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    Electrolyte Imbalance

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    mewilkin
    The document discusses electrolyte abnormalities including high or low sodium, potassium, calcium, and magnesium. It provides the etiologies, signs and symptoms, diagnostic testing, and treatment approaches for abnormalities in each of these electrolytes. Treatment involves gradual correction of electrolyte levels to prevent complications like central pontine myelinolysis.

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    Electrolyte Imbalance

    Uploaded by

    mewilkin
    153 views3 pages
    The document discusses electrolyte abnormalities including high or low sodium, potassium, calcium, and magnesium. It provides the etiologies, signs and symptoms, diagnostic testing, and treatment approaches for abnormalities in each of these electrolytes. Treatment involves gradual correction of electrolyte levels to prevent complications like central pontine myelinolysis.

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    The document discusses electrolyte abnormalities including high or low sodium, potassium, calcium, and magnesium. It provides the etiologies, signs and symptoms, diagnostic testing, and treatment approaches for abnormalities in each of these electrolytes. Treatment involves gradual correction of electrolyte levels to prevent complications like central pontine myelinolysis.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    153 views3 pages

    Electrolyte Imbalance

    Uploaded by

    mewilkin
    The document discusses electrolyte abnormalities including high or low sodium, potassium, calcium, and magnesium. It provides the etiologies, signs and symptoms, diagnostic testing, and treatment approaches for abnormalities in each of these electrolytes. Treatment involves gradual correction of electrolyte levels to prevent complications like central pontine myelinolysis.

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    Electro lyte Na

    Etiology 6 Ds: WATER loss Diuresis Dehydration Diabetes insipidus (DI) Docs iatrogenic Diarrhea Disease kidney Also: Hypertonic Na gain aldosteron/ADH Pure water loss DI Hypotonic fluid loss intake, diarrhea, burns, osmotic dieresis ( mannitol, glucose in DKA)

    S/sx Thirst Oliguria Polyuria DI Neurologic sx Doughy skin

    Labs Na > 145 mEq/L

    Treatment Hypotonic Saline D5Q Oral water GRADUALLY over 48 72 hrs to prevent cerebral edema

    Na

    ADH Osmolality: High > 295 hyperglycemia, hypertonic infusion Normal 280 - 295 triglyceride Low < 280 Volume: 1. Hypervolemic renal failure, nephrotic syndrome, cirrhosis, CHF, hypothyroidism, 2. Euvolemic SIADH, renal failure, drugs 3. Hypovolemic Diuretics ( HCTZ), diarrhea, vomiting, third spacing, dehydration, DKA, 1 adrenal insufficiency Hemolysis Excretion renal insufficiency, drugs (spironolactone, ACEI, NSAIDS), hypoaldosteronism, renal tubular acidosis Cellular shifts rhabdomyolysis, insulin deficiency, acidosis, drugs (digitalis, BB) exercise Iatrogenic

    Asymptomatic Confusion Lethargy Muscle cramps reflexes

    Na < 135

    Hypotonic + : 1. Hypervolemic Water restriction, diuretics 2. Euvolemic water restriction 3. Hypovolemic NS If tx to rapidly central pontine myelinolysis

    N/V Intestinal colic Areflexia Weakness Flaccid paralysis Paresthesias

    K>5 ECG TALL, peaked T waves, wide QRS, PR prolongation, loss P waves cardiac arrest

    C BIG K (mnemonic) Calcium gluconate ECG cardiac cell membrane stabilization Bicarbonate Insulin Glucose Kayexalate remove K + Albuterol Dialysis if severe

    Transcellular shifts insulin, BB, alkalosis GI losses diarrhea, chronic laxative, vomiting, NG suction Renal losses diuretics, DKA, Mg CHIMPANZEES MALIGNANCY, PTH Calcium supplementation Hyperparathyroidism/hyperthyroi dism Iatrogenic/Immobility Milk alkali syndrome Pagets disease Adrenal insufficiency/Acromegaly Neoplasm Zollinger Ellison syndrome Excess vit A Excess vit D Sarcoidosis PTH MG Vit D Acute pancreatitis DiGeorges syndrome infants + tetany

    Ca

    Muscle weakness Cramps Ileus Hypotension Reflexes Fatigue BONES osteopenia, fractures STONES kidney GROANES constipation Psych OVERTONE weakness, fatigue, MS

    K < 3.6 24 hrs UA ECG U waves, T wave flatting, ST depression, AV block arrest >10.2 ECG Q - T

    K repletion + Mg repletion

    IV hydration followed by Furosemide (Loops lose calcium) Severe calcitonin, bisphosphonates, glucocorticoids, dialysis AVOID HCTZ b/c Ca tubular reabsorption

    Ca

    Ca < 8.5 Abdominal cramps Tetany Perioral + acral paresthesias CHVOSTEKS sign facial spasm from tapping of the facial nerve TROUSSEAUS sign carpal spasm after arterial occlusion by BP cuff ECG prolonged QT Recalculate Ca for low Albumin

    Tx underlying d/o Mg repletion Ca supplements

    Mg

    intake loss diuretics, diarrhea, vomiting, Ca, alcoholism

    Sx related to K Ca Muscles cramps

    < 1.5 K Ca ECG prolonged

    IV or oral supplements

    DKA Pancreatitis

    N/V Weakness Severe tetany

    PR and QT

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