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ELECTROLYTE DISORDERS

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Information about ELECTROLYTE DISORDERS
Health & Medicine

Published on October 20, 2008

Author: crisbertc

Source: slideshare.net

Description

ELECTROLYTE DISORDERS
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ELECTROLYTE DISORDERS CRISBERT I. CUALTEROS, MD http://crisbertcualteros.page.tl

HYPONATREMIA Plasma concentration < 135 meq/L

Plasma concentration < 135 meq/L

Generation of Hyponatremia Plasma Na = Na + K/ TBW

Plasma Na = Na + K/ TBW

Sign and Symptoms Lethargy, Apathy Disorientation Muscle cramps Anorexia Nausea Agitation

Lethargy, Apathy

Disorientation

Muscle cramps

Anorexia

Nausea

Agitation

Sign and Symptoms Abnormal sensorium Depressed deep tendon reflexes Cheyne-Stokes respiration Hypothermia Seizures

Abnormal sensorium

Depressed deep tendon reflexes

Cheyne-Stokes respiration

Hypothermia

Seizures

Diagnostic Approach Hyponatremia Na and Water Deficit Water Excess Na and Water Excess Hypervolemia Hypovolemia Euvolemia

Diagnostic Approach Hyponatremia Hypovolemia Euvolemia Hypervolemia Renal Losses Diuretic excess Mineralcorticoid Deficiency Salt losing nephritis RTA Extrarenal Losses Vomiting Diarrhea Burn Pancreatitis Peritonitis Urine Na >20 Urine Na<10

Diagnostic Approach Hyponatremia Hypovolemia Euvolemia Hypervolemia Glucocorticoid Deficiency Hypothyroidism Pain Emotional Stress Drugs SIADH Urine Na >20

Diagnostic Approach Hyponatremia Hypovolemia Euvolemia Hypervolemia Nephrotic Syndrome Cardiac Failure Cirrhosis ARF CRF Urine Na <10 Urine Na >20

Treatment Na deficit = 0.5 x wt (kg) x (D Na – A Na ) Calculation of Desired Negative Water Balance TBW = Wt (kg) x 0.6 Actual plasma Na x TBW Desired plasma Na TBW-Desired TBW = fluid to be removed

Na deficit = 0.5 x wt (kg) x (D Na – A Na )

Calculation of Desired Negative Water Balance

TBW = Wt (kg) x 0.6

Actual plasma Na x TBW

Desired plasma Na

TBW-Desired TBW = fluid to be removed

Rate of Correction First 24 hours = 10 -12 mEq/day Seizure and Neurologic symptoms 1.5 – 2 mEq/L/h for 3 to 4 hours

First 24 hours = 10 -12 mEq/day

Seizure and Neurologic symptoms

1.5 – 2 mEq/L/h for 3 to 4 hours

Central Demyelinating Lesion Paraparesis Quadriparesis Dysarthria Dysphagia Coma

Paraparesis

Quadriparesis

Dysarthria

Dysphagia

Coma

Risk Factor for Demyelination More than 25 mEq/L elevation of Na within the first 48 hours Overcorrection of plasma Na above 140 mEq/L

More than 25 mEq/L elevation of Na within the first 48 hours

Overcorrection of plasma Na above 140 mEq/L

HYPERNATREMIA Plasma Na > 150 mEq/L

Plasma Na > 150 mEq/L

Generation of Hypernatremia Plasma Na = Na + K/TBW

Plasma Na = Na + K/TBW

Sign and Symptoms Lethargy Weakness Irritability Twitching Seizures Coma Death

Lethargy

Weakness

Irritability

Twitching

Seizures

Coma

Death

Diagnostic Approach Hypernatremia Na and H2O Deficits H2O losses Na Addition Excess Hypovolemia Euvolemia Hypervolemia

Diagnostic Approach Hypernatremia Hypovolemia Euvolemia Hypervolemia Renal losses Osmotic and loop diuretics Post obstruction Extrarenal Losses Sweating Burns Diarrhea Urine Na >20 Urine Na <10

Diagnostic Approach Hypernatremia Hypovolemia Euvolemia Hypervolemia Renal Losses Nephrogenic DI Central DI Extrarenal Losses Respiratory and Dermal Incensible Losses Urine Na = Variable Urine Na = Variable

Hypernatremia Hypovolemia Euvolemia Hypervolemia Primary Hyperaldoteronism Cushing’s Syndrome Hypertonic Dialysis Hypertonic NaHCO3 NaCl tablets Urine Na >20 mEq/L

Treatment Correction of ECF Volume Depletion Isotonic Saline Until the ECF volume is achieved Followed by Hypotonic NaCl or 5% glucose solution

Correction of ECF Volume Depletion

Isotonic Saline Until the ECF volume is achieved

Followed by Hypotonic NaCl or 5% glucose solution

Treatment Correction of ECF Volume Expansion Diuretics or Dialysis

Correction of ECF Volume Expansion

Diuretics or Dialysis

Water Replacement Computation TBW = Wt (Kg) x 0.6 Actual plasma Na x TBW Desired plasma Na

Computation

TBW = Wt (Kg) x 0.6

Actual plasma Na x TBW

Desired plasma Na

HYPOKALEMIA Plasma K < 3.0 mEq/L

Plasma K < 3.0 mEq/L

Sign and Symptoms Cardiac Atrial and ventricular ectopic beats Abnormal EKG Flat T mave Prominent U wave

Cardiac

Atrial and ventricular ectopic beats

Abnormal EKG

Flat T mave

Prominent U wave

Sign and Symptoms Neuromuscular Constipation, Ileus Weakness, paralysis Respiratory paralysis Rhabdomyolysis

Neuromuscular

Constipation, Ileus

Weakness, paralysis

Respiratory paralysis

Rhabdomyolysis

Sign and Symptoms Renal Impaired concentrating ability (polyuria, polydipsia) Increase renal NH3 production Impaired urinary acidification Metabolic alkalosis

Renal

Impaired concentrating ability (polyuria, polydipsia)

Increase renal NH3 production

Impaired urinary acidification

Metabolic alkalosis

Causes Hypokalemia due to Redistribution Alkalosis Insulin excess Beta-adrenergic agonist Hypokalemic periodic paralysis

Hypokalemia due to Redistribution

Alkalosis

Insulin excess

Beta-adrenergic agonist

Hypokalemic periodic paralysis

Causes Extrarenal Loss Diarrhea GI fistula Laxative abuse Profuse sweating

Extrarenal Loss

Diarrhea

GI fistula

Laxative abuse

Profuse sweating

Causes Renal Loss Hypertensive Disorder Malignant hypertension Renovascular hypertension Renal secreting tumors Primary Aldosteronism Cushing’s Syndrome Congenital adrenal hyperplasia

Renal Loss

Hypertensive Disorder

Malignant hypertension

Renovascular hypertension

Renal secreting tumors

Primary Aldosteronism

Cushing’s Syndrome

Congenital adrenal hyperplasia

Causes Renal Loss Normotensive RTA Vomiting Diuretics Mg depletion Barter’s syndrome Gittleman’s syndrome

Renal Loss

Normotensive

RTA

Vomiting

Diuretics

Mg depletion

Barter’s syndrome

Gittleman’s syndrome

Diagnostic Approach Hypokalemia Redistribution Extrarenal U K <20 Renal loss U K >20 Metabolic acidosis Diarrhea GI fistulas Laxative abuse Normal Acid-Base Profuse sweating Laxative abuse Gastric fistula Previous vomiting

Diagnostic Approach Hypokalemia Redistribution Extrarenal Loss U K <20 Renal Loss U K >20 Hypertensive High Plasma Renin Malignant HPN Renovascular HPN Renin secreting tumors Low Plasma Renin Primary Aldosteronism Cushing’s Syndrome Adrenal hyperplasia

Diagnostic Approach Hypokalemia Redistribution Extrarenal Loss U K <20 Renal Loss U K >20 Normotensive Metabolic Alkalosis U Cl <10 Vomiting U Cl >10 Diuretics Mg Depletion Barter syndrome Gittleman syndrome

Diagnostic Approach Hypokalemia Redistribution Extrarenal Loss U K <20 Renal Loss U K >20 Normotensive Metabolic acidosis Normal Anion Gap RTA Increase Anion Gap Diabetic Ketoacidosis Ethylene Glycol

Treatment Potassium Deficit 4.0 to 3.0 mEq/L = loss of 200 to 400 mEq/L 3.0 to 2.0 mEq/L = additional 200 to 400 mEq/L loss

Potassium Deficit

4.0 to 3.0 mEq/L = loss of 200 to 400 mEq/L

3.0 to 2.0 mEq/L = additional 200 to 400 mEq/L loss

Treatment Rate of Repletion 3.0 – 3.5 mEq/L = oral KCL 60-80 mEq/day <2.5 mEq/L = 10-20 mEq/hour IV

Rate of Repletion

3.0 – 3.5 mEq/L = oral KCL 60-80 mEq/day

<2.5 mEq/L = 10-20 mEq/hour IV

HYPERKALEMIA Plasma K > 5.0 mEq/L

Plasma K > 5.0 mEq/L

Etiology of Hyperkalemia Movement from cells to ECF Metabolic acidosis Insulin deficiency and hyperosmolarity (DM) Tissue catabolism B adrenergic blockade Severe exercise Digitalis overdose Periodic paralysis – hyperkalemic form

Movement from cells to ECF

Metabolic acidosis

Insulin deficiency and hyperosmolarity (DM)

Tissue catabolism

B adrenergic blockade

Severe exercise

Digitalis overdose

Periodic paralysis – hyperkalemic form

Etiology of Hyperkalemia Decrease Urinary Excretion Renal failure Effective circulating volume depletion RTA – hyperkalemic form Hypoaldosteronism

Decrease Urinary Excretion

Renal failure

Effective circulating volume depletion

RTA – hyperkalemic form

Hypoaldosteronism

Etiology of Hyperkalemia Hypoaldosteronism NSAID Converting enzyme inhibitors Cyclosporine K sparing diuretics Primary adrenal insufficiency

Hypoaldosteronism

NSAID

Converting enzyme inhibitors

Cyclosporine

K sparing diuretics

Primary adrenal insufficiency

Sign and Symptoms Cardiac 5.0 – 6.5 = peak T wave 6.5 – 8.0= flattening of P wave, prolongation of PR interval, widening of QRS complex >8.0 = sine wave pattern, V fibrillation or cardiac arrest

Cardiac

5.0 – 6.5 = peak T wave

6.5 – 8.0= flattening of P wave, prolongation of PR interval, widening of QRS complex

>8.0 = sine wave pattern, V fibrillation or cardiac arrest

Treatment Antagonism of Membrane Calcium gluconate = 10 – 20 ml Peak effect = 5 minutes

Antagonism of Membrane

Calcium gluconate = 10 – 20 ml

Peak effect = 5 minutes

Treatment Increase K entry into the cells Glucose–Insulin solution ( 10 u in 50 ml D50W) Sodium Bicarbonate B adrenergic agonist

Increase K entry into the cells

Glucose–Insulin solution ( 10 u in 50 ml D50W)

Sodium Bicarbonate

B adrenergic agonist

Treatment Removal of Excess K Diuretics Cation exchange resin Hemodialysis or Peritoneal Dialysis

Removal of Excess K

Diuretics

Cation exchange resin

Hemodialysis or Peritoneal Dialysis

 

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