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electrolyte emergencies

JasminFlorian
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electrolyte emergencies

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    1. Electrolyte Emergencies

    3. Hyponatremia Causes Loss of salt and water Diuretics Addisons disease Osmotic diuresis (DKA) Vomiting Diarrhea Diaphoresis

    4. Hyponatremia Causes Increase in body water (dilutional hyponatremia) Excess water intake (water intoxication) CHF Renal failure Cirrhosis

    5. Hyponatremia Signs/Symptoms Lethargy, apathy secondary to cerebral edema Headache Muscle twitching, cramps Seizures Na+ < 110 mEq/L

    6. Hyponatremia Treatment NS infused at a rate to restore normal sodium over 48 hours

    7. Hypernatremia Elevated serum sodium Na+ >150 mEq/L

    8. Hypernatremia Causes Pure water loss Diabetes insipidus Pure solute gain NaHCO3 administration

    9. Hypernatremia Causes Water loss > Solute loss Diarrhea Vomiting Sweating Osmotic diuresis

    10. Hypernatremia Signs/Symptoms Irritability, restlessness Coma Intracranial hemorrhage Blood sludging - thrombosis Seizures Thirst, dry mucus membranes, poor skin turgor

    11. Hypernatremia Treatment Infusion of D5W (free water) to correct water deficit over 48 hours

    12. Hypokalemia Decreased serum potassium K+ < 3.5 mEq/L

    13. Hypokalemia Causes Gastrointestinal losses Diarrhea Vomiting NG suction Urinary losses Diuretics Osmotic diuresis

    14. Hypokalemia Causes Intracellular shifts Alkalosis ? agents Theophylline Inadequate intake

    15. Hypokalemia Signs/Symptoms Weakness, hyporeflexia, paresthesias Decreased GI motility Nausea, vomiting Increased sensitivity to digitalis

    16. Hypokalemia Signs/Symptoms EKG changes Flat to inverted T waves U waves ST segment depression Cardiac arrhythmias Ventricular ectopy V-Fib

    17. Hypokalemia Treatment Correct underlying cause 10 mEq KCL IV over 1 hour, repeated until serum K+ > 3.5 mEq/L

    18. Hyperkalemia Elevated serum potassium K+ > 5.5 mEq/L K+ > 6 mEq/L - Emergency K+ > 7 mEq/L - Life Threat

    19. Hyperkalemia Causes Decreased excretion Renal failure Addisons disease ? - blockers Hyperglycemia Acidosis

    20. Hyperkalemia Causes Increased intake Crush injury, burns, sepsis Massive hemolysis Blood transfusion High-dose penicillin Increased oral intake

    21. Hyperkalemia Signs/Symptoms Muscle weakness Numbness, tingling EKG changes Tall, peaked T waves Broadening of QRS; decreased P wave size Sine wave leading to V-Fib then asystole

    22. Hyperkalemia Treatment Calcium - 0.5 - 1.0g Antagonizes cardiac toxicity NaHCO3 - 50 mEq Drives K+ into cells D50W (25g)/insulin (10 units regular) Drives K+ into cells

    23. Hypocalcemia Decreased serum calcium Ca2+ < 8.5 mg/100ml

    24. Hypocalcemia Causes Hypoparathyroidism Vitamin D deficiency Decreased dietary intake Alkalosis Massive blood transfusion Citrate toxicity

    25. Hypocalcemia Signs/Symptoms Paresthesias Hyperreflexia, carpopedal spasm, tetany Seizures Trousseaus sign: Carpopedal spasm following BP cuff compression of arm

    26. Hypocalcemia Signs/Symptoms Chvosteks sign Contraction of facial muscles when face is tapped at angle of jaw Laryngospasms Prolonged QT interval Increased ventricular irritability

    27. Hypocalcemia Management Calcium chloride 1g over 10 - 20 minutes Overly rapid administration of calcium can cause bradycardia, hypotension, and cardiac arrest

    28. Hypercalcemia Increased serum calcium Ca2+ > 10.5 mg/100ml

    29. Hypercalcemia Causes Malignancies Skeletal, breast, lungs Hyperparathyroidism Vitamin D toxicity Addisons disease Milk/alkali syndrome

    30. Hypercalcemia Signs/Symptoms Apathy, fatigue, depression, coma Muscle weakness Hypertension Anorexia, nausea, abdominal pain

    31. Hypercalcemia Signs/Symptoms Kidney stones Short QT interval, heart block, cardiac arrest Bones, Stones, Hypertones, Abdominal moans

    32. Hypercalcemia Treatment 1 - 2 liters NS over 1 hour Decrease Ca2+ reabsorption Furosemide 40 mg IV Inhibits Ca2+ reabsorption Calcitonin Directly lowers Ca2+

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