HYPOs and HYPERs Signs and Symptoms

HYPOVOLEMIA	HYPERVOLEMIA
Weak and thready pulse	Bounding pulse
Low blood pressure, orthostatic hypotension	High blood pressure
Flat neck and hand veins	Distended neck and hand veins
Diminished peripheral pulses	Jugular vein distention
Increased respiration	ascites, crackles, dyspnea
lethargy to coma, fever	Altered LOC, headache, visual disturbance
Decrease urinary output	Paresthesia, pitting edema
High  urine specific gravity	Low urine specific gravity
Dry skin, dry mouth, poor skin turgor
Low GIT motility, constipation, thirst,
Weight loss
LAB Result:
High serum osmolality	Low serum osmolality
High hematocrit	Low Hematocrit
High BUN	Low BUN
High serum Na level	Low serum Na level

HYPONATREMIA < 135 mEq/L	HYPERNATREMIA > 145 mEq/L
excessive diaphoresis	oliguria
vomiting	Cushing syndrome
diarrhea	Restlessness, weakness, coma
muscle twitching	fever
convulsion	Flushed skin
hypoaldosterone	hyperaldosterone
hyperactive bowel sounds	Rx: diuretic

HYPOKALEMIA < 3.5 mEq/L	HYPERKALEMIA > 5.1 mEq/L
Muscle weakness and leg cramps	Slow, weak irregular heart rate, decreased BP
ST depression, flat inverted T wave	Tall peak T wave, flat P wave
presence of U waves	Prolonged PR interval
	diarrhea and intestinal colic, muscle twitches, cramps, paresthesia
	Late S/S: muscle weakness, paralysis

HYPOCALCEMIA < 8.6 mg/dL	HYPERCALCEMIA > 10 mg/dL
Muscle spasm, tingling of fingers, paresthesia followed by numbness	Increase heart rate, High blood pressure
(+)Trousseau’s   Chvostek’s sign	Bounding peripheral pulse
Hyperactive bowel sounds, abdominal cramping and diarrhea	Shortened ST segment, widened T wave
Hyperactive tendon reflex
neuromuscular excitability, muscle cramps, twitching, tetany, seizures
Lactose intolerance	Rx: Phosphorus, calcitonin

HYPOMAGNESEMIA < 1.6 mg/dL	HYPERMAGNESEMIA >2.6 mg/dL
Tall T waves, depressed ST segments	Prolonged PR, widened QRS
Hypertension	Hypotension
Tachycardia	Bradycardia
Trousseau’s and  Chvostek’s sign
	Rx: Calcium chloride and gluconate

HYPOPHOSPHATEMIA < 2.7 mg/dL	HYPERPHOSPHATEMIA > 4.5 mg/dL
Hyperparathyroidism	Hypoparathyroidism
Platelet aggregation
Bleeding
Hypercalcemia	Hypocalcemia
Cause: use of aluminum hydroxide-based or magnesium based antacids	Rx: Phosphate binding meds with meals

HYPOGLYCEMIA < 70 mEq/L	HYPERGLYCEMIA > 110 mEqL
Anxiety	Coma
Diaphoresis	Confusion
Hunger	Diaphoresis
Shakiness, palpitation, tremors	Thirst, fatigue
Weakness	Kussmaul respiration, restlessness, weakness
*Administer glucose orally immediately; the rapid releasing sugar is followed by a complex carbohydrate and protein	Polyuria, Polydipsia, Polyphagia
	DM 1-nearly or absolute deficiency of insulin DM 2-insufficient insulin to stabilize fat and protein metabolism
	Diabetic Ketoacidosis (DKA)-life threatening complication of DM1, severe insulin deficiency >300 mg/dL dehydration, ketosis, acidosis- fruity breath, Kussmaul respiration
	Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) without ketosis or acidosis

HYPOTHYROIDISM	HYPERTHYROIDISM
Thyroid gland -regulates the body’s metabolism
Low T3 T4	High T3 T4
Low metabolism rate	High metabolism rate, tachycardia
	Graves disease (autoimmune disorder of hyperactivity of the thyroid gland)
	Thyrotoxicosis
Lethargy, fatigue	Goiter
Intolerance to cold	Heat intolerance
Weight gain	Weight loss
Dry skin	Thyroid storm- fever, tachycardia, hypertension, N&V, diarrhea, anxiety,, seizure, delirium, coma
Bradycardia	Tachycardia
Constipation	Diarrhea
Myxedema coma (hypotension, bradycardia, hypothermia, hypoglycemia, hyponatremia, respiratory failure, coma)	Exopthalmos
Rx: Levothryroxine (Synthroid), Liothyronine (Cytomel), Liotrix	Rx: Propylthiouracil, Methimazole, Potassium Iodide Lugol’s solution, Radioactive iodine
Diet: low calcium, low cholesterol, low fat

HYPOPARATHYROIDISM	HYPERPARATHYROIDISM
Parathyroid hormone regulates calcium, phosphorus, and magnesium balance
Hyposecretion of parathyroid hormone	Hypersecretion of parathyroid hormone
Hypocalcemia	Hypercalcemia
Hyperphosphatemia	Hypophosphatemia
Numbness, tingling of face	Fatigue, muscle weakness
Trousseau’s sign, Chvostek’s sign	Skeletal pain
Tetany	Bone deformities
Dysphagia, photophobia	Anorexia, vomiting, pain, weight loss, constipation
Hypotension	Hypertension, cardiac dysrhythmia
Recommended diet: high in Calcium	Renal stones

HYPOPITUITARISM	HYPERPITUITARISM
Hormones affected: GH growth hormone, LH luteinizing hormone, FSH follicle stimulating hormone, TSH thyroid stimulating hormone, ACTH adrenocorticotropic hormone, ADH antidiuretic hormone
Diabetes insipidus (hyposecretion of ADH antidiuretic hormone) - polyuria, polydipsia Rx: fluid replacement       vasopressin replacement	Large hands and feet, thickening and protrusion of the jaw, arthritic changes, visual disturbances, diaphoresis, oily, rough skin, organomegaly, hypertension, dysphagia, deepening of the voice
	SIADH-Syndrome of inappropriate antidiuretic hormone (excessive ADH)- water intoxication, hyponatremia)
	Cushing disease
	Gigantism, Acromegaly

ADDISON’S DISEASE	CUSHING DISEASE
Hyposecretion of adrenal cortex hormones (glucocorticoids and mineralocorticoids)	Excessive ACTH; excessive cortisol
	Generalized muscle wasting and weakness
Addisonian crisis – acute adrenal insufficiency Ilife threatening) Severe headache, generalized weakness, severe abdominal, leg and lower back pain, irritability and confusion, severe hypotension, shock	Moon face, buffalo hump
Lethargy, fatigue, muscle weakness	truncal obesity with thin extremities, supraclavicular fat pads, weight gain
GIT disturbances, weight loss	Hirsutism (masculine characteristics in women)
Menstrual changes, impotence in men	easy bruising
Hypoglycemia, hyponatremia	hyperglycemia, hypernatremia
	acne
Hyperkalemia, hypercalcemia	hypokalemia, hypocalcemia
Postural hypotension	hypertension
Hyperpigmentation of skin (bronzed) with primary disease	Reddish –purple striae on the abdomen and upper thighs
Diet: High protein, high carbohydrate, normal sodium intake	Nursing priority: prevent fluid overload due to sodium and water retention
Rx: steroid replacement Fludrocortisone acetate (Florinef Acetate)	Rx: hypophysectomy
Conn’s syndrome- hypersecretion of mineralocorticoids (aldosterone) from adrenal cortex caused by adenoma