Professional Documents
Culture Documents
ELECTROLYTE DISORDERS
Dr. Camelia Diaconu
November 22, 2016
Homeostasis
2
INTRACELLULAR EXTRACELLULAR
POTASSIUM SODIUM
MAGNESIUM CHLORIDE
PHOSPHORUS BICARBONATE
Diffusion
Osmosis
Active transport
Filtration
Regulation of fluids
9
Hypothalamus
Pituitary gland
Kidneys
ADH (Antidiuretic Hormone)
10
Water-retaining hormone
Angiotensin
Lungs
I
Angiotensin Adrenal
II gland
Aldosteron
12 Peripheral
vasoconstriction
TONICITY
13
Ringers Solution
0.45% NaCl
0.33% NaCl
HYPERTONIC SOLUTIONS
18
3% NaCl
5% NaCl
Whole blood
Albumin
Tube feedings
Cl 95-105
Na 135 145
K 3.5-5
Ca 8.5-10.2
Mg 1.5-2
Phosphate 2.5-4.5
Fluid and electrolyte imbalances
21
Na
imbalance K imbalance
<135 or <3.5 or >5
>145
Chloride Mg
imbalance imbalance
<95 or >105 <1.5 or >2
23
Natrium
SODIUM
24
Na 122 mmol/L
Hyponatremia is associated with
unfavorable evolution
Plasmatic osmolality
2 x seric Na + seric glucose /18 + BUN/2.8
Hyponatremia (Na<135 mEq/L)
32
Excessive diaphoresis
Insufficient Na intake
Alcoholism
Hyponatremia is an
alteration of water balance
Water input
> Renal water
excretion
Hyponatremia
34
Hypovolemic
Euvolemic
Hypervolemic
Redistribution
Pseudohyponatremia
Hypovolemic hyponatremia
Volume replacement with hypotonic
fluids, vomiting, diarrhea, 3rd space
sequestration, renal losses
Drugs
HypoNa with:
Hypouricemia
Water excess
> Na excess
Hyperproteinemia Hyperlipidemia
Lab evaluation of hypoNa
Seric Osm
Urine Osm
Glycemia: seric Na with 1.6-2.4 mmol/L for each
100 mg/dL increase of glycemia > 100 mg/dL
Rapid correction
Thirst, dehydration
Dry mucus membranes
Flushed skin
Tachycardia
Irritability, lethargy, weakness
Seizures, coma
Hyperactive deep tendon reflexes
Dry, swollen tongue
Hypernatremia treatment in ED
50
Low Na diet
May use salt substitutes if K+ OK
Weigh daily
53
Potassium
Potassium Imbalances
54
Increased loss:
Shift into the cell:
- Hyperaldosteronism
- Alkalosis and sodium - Diuretics
bicarbonate
- Beta-agonists - Renal tubular acidosis
- Adm. of insulin and glucose - Renal artery stenosis
- GI loss: vomiting, diarrhea
HypoK
Miscellanous:
- Hypercalcemia
- Mg deficiency Reduced intake
- Acute leukemia
- Drugs and toxins (penicilin,
theophylline)
56
19/10/2009
HypoK ECG changes
57
HypoK ED treatment
58
IV or PO replacement
Give K+ IV diluted in a large vein
* Never push K+ as a bolus *
Monitor site for infiltration
Arterial
ECG blood gases
(check for
acidosis)
Digoxin
Electrolytes level in
appropriate
pts
Hyperkalemia ED treatment
63
If digoxin
Avoid calcium, give digoxin immune
toxicity with Fab therapy
hyperK
Diuresis is
maintained Kayexalate (po
with or rectal) 1 g
furosemide binds 1 mEq K
20-40 mg IV
Calcium
Calcium
67
Parathyroid hormone
Helps
with Ca retention and phosphate
excretion through the kidneys
Renal failure
Vit. D defficiency
Acute pancreatitis
Hyperphosphatemia
Hypocalcemia S/S
70
Muscle cramps
Hyperactive deep tendon reflexes
Paresthesia of fingers, toes and
face
PositiveTrousseaus/Chvosteks
sign
Tetany
Laryngeal spasms
Confusion, memory loss
Cardiac dysrhythmias
Hypocalcemia - seizures,
71
mental changes
72
Hypocalcemia ED treatment
73
Short QT
Hypercalcemia ED treatment
77
Magnesium
HypoMg (<1,5 mEq/L) - Causes
79
Cardiac monitoring
Seizure precautions
Treat with oral, IM, IV or Mg salts
Monitor urine output
Renal failure
Excessive use of Mg containing antacids
Untreated diabetic ketoacidosis
84
HyperMg ECG changes
85
HyperMg ED treatment
86
Phosphorus
PHOSPHORUS
88
N = 2.7-4.5 mg/dL
Hypophosphatemia (<2.7 mg/dL)
- Causes -
89
insufficientintake
malnutrition, starvation
hyperparathyroidism
90
Its Over
THANK YOU !
96
19/10/2009