F10 · Body salts out of balance
Risk Food and fluids
Definition
Levels of salts such as sodium or potassium may become unsafe.- Vomiting
- diarrhea
- kidney disease
- diuretics
- fluid shifts
- Weakness
- cramps
- confusion
- irregular heartbeat
- abnormal blood tests
📋 Scenario
A patient on strong water tablets for heart failure has had two days of diarrhea.
Subjective (S): "I have had loose stools and I am passing a lot of urine."
Objective (O): On high-dose diuretic; 6 loose stools in 24 hours; potassium 3.8 mmol/L (low-normal); pulse regular 80/min; no cramps or weakness.
Assessment tools for this scenario: CP-FLUID Fluid Balance & Nutrition Score CP-ELIM Elimination Check
Validated scales to consider: MUST, fluid chart, glucose, Bristol Stool Chart, bladder scan
**CarePath diagnosis:** Body salts out of balance related to diuretics and diarrhea (risk factors); no signs of the problem are present yet.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Check blood results. | Blood results show potassium and sodium levels so a fall is caught early. |
| Give replacements as ordered. | Replacements restore low salts before they cause weakness or a dangerous heart rhythm. |
| Monitor heart rhythm. | Low potassium can cause an irregular heartbeat, so monitoring detects it early. |
| Report symptoms. | Cramps, weakness or confusion can be the first signs of imbalance, and reporting them prompts testing. |
| Teach diet and medicine advice. | Knowing which foods and medicines help keeps levels safe after discharge. |
**Expected outcomes**
- Within 48 hours: potassium and sodium back in the normal range, no cramps or irregular heartbeat.
- Patient names food and medicine advice.
**Linking the data to the diagnosis**
This is a risk statement: the salt imbalance has not occurred yet. The patient takes a high-dose diuretic and has had 6 loose stools in 24 hours. Potassium is 3.8 mmol/L (low-normal), the pulse is regular at 80/ min, and there are no cramps or weakness. She says she has loose stools and is passing a lot of urine. The diagnosis rests on the risk factors of diuretic use and diarrhea. The plan aims for potassium and sodium in the normal range within 48 hours, no cramps or irregular heartbeat, and the patient naming food and medicine advice.
CarePath diagnosis
Body salts out of balance related to diuretics and diarrhea (risk factors); no signs of the problem are present yet.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Check blood results. | Blood results show potassium and sodium levels so a fall is caught early. |
| 2. Give replacements as ordered. | Replacements restore low salts before they cause weakness or a dangerous heart rhythm. |
| 3. Monitor heart rhythm. | Low potassium can cause an irregular heartbeat, so monitoring detects it early. |
| 4. Report symptoms. | Cramps, weakness or confusion can be the first signs of imbalance, and reporting them prompts testing. |
| 5. Teach diet and medicine advice. | Knowing which foods and medicines help keeps levels safe after discharge. |
Expected outcomes
- Within 48 hours: potassium and sodium back in the normal range, no cramps or irregular heartbeat.
- Patient names food and medicine advice.
Linking the data to the diagnosis
This is a risk statement: the salt imbalance has not occurred yet. The patient takes a high-dose diuretic and has had 6 loose stools in 24 hours. Potassium is 3.8 mmol/L (low-normal), the pulse is regular at 80/ min, and there are no cramps or weakness. She says she has loose stools and is passing a lot of urine. The diagnosis rests on the risk factors of diuretic use and diarrhea. The plan aims for potassium and sodium in the normal range within 48 hours, no cramps or irregular heartbeat, and the patient naming food and medicine advice.