Electrolyte Imbalances: Phosphate and Magnesium Imbalances

1. Phosphate & Magnesium imbalances

2. UNIT –IICOMMON SIGNS & SYMPTOMS TOPIC: Electrolyte imbalances-phosphate and magnesium imbalances Prepared by, Mrs. AnjuUllas Lecturer Dept. of Medical Surgical Nursing Yenepoya Nursing College

3. Hypophosphatemia Meaning Hypophosphatemia is an electrolyte disturbance in which there is an abnormally low level of phosphate in the blood. Hypophosphatemia is defined as: • Mild 2-2.5 mg/dL • Moderate 1-2 mg/dL • Severe < 1 mg/dL

4. Etiology and risk factors • loss or long term lack of intake • increased growth or tissue repair and recovery from malnourished states. • Prolonged and excessive intake of antacids. • Increased sodium found in Cushing’s syndrome, • Increased calcium found in hyperparathyroidism. • Phosphate loss occurring in burns and metabolic alkalosis

5. Pathophysiologic changes Phosphate depletion impairs the conversion of glucose and many other intermediate substances to ATP. The ultimate result is the disruption in the sole mechanism responsible for regeneration of ATP. This depletion can affect almost all the organ systems.

6. Clinical manifestations • Decreased cardiac and respiratory functions • Muscle weakness • Brittle bones, bone pain • Confusion and seizure

7. Management • Diet and dietary supplementation • Total parenteral nutrition is the intervention till the phosphate level become stable

8. Hyperphosphtemia Meaning Hyperphosphatemia is an electrolyte disturbance in which there is an abnormally elevated level of phosphate in the blood, ie. serum phosphate concentration > 4.5 mg/dL

9. Etiology and risk factors foods rich in phosphate Increased colonic motility Addison’s disease Renal failure Tumor lyses syndrome

10. Clinical manifestations • Tachycardia, palpitations and restlessness. • Anorexia, nausea, vomiting. • Tetany, serious dysrrythmias. • All the clinical features of hypocalcemia

11. Management Severe, renal failure moderate Hyper phosphatemia mild hyper phosphatemia limiting the high phosphate foods like Milk and Milk products calcium or Aluminum products that promotes the binding and excretion of phosphate. DIALYSIS

12. MAGNESIUM IMBALANCES

13. Hypomagnesemia Meaning Hypomagnesemia is an electrolyte disturbance in which there is a low level of magnesium in the blood. Normal magnesium levels are between 1.46–2.68 mg/dL (0.6-1.1 mmol/L) with levels less than 1.46 mg/dL (0.6 mmol/L) defining hypomagnesemia.

14. Etiological factors Other electrolyte imbalances malnutrition; Mal-absorption syndromes critically ill and alcoholics acute renal failure IV or TNP therapy without magnesium replacement hyperglycemia phosphorus in the intestine Estrogen therapy medications

15. Clinical features • myocardial irritability • GI changes from decreased contractility • Neuromuscular changes • Cardiac abnormalities

16. Management • oral magnesium replacement in the form of magnesium-containing antacids or parenteral magnesium sulfate. • Increase in dietary intake of magnesium • IV magnesium reduces the tendency of the small airways to spasm and has been found useful in treating acute asthma that has been refractory to other treatment

17. Hypermagnesemia Hypermagnesemia is an electrolyte disturbance in which there is a high level of magnesium in the blood, with levels greater than 2.68 mg/dL (1.1 mmol/L) defining hypermagnesemia.

18. Etilology and risk factors • renal insufficiency • excessive use of magnesium-containing antacids or laxatives • administration of potassium sparing diuretics • severe dehydration from ketoacidosis • overuse of IV magnesium sulfate

19. drowsiness, LOC decrase in muscle activity hypotension. ECG changes delayed myocardial conduction severe muscle weakness, lethargy CLINICAL MANIFESTATIONS:

20. Management • Management of hypermagnesemia includes decreasing the use of magnesium sulfate. • Saline infusionswith a diuretic increases renal eliminationof magnesium. • IV calcium may also be used otantagonixe the effect of hypermagnesemis. • Albuterol has also been used to reduce magnesium levels. • The presence of severe respiratory distresses require ventilatory assistance. • If renal failure is present, hemodialysis may be necessary

21. Nursing management

22. Assessment • Serum electrolyte levels • ECG – continuous cardiac monitoring • Deterioration in the general condition of the patient • Hydration status • Urine output • Functions of various organs and systems • Weight monitoring

23. Nursing diagnoses • Risk for injury related to unstable electrolyte levels • Risk for activity intolerance related to muscular weakness secondary to electrolyte imbalances. • Risk for decreased cardiac output related to improper cardiac muscle action secondary to electrolyte imbalances. • Risk for impaired skin integrity related to loss of fluids and electrolyte imbalances.

28. In Brief The Nurses’ Role Can Be Explained As Follows Teaching Promoting Assisting Ensuring

29. Summary In this topic we have discussed about the definition, causes, pathophysiology, clinical manifestation and management of phosphate and magnesium imbalances

30. Conclusion Electrolytes are chemicals in the body that regulate important physiological functions. Electrolyte imbalance causes a variety of symptoms that can be severe. These can be life-threatening if not managed appropriately.

31. Evaluation • define phosphate imbalances • enlist the causes and phosphate imbalances • explain the clinical manifestation and management of phosphate imbalances • definemagnesium imbalances • enlist the causes and pathophysiologyof magnesium imbalances • explain the clinical manifestation and management of magnesium imbalances

32. Reference • Black MJ. Textbook of Medical Surgical Nursing.7thed.St. louis:Saunders • Brunner. Text book of Medical Surgical Nursing.6thed.Philadelphia:Saunders; • Linda S Williams. Understanding Medical Surgical Nursing. 5th ed. Jaypee • Dr. Ajay H. Emergencies in medical practice. 5th edition