• Electrolytes are found in body fluids and cells, and play a role in many basic cell functions, like sending
nerve signals to muscles.
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Sodium (Na+)
• Helps maintain the body's water content and fluid balance
• Plays an important role in keeping acids and alkaline substances in balance in the body and helps transmit nerve signals.
• Hypernatremlia is too much sodium in the blood. Symptoms can include intense thirst, flushed skin, fever, seizures, and death.
• Hyponatremia or low blood sodium levels can occur in CKD, most often if the dialysate does not have enough sodium. Signs and symptoms can include low blood pressure, muscle cramping, restlessness, anxiety, pain in the access site, headache, and nausea
Potassium (K+)
• Helps control the nerves and muscles - including the heart.
• It helps keep the body's water balance and aids glucose metabolism
• Hyperkalemia - higher-than-normal level of potassium in the blood.
• Causes:
• Eating too many high-potassium foods (dialysis patients)
• Bleeding
• Trauma
• Hemolysis (breakdown of Red Blood Cells)
• Missed treatments
• Symptoms of hyperkalemia:
• Muscle weakness
• Abdominal cramps
• Abnormal heart rhythyms
• May be sudden cardiac arrest with no early warning symptoms.
• Hypokalemia- lower-than-normal blood potassium level.
• Not common in people on dialysis
• Can occur if the patient is vomiting and has diarrhea, has a diet that does not include enough potassium, or has too much potassium removed by dialysis.
• Can be very dangerous, causing fatigue, muscle weakness, and abnormal heart rhythms.
Calcium (Ca++)
• Mainly found in bones and teeth :
• The body needs small, constant levels of calcium in the blood and fluids at all times to control blood clotting, enzyme regulation, hormone action, and nerve and muscle function.
• Hypercalcemia - high blood calcium level.
• Most often due to high doses of Vitamin D or calcium
• Symptoms: Vomiting, weakness, confusion, coma
• Hypocalcemia - low calcium level.
• Most often due to problems with the metabolism and absorption of calcium
• Occurs with hyperphosphatemia
• Symptoms: numbness, seizures, tetany (tremors, muscle spasms, and muscle pain)
Phosphorus (P)
• Like calcium, phosphorus is mainly found in the bones and teeth
• Plays a vital role in the body's use of energy
• Hyperphosphatemia - high phosphorus level
• People whose kidneys don't work can't excrete phosphorus, so it builds up in their blood
• Short term: Can cause severe itching
•Long term: Contributes to bone disease
• Most important problems related to hyperphosphatemia is hypocalcemia and metastatic calcification (calcium phosphate deposits that are found in the skin, eyes, lungs, heart, joint, and blood vessels)
• Hypophosphatemia- low phosphorus level
• In CKD patients, this is most often due to a poor diet or taking too many phosphate binders.
• Mild or moderate hypophosphatemia usually does not have symptoms.
• Symptoms are usually not seen until phosphorus is < l mg/dl and include muscle weakness, paralysis, and problems with the function of red blood cells
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Nurse's Role in Electrolyte Management
• Water system checks are critical. Patients should not start dialysis each day until the water system QA/QC has been completed.
• Double check that the correct dialysate is delivered.
• If you mix dialysate, double check, with other staff person, that you have mixed the solution correctly.
• Encourage patients to follow their prescribed diet and fluid limits. Reinforce what patients are told about diet
and fluids.
• Report all symptoms to the nurse.
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