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Na, K, Ca, Mg, Phosphate 불균형

NCLEX Review Guide: Fluid, Electrolyte & Acid-Base Balance

Sodium (Na+) Imbalances

Hyponatremia (Na+ < 135 mEq/L)

  • Causes: SIADH, excessive water intake, diuretics, heart failure, kidney disease
  • Signs/Symptoms: Confusion, seizures, muscle cramps, nausea, headache, altered mental status
  • Critical Alert: Rapid correction can cause central pontine myelinolysis - correct slowly!

Hypernatremia (Na+ > 145 mEq/L)

  • Causes: Dehydration, diabetes insipidus, excessive salt intake, fever
  • Signs/Symptoms: Thirst, dry mucous membranes, restlessness, seizures, coma
  • Priority Intervention: Replace water deficit slowly to prevent cerebral edema

Key Points

  • Normal Na+ range: 135-145 mEq/L
  • Sodium follows water - assess fluid volume status
  • CNS symptoms occur with both high and low sodium

Potassium (K+) Imbalances

Hypokalemia (K+ < 3.5 mEq/L)

  • Causes: Diuretics, diarrhea, inadequate intake, hyperaldosteronism
  • Signs/Symptoms: Muscle weakness, fatigue, cramping, cardiac dysrhythmias, paralytic ileus
  • Cardiac Risk: Flattened T waves, U waves, increased risk of digoxin toxicity

Hyperkalemia (K+ > 5.0 mEq/L)

  • Causes: Kidney failure, ACE inhibitors, tissue breakdown, acidosis
  • Signs/Symptoms: Muscle weakness, paresthesias, cardiac arrest
  • Life-threatening: Peaked T waves, widened QRS, can lead to cardiac arrest

Memory Aid: Potassium

MURDER: Muscle weakness, Urine changes, Respiratory paralysis, Decreased cardiac contractility, Early signs GI, Reflexes decreased

Key Points

  • Normal K+ range: 3.5-5.0 mEq/L
  • Never give IV potassium as bolus - always dilute and infuse slowly
  • Monitor ECG changes closely

Calcium (Ca2+) Imbalances

Hypocalcemia (Ca2+ < 8.5 mg/dL)

  • Causes: Hypoparathyroidism, vitamin D deficiency, pancreatitis, hypoalbuminemia
  • Signs/Symptoms: Tetany, Chvostek's sign, Trousseau's sign, laryngospasm, seizures
  • Emergency: Laryngospasm can cause airway obstruction

Hypercalcemia (Ca2+ > 10.5 mg/dL)

  • Causes: Hyperparathyroidism, malignancy, prolonged immobilization, vitamin D excess
  • Signs/Symptoms: "Stones, bones, groans, psychiatric moans" - kidney stones, bone pain, constipation, confusion

Memory Aid: Calcium

CATS: Convulsions, Arrhythmias, Tetany, Spasms (Low Ca2+)

SMASHED: Stupor, Muscle weakness, Arrhythmias, Stones, Hypercalciuria, Excessive urination, Digestive upset (High Ca2+)

Magnesium (Mg2+) Imbalances

Hypomagnesemia (Mg2+ < 1.5 mEq/L)

  • Causes: Alcoholism, malabsorption, diuretics, diabetes
  • Signs/Symptoms: Similar to hypocalcemia - tetany, seizures, personality changes
  • Important: Hypomagnesemia can cause refractory hypokalemia and hypocalcemia

Hypermagnesemia (Mg2+ > 2.5 mEq/L)

  • Causes: Kidney failure, excessive antacid use, eclampsia treatment
  • Signs/Symptoms: Muscle weakness, decreased reflexes, respiratory depression, cardiac arrest
  • Antidote: Calcium gluconate reverses magnesium toxicity

Key Points

  • Normal Mg2+ range: 1.5-2.5 mEq/L
  • Magnesium is essential for potassium and calcium balance
  • Check deep tendon reflexes to monitor magnesium levels

Phosphate (PO4³⁻) Imbalances

Hypophosphatemia (PO4³⁻ < 2.5 mg/dL)

  • Causes: Malnutrition, alcoholism, respiratory alkalosis, refeeding syndrome
  • Signs/Symptoms: Muscle weakness, respiratory failure, decreased cardiac contractility, confusion

Hyperphosphatemia (PO4³⁻ > 4.5 mg/dL)

  • Causes: Kidney failure, excessive vitamin D, tumor lysis syndrome
  • Signs/Symptoms: Usually asymptomatic, but can cause hypocalcemia symptoms
  • Key Relationship: Phosphate and calcium have inverse relationship

Commonly Confused Points

Electrolyte Low Symptoms High Symptoms Key Memory Aid
Sodium CNS depression, seizures CNS irritability, thirst Water follows sodium
Potassium Muscle weakness, flat T waves Muscle weakness, peaked T waves Both cause weakness!
Calcium Tetany, spasms Muscle weakness, stones Low = hyperexcitable
Magnesium Like low calcium CNS depression Affects Ca2+ and K+

Clinical Scenario

A patient receiving furosemide (Lasix) develops muscle cramps and fatigue. ECG shows flattened T waves. What electrolyte imbalance is most likely, and what is the priority intervention?

Answer: Hypokalemia from diuretic use. Priority: Check serum K+ level and replace potassium safely (never IV push).

Study Tips & Quick Checks

NCLEX Success Tips

  1. Always consider the opposite electrolyte when one is abnormal (Ca2+ ↔ PO4³⁻)
  2. Look for medication causes - diuretics are common culprits
  3. Assess cardiac symptoms first - they're life-threatening
  4. Remember safe administration - never rapid IV electrolyte replacement

Quick Check - Can you identify?

  • ☐ Normal ranges for all 5 electrolytes
  • ☐ Which electrolytes cause cardiac dysrhythmias
  • ☐ Signs of tetany vs. muscle weakness
  • ☐ Safe IV administration principles
  • ☐ When to check magnesium with other imbalances

Common Pitfalls

  • Don't confuse muscle weakness causes - both high and low K+ cause weakness
  • Remember: Correct magnesium FIRST before correcting calcium or potassium
  • Never give IV potassium faster than 10 mEq/hour through peripheral line

You've got this! Master these electrolyte basics and you'll confidently tackle NCLEX questions. Remember: Safety first, assess systematically, and trust your nursing knowledge! 💪🩺

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