Potassium (K) 3.5 – 5.0 mEq/L (3.5 – 5.

0 mmol/L)
Hypokalemia Hyperkalemia
Cardiovascular
PR thready, weak, irregular
weak peripheral pulses
Heart Rate slow, weak, irregular
BP ↓ orthostatic hypotension ↓
Respiratory
shallow, ineffective respirations profound weakness of the skeletal
– result from profound weakness of muscles leading to respiratory failure
the skeletal muscles of respiration
diminished breath sounds
Neuromuscular
anxiety Early:
lethargy muscle twitches
confusion cramps
coma paresthesias (tingling and burning
followed by numbness in the hands
and feet and around the mouth)

skeletal muscle weakness
leg cramps
Late:
profound weakness
ascending flaccid paralysis in the
arms and legs (trunk, head, and
respiratory muscles become affected
when serum potassium reaches a
lethal level)

loss of tactile discrimination

paresthesias
deep tendon hyporeflexia
Gastrointestinal
Motility ↓ ↑
Bowel Sounds hypoactive to absent hyperactive
nausea
vomiting
constipation diarrhea
abdominal distention
paralytic ileus
Laboratory Findings
Serum Potassium Level ↓ 3.5 mEq/L (3.5 mmol/L) ↑ 5.0 mEq/L (5.0 mmol/L)
ECG Changes ST depression tall peaked T waves
shallow, flat, or inverted T wave flat P waves
prominent U wave widened QRS complexes
prolonged PR intervals
 Sodium (Na) 135 – 145 mEq/L (135 – 145 mmol/L)
Hyponatremia Hypernatremia
Cardiovascular
symptoms vary with changes in Heart Rate and BP
vascular volume respond to vascular volume status
Normovolemic PR rapid
BP normal
Hypovolemic PR thready, weak, rapid
BP ↓
flat neck veins
normal or ↓ central venous pressure
Hypervolemic PR rapid, bounding
BP normal or ↑
normal or ↑ central venous pressure
Respiratory
shallow, ineffective respiratory pulmonary edema if hypervolemia is
movement present
– late manifestation related to
skeletal muscle weakness
Neuromuscular
generalized skeletal muscle Early:
weakness spontaneous muscle twitches;
– worse in the extremities irregular muscle contractions

Deep Tendon Reflexes
Central Nervous System
Normovolemic/Hypovolemic
Hypervolemic
Gastrointestinal
Motility
Bowel Sounds
Renal
Urine Output
Integumentary
Laboratory Findings
Serum Sodium Level
Urine Specific Gravity
Late:
skeletal muscle weakness;
↓ ↓ or absent
headache altered cerebral function
personality changes – most common manifestation
confusion
seizures
coma
agitation, confusion, seizures
lethargy, stupor, coma
↑
hyperactive
nausea extreme thirst
abdominal cramping
diarrhea
↑ ↓
dry mucous membranes dry and flushed skin
dry and sticky tongue and mucous
membranes
presence / absence of edema
– depending on fluid volume changes
↓ 135 mEq/L (135 mmol/L) ↑ 145 mEq/L (145 mmol/L)
↓ ↑
 Calcium (Ca) 9.0 – 10.5 mg/dL (2.25 – 2.75 mmol/L)
Hypocalcemia Hypercalcemia
Cardiovascular
Heart Rate ↓ Early: ↑
Late: ↓ can lead to cardiac arrest
BP ↓ ↑
Peripheral Pulses ↓ bounding, full
Respiratory
not directly affected; ineffective respiratory movement as
however, a result of profound skeletal muscle
respiratory failure / arrest can result weakness
from ↓ respiratory movement
because of muscle tetany or seizures
Neuromuscular
irritable skeletal muscles: profound muscle weakness
twitches disorientation
cramps lethargy
tetany coma
seizures

painful muscle spasms in the calf /

foot during periods of inactivity

paresthesias followed by numbness

that may affect the lips, nose, and
ears in addition to the limbs

(+) Trousseau’s and Chvostek’s signs

anxiety
irritability
Deep Tendon Reflexes hyperactive ↓ or absent
Renal
Urinary Output varies depending on the cause
Gastrointestinal
Motility ↑ ↓
Bowel Sounds hyperactive hypoactive
cramping anorexia
nausea
abdominal distention
diarrhea constipation
Laboratory Findings
Serum Calcium Level ↓ 9.0 mg/dL (2.25 mmol/L) ↑ 10.5 mg/dL (2.75 mmol/L)
ECG Changes prolonged ST interval, shortened ST segment
prolonged QT interval widened T wave
 Magnesium (Mg) 1.3 – 2.1 mEq/L (0.65 – 1.05 mmol/L)
Hypomagnesemia Hypermagnesemia
Cardiovascular
dysrhythmias
Heart Rate ↑ ↓
BP ↑ ↓
Respiratory
shallow respirations respiratory insufficiency when
skeletal muscles of respiration are
involved
Neuromuscular
twitches ↓ or absent deep tendon reflexes
paresthesias
skeletal muscle weakness
(+) Trousseau’s and Chvostek’s signs

hyperreflexia

tetany
seizures
Central Nervous System
irritability drowsiness and lethargy that
confusion progresses to coma
Laboratory Findings
Serum Magnesium Level ↓ 1.3 mEq/L (0.65 mmol/L) ↑ 2.1 mEq/L (1.05 mmol/L)

ECG Changes tall T waves prolonged PR interval

depressed ST segments widened QRS complexes
 Phosphorus / Phosphate (P) 3.0 – 4.5 mg/dL (0.97 – 1.45 mmol/L)
Hypophosphatemia Hyperphosphatemia
Cardiovascular
↓ contractility and cardiac output ↓ heart rate and BP
Peripheral Pulses ↓ ↓
Respiratory
shallow respirations not directly affected;
however,
respiratory failure / arrest can result
from ↓ respiratory movement
because of muscle tetany or seizures
Neuromuscular
Weakness irritable skeletal muscles:
twitches
↓ bone density cramps
– can cause fractures and alteration tetany
in bone shape seizures

rhabdomyolysis painful muscle spasms in the calf /

(breakdown of damaged skeletal foot during periods of inactivity
muscle)
paresthesias followed by numbness
that may affect the lips, nose, and
ears in addition to the limbs

(+) Trousseau’s and Chvostek’s signs

anxiety
irritability
Deep Tendon Reflexes ↓ hyperactive
Central Nervous System
irritability
confusion
seizures
Hematological
Platelet Aggregation ↓
Bleeding ↑
immunosuppression
Gastrointestinal
Motility ↑
Bowel Sounds hyperactive
cramping

diarrhea
Laboratory Findings
Serum Phosphorus / Phosphate Level ↓ 3.0 mg/dL (0.97 mmol/L) ↑ 4.5 mg/dL (1.45 mmol/L)