itching
Hypophosphatemia
- Cardiac arrhythmias
- Respiratory distress
- Irritability
- Confusion
Hyperchloremia
- Thirst
- Pitting edema
- Dehydration
- Vomiting and/or diarrhea
- Respiratory distress
- Confusion
Hypochloremia
- Dehydration
- Hyponatremia
- Nausea and vomiting
- Respiratory distress
- Muscle weakness
- Diaphoresis
Expected Outcomes
- Patient will maintain normal electrolyte levels (serum potassium, sodium, calcium, magnesium, and phosphorus)
- Patient will maintain normal fluid balance
- Patient will maintain adequate hydration
- Patient will maintain normal kidney function
- Patient will maintain normal sinus rhythm
- Patient will have decrease/absent edema
- Patient will verbalize understanding of nutritional status and ways to maintain normal electrolyte levels
Nursing Assessment for Risk for Electrolyte Imbalance
1. Auscultate heart sounds.
Patients with electrolyte imbalances are more likely to develop cardiac abnormalities.
2. Assess cardiac rhythm.
Cardiac dysrhythmias are common when electrolyte abnormalities are present.
3. Assess vital signs routinely.
Electrolyte abnormalities can lead to arrhythmias and respiratory failure.
4. Assess mental status.
Severe electrolyte abnormalities can cause a change in mentation and confusion.
5. Monitor intake and output.
Excessive fluid intake or insufficient fluid intake can cause abnormalities in electrolytes Page Break.
6. Assess respiratory status and auscultate breath sounds.
Severe electrolyte abnormalities can cause respiratory distress and lead to respiratory failure.
7. Assess laboratory values.
Patients at risk of electrolyte imbalances should have routine lab work completed to monitor for any changes so that treatment and supplements are not delayed.
8. Assess patient’s overall medical history.
This will help the nurse to potentially pinpoint a cause of any imbalances or what condition may put the patient most at risk of an electrolyte imbalance.
9. Assess pain level.
Electrolyte abnormalities can cause discomfort (i.e. muscles cramps/abdominal cramping).
Nursing Interventions for Risk for Electrolyte Imbalance
1. Weigh patient daily.
Regular monitoring of patient’s weight will indicate if there is fluid volume excess which could cause changes in electrolyte levels.
2. Administer pain medication as appropriate.
Electrolyte abnormalities may cause discomfort and patients may need treatment for pain.
3. Provide intravenous or oral hydration as needed.
Patients are more prone to electrolyte imbalances when experiencing vomiting and/or diarrhea – ensure patient is maintaining appropriate hydration status.
4. Supplement electrolyte levels as appropriate and as ordered by the healthcare provider.
If patients’ electrolyte levels are low additional supplements may be needed orally or intravenously to maintain appropriate levels, administer these as ordered by the healthcare provider.
5. Administer oxygen as needed.
Electrolyte imbalances can cause respiratory distress/failure – monitor closely and if needed supply supplemental oxygen therapy.
6. Educate patient and family on signs and symptoms of electrolyte abnormalities.
This will help to provide the patient with more independence at home in managing their care and preventing further complications or episodes of electrolyte abnormalities.
7. Educate patient and family member on the importance of balanced nutritional state and importance of hydration.
This will help patients to understand how their nutritional status affects their electrolyte levels.
8. Educate patient and family members on the importance of taking medications as prescribed and what their specific medications are used for.
Understanding their individualized medication regimen will help the patient to develop more independence in their care and can help them to be more compliment with their medications.
References and Sources
- Ackley, B.J., Ladwig, G.B., Flynn Makic M.B., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing diagnosis handbook: An evidence-based guide to planning care (12th edition). Mosby.
- American Heart Association. (2005). Part 10.1: Life-threatening electrolyte abnormalities. Circulation 112 (24). https://doi.org/10.1161/CIRCULATIONAHA.105.166563
- Burke, A. (2021). Fluid and electrolyte imbalances: NCLEX-RN. https://www.registerednursing.org/nclex/fluid-electrolyte-imbalances/
- Shrimanker I, Bhattarai S. Electrolytes. 2021 Jul 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 31082167.
