Question

‏Describe the cause, clinical manifestations, management, and nursing interventions for the following imbalances: calcium deficit (hypocalcemia) and calcium excess (hypercalcemia); magnesium deficit (hypomagnesemia) and magnesium excess (hypermagnesemia); phosphorus deficit (hypophosphatemia) and phosphorus excess (hyperphosphatemia); chloride deficit (hypochloremia) and chloride excess (hyperchloremia).

Answer 1

calcium deficit (hypocalcemia)

Hypocalcemia is a condition in which there are lower-than-average levels of calcium in the liquid part of the blood, or the plasma.

causes

• not enough calcium or vitamin D in your diet
• infections
• some medications, such as phenytoin (Dilantin), phenobarbital, and rifampin
• stress
• anxiety
• intense exercise
• irregular magnesium or phosphate levels
• kidney disease
• diarrhea, constipation, or other intestinal disorders that prevent your body from absorbing calcium properly

clinical manifestation

• muscle stiffness
• muscle spasms
• paresthesias, or feelings of pins and needles, in the extremities
• changes in mood, such as anxiety, depression, or irritability
• memory issues
• hypotension
• difficulty speaking or swallowing
• fatigue
• parkinsonism
• papilledema, or swelling of the optic disc

TREATMENT

Some cases of hypocalcemia go away without treatment. Some cases of hypocalcemia are severe and can even be life-threatening. If you have an acute case, your doctor will most likely give you calcium through your vein, or intravenously. Other treatments for hypocalcemia include:

Medications

Many hypocalcemia cases are easily treated with a dietary change. Taking calcium, vitamin D, or magnesium supplements, or eating foods with these can help treat it

2)HYPERCALCEMIA

CAUSES

Hyperparathyroidism

Granulomatous diseases, such as tuberculosis and sarcoidosis,

lung cancer, breast cancer, and blood cancers

Dehydration

CLINICAL MANFESTATION

• headaches
• fatigue

Kidneys

Symptoms related to the kidneys include:

• excessive thirst
• excessive urination
• pain between your back and upper abdomen on one side due to kidney stones

Abdomen

Symptoms related to the abdomen include:

• nausea
• abdominal pain
• decreased appetite
• constipation
• vomiting

Heart

High calcium can affect the electrical system of the heart, causing abnormal heart rhythms.

TREATMENT

• Calcitonin is a hormone produced in the thyroid gland. It slows down bone loss.
• Intravenous fluids hydrate you and lower calcium levels in the blood.
• Corticosteroids are anti-inflammatory medications. They’re useful in the treatment of too much vitamin D.
• Loop diuretic medications can help your kidneys move fluid and get rid of extra calcium, especially if you have heart failure.
• Intravenous bisphosphonates lower blood calcium levels by regulating bone calcium

HYPOMAGNESEMIA

cause

Celiac disease, Crohn’s disease, and chronic diarrhea,TYPE 2 DIABETES,alcohol dependance

symptoms

• nausea
• vomiting
• weakness
• decreased appetite

treatment- dietary changes,

Examples of magnesium-rich foods include:

• spinach
• almonds
• cashews
• peanuts
• whole grain cerea

HYPER MAGNESEMIA

cause is kidney failure

symptoms:

• diarrhea
• nausea and vomiting
• lethargy
• muscle weakness
• abnormal electrical conduction in the heart
• low blood pressure
• urine retention
• respiratory distress
• cardiac arrest

TREATMENT

intravenous (IV) calcium gluconate to help reverse the effects of excess magnesium. IV furosemide may be given for diuresis and excretion of magnesium if adequate kidney function is intact. Dialysis may need to be used to flush magnesium from the body if hypermagnesemia is severe or renal function is poor.

5)HYPOPHOSPHATEMIA

• evere malnutrition, such as from anorexia or starvation
• alcoholism
• severe burns
• a diabetes complication called diabetic ketoacidosis
• the kidney disorder, Fanconi syndrome
• an excess of parathyroid hormone (hyperparathyroidism)
• chronic diarrhea

SYMPTOMS

• muscle weakness
• fatigue
• bone pain
• bone fractures
• appetite loss
• irritability
• numbness
• confusion

TREATMENT

You can correct mild symptoms, and prevent low phosphate in the future, by adding more phosphate into your diet. Milk and other dairy foods are good sources of phosphate. Or, you can take a phosphate supplement. If your vitamin D levels are low, you’ll also need to increase your intake of this vitamin.

If your hypophosphatemia is severe, you may need to get high doses of phosphate through a vein (IV).

HYPERPHOSPHATEMIA

• low parathyroid hormone levels (hypoparathyroidism)
• damage to cells
• high vitamin D levels
• diabetic ketoacidosis — high levels of acids called ketones in the blood of people with diabetes
• injuries — including those that cause muscle damage
• serious body-wide infections

SYMPTOMS

• muscle cramps or spasms
• numbness and tingling around the mouth
• bone and joint pain
• weak bones
• rash

TREATMENT

• reduce the amount of phosphate in your diet
• remove extra phosphate with dialysis
• lower the amount of phosphate your intestines absorb using medication

chloride deficit (hypochloremia)

causes

• congestive heart failure
• prolonged diarrhea or vomiting
• chronic lung disease, such as emphysema
• metabolic alkalosis, when your blood pH is higher than normal

symptoms

• fluid loss
• dehydration
• weakness or fatigue
• difficulty breathing
• diarrhea or vomiting, caused by fluid loss

TREATMENT :If your hypochloremia is mild, then it can sometimes be corrected by an adjustment to your diet. This could be as simple as consuming more sodium chloride (salt).

chloride excess (hyperchloremia)

CAUSES

• intake of too much saline solution while in the hospital, such as during a surgery
• severe diarrhea
• chronic or acute kidney disease
• ingestion of salt water
• extremely high ingestion of dietary salt
• bromide poisoning, from bromide-containing drugs

SYMPTOMS

• fatigue
• muscle weakness
• excessive thirst
• dry mucous membranes
• high blood pressur

TREATMENT

• For dehydration, treatment will include hydration.
• If you received too much saline, the supply of saline will be stopped until you recover.
• If your medications are causing the issue, your doctor might modify or stop the medication.
• For a kidney problem, you’ll likely be referred to a nephrologist, a doctor specializing in kidney health. You may need dialysis to filter your blood in place of your kidneys if your condition is severe.
• Hyperchloremic metabolic acidosis may be treated with a base called sodium bicarbonate.