Bicarbonate (HCO3-)
22 - 26 mEq/L
Chloride (Cl-)
96 - 106 mEq/L
Phosphate (PO4^3-)
2.4 - 4.4 mEq/L
Potassium (K+)
3.5 - 5.0 mEq/L
Magnesium (MG2+)
1.5 - 2.5 mEq/L
Sodium (Na+)
135 - 145 mEq/L
Calcium (Ca 2+)
8.6 - 10.2 mEq/L
Normal Plasma Osmolality
280 - 295 mOsm/kg
Hypokalemia: Assessment: "CRAMPS
Complications of GI losses*R*eflexes decreased; ResReflexes decreased; *R*espirations low and shallow*A*rrhythmias and AArrhythmias and *A*bdominal distention Muscle CrampsPulse - Irregular and weak; low BPSerum K = <3.5
Hypokalemia: Interventions: "POTASSIUM
Potatoes, avocados, bananas (food high in K)Oral potassiumT waves flat or depressed (monitor) Arrhythmias (monitor) Shallow respiration (monitor)Sounds of breathing diminished (monitor) IV supplement is never a push Urine output (monitor) Muscle cramping = fall precautions
Hypokalemia: Evaluation: No "CRAMPS
Complications of GI are goneReflexes WNL, Respiration WNLArrhythmias are goneMuscle cramps are gonePulse WNLSerum K is 3.5 - 5.0
Hyperkalemia: Assessment: "DEATH
Dysrhythmias - irregular and bradycardiaEKG changes - Tall T waveAbdominal cramping - diarrheaThe muscles twitch Hypotenison; Irritable, restless
Hyperkalemia: Interventions: "STOPS
Stop infusion of IV potassiumTall T waves = telemetry and vital signs Orders = Kayexalate or dextrose with insulin Potassium restricted foods and potassium losing diuretics Salt substitutes NOT allowed
Hyperkalemia: Evaluations: No "DEATH
Dyrhythmias goneEKG changes are goneAbdominal cramping and diarrhea are not thereThe muscle twitch is goneHypotension, irritability restlessness not present
Hypocalcemia: Assessment: "TWITCH"He's a skinny CAT
Trousseau's signWatch for dysrhythmias - prolonged QT intervalIncrease in bowel sounds, diarrheaTetany, twitching, tinglingChvostek's SignHypotension
Hypocalcemia: Interventions: "SAFE"He's a skinny CAT
Seizure precautionsAdminister calcium supplementsFoods high in calciumEmergency equipment on standby
Hypocalcemia: Assessment: No "TWITCH"He's a skinny CaT
Trousseau's sign goneWatch for dysrhythmias goneIncrease in bowel sounds, diarrhea not presentTetany, twitching, tingling goneChvostek's Sign goneHypotension BP WNL
Hypercalcemia: Assessment: "CALCIUM" He's a fat CaT
Cardiac dysrhthmias - shortened QT. IntervalA norexia, nausea, vomitingLOC decreasedCalcium level >10.5Increase in drowsinessUnderactive reflexesMuscle weakness
Hypercalcemia: Interventions: "The 7 Fs" He's a fat CaT
1) Fluids to promote excretion2) Furosemide (lasix) 3) Foods low in Calcium4) Fiber5) Focus on VS6) Fall prevention7) Fractures (monitor for pathological)
Hypercalcemia: Evaluation: No "CALCIUM" He's a fat CaT
Cardiac dysrhthmias - noneA norexia, nausea, vomiting - not presentLOC decreased - WNLCalcium level >10.5 - WNLIncrease in drowsiness - not presentUnderactive reflexes - not presentMuscle weakness - not present
Hypomagnesemia: Assessment "TWITCH
Trousseau's signWatch for dysrhythmiasIncrease neruomuscular excitability; Inspiration laryngeal stridorTetany, twitching, tinglingChvostek's SignHypoactive bowel sounds, constipation
Hypomagnesemia: Interventions: "SAFE
Seizure precautionsAdminister magnesium sulfate per orderFoods high in magnesiumEmergency equipment on standby
Hypomagnesemia: Assessment No "TWITCH
Trousseau's sign - goneWatch for dysrhythmias - goneIncrease neruomuscular excitability; Inspiration laryngeal stridor - goneTetany, twitching, tingling - goneChvostek's Sign - goneHypoactive bowel sounds, constipation - not present
Hypermagnesemia: Assessment: "MAGNESIUM
Mg level >2.1ArrhythmiasGets flushed, diaphoreticNeuromuscular excitabilityEvaluate for low BP, Low HR, Low RRSensorium (LOC) decreasedIncreased RR depression (trend)Underactive reflexes Muscle weakness
Hypermagnesemia: Interventions: "DOME
Decrease magnesium intakeOrder for diuretics if stable renal functionMonitor closely for seizures neurological Evaluate VS, LOC, reflexes, EKG
Hypermagnesemia: Evaluation: "No MAGNESIUM
Mg level normalArrhythmias - goneGets flushed, diaphoretic - goneNeuromuscular excitability - WNL; no N/VEvaluate for low BP, Low HR, Low RR - goneSensorium (LOC) WNLIncreased RR depression (trend) - noneUnderactive reflexes - WNLMuscle weakness - not present