Calcium and Magnesium Imbalance for Certified Emergency Nursing (CEN)
Included In This Lesson
Outline
Calcium and Magnesium Imbalance
Definition/Etiology:
- Hypocalcemia
- Serum calcium levels below 8.8
- Hypercalcemia
- Serum calcium above 10.2
- Hypermagnesemia
- Serum level above 2.2
- Hypomagnesemia
- Serum level below 1.7
Pathophysiology:
- Hypercalcemia – The principal pathophysiologic alteration in severe hypercalcemia accompanying hyperparathyroidism and malignancy is enhanced osteoclastic bone resorption. Hypercalcemia impairs renal mechanisms that lead to sodium and calcium excretion; PTH and PTHrP acting on renal tubules enhance further calcium reabsorption.
- Hypocalcemia – Hypocalcemia results whenever there is a net efflux of calcium from the extracellular fluid in greater quantities than the intestines or bones can replace. Symptoms are primarily neurological, with the inadequate calcium levels causing hyperexcitability of neuronal membranes.
- Hypermagnesium- The pathophysiology of hypermagnesemia related to excess laxative use is different. In this case, the huge amount of magnesium given through the digestive tract can lead to overwhelming the excretory mechanism, especially in cases with underlying subclinical renal failure
- Hypomagnesemia is an electrolyte disturbance caused when there is a low level of serum magnesium (less than 1.46 mg/dL) in the blood. Hypomagnesemia can be attributed to chronic disease, alcohol use disorder, gastrointestinal losses, renal losses, and other conditions.
Clinical Presentation:
Hypercalcemia:
- Frequent urination and thirst
- Fatigue
- Bone pain
- HA, N/V/D
- Constipation
- Forgetfulness, depression, anxiety
- Muscle aches, cramping, twitches
- flank or thigh pain and polyuria and constipation. Flank and thigh pain secondary to renal calculi. Polyuria from the inhibition of ADH by calcium in the distal tubules.
Hypocalcemia:
- Muscle cramps
- Dry scaly skin, brittle nails
- Confusion, memory problems, irritability, restlessness, depression, hallucinations.
- Circumoral parasthesias
- Bleeding abnormalities because calcium assists in th converting prothrombin to thrombin in the coagulation cascade.
- Bronchospasm can lead to laryngeal stridor and seizures secondary to neuromuscular irritability.
Hypermagnesemia:
Non-specific bone pain, anorexia, lethargy, headache, confusion.
Hypomagnesemia:
- Tremors
- Tetany
- fatigue
- back pain.
Collaborative Management:
- Get an EKG STAT
- EKG – prolonged QT with Hypo C – leads to torsades
- Increased calcium predisposes pt to repolarization changes (shortened QT) which can lead to cardiac arrest. Hypercalcemia can enhance digitalis effect.
- In assessing for hypocalcemia, one of the things we can use is Chvostek’s Sign. This entails tapping a finger on the skin above the supramandibular portion of the parotid gland and observing for twitching of the upper lip on the same side as the stimulation.
- Treat with NS to increase calcium excretion, Loop diuretics prevent tubular reabsorption of calcium
Evaluation | Patient Monitoring | Education:
- Symptom reduction?
- Serial labs for return to baseline.
- Continued cardiac monitoring
- Education based on underlying cause of imbalance
Linchpins: (Key Points)
- Labs labs labs
- Heart guard
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Emergency Nurses Association. (2022). Emergency Nursing Orientation 3.0. Cambridge, MA: Elsevier, Inc.
- Sheehy, S. B., Hammond, B. B., & Zimmerman, P. G. (2013). Sheehy’s manual of emergency care (Vol. 7th Edition). St. Louis, MO: Elsevier/Mosby.
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System