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Electrolytes Disturbances

Electrolytes Disturbances. Jamal A. Alhashemi, MBBS, MSc , FRPC, FCCP, FCCM Professor of Anesthesiology & Critical Care Medicine Faculty of Medicine, King Abdulaziz University. Principles of Electrolyte Disturbances. Implies an underlying disease process

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Electrolytes Disturbances

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  1. Electrolytes Disturbances Jamal A. Alhashemi, MBBS, MSc, FRPC, FCCP, FCCM Professor of Anesthesiology & Critical Care Medicine Faculty of Medicine, King Abdulaziz University

  2. Principles of Electrolyte Disturbances • Implies an underlying disease process • Treat the electrolyte change, but seek the underlying cause • Clinical manifestations usually not specific to a particular electrolyte change, e.g., seizures, arrhythmias

  3. Principles of Electrolyte Disturbances • Clinical manifestations determine urgency of treatment, not laboratory values • Speed and magnitude of correction dependent on clinical circumstances • Frequent reassessment of electrolytes required

  4. Hypokalemia • Etiology – renal loss, extrarenal loss, transcellular shift, decreased intake • Manifestations – cardiac, neuromuscular, gastrointestinal • Deficit poorly estimated by serum levels

  5. Hypokalemia • Titrate administration of K+ against serum level and manifestations • Correct hypomagnesemia • ECG monitoring with emergent administration • Allowable maximum iv dose per hour controversial • Treat hypokalemia urgently in acidosis

  6. Hypokalemia <

  7. Hyperkalemia • Etiology – renal failure, transcellular shifts, cell death, drugs • Manifestations – cardiac, neuromuscular

  8. Hyperkalemia – Treatment • Stop intake • Give calcium for cardiac toxicity • Shift K+ into cell – glucose + insulin, NaHCO3, inhaled -agonist • Remove from body – diuretics, sodium polystyrene sulfonate,dialysis

  9. Hyperkalemia

  10. Hyponatremia • Hypo-osmolarhyponatremia • Euvolemic • Hypovolemic • Hypervolemic • Normo- or hyperosmolarhyponatremia • Pseudohyponatremia • Manifestations – neurologic, muscular, gastrointestinal

  11. Hyponatremia – Treatment • HypovolemicNa – give normal saline, rule out adrenal insufficiency • HypervolemicNa – increase free water loss • Euvolemichyponatremia • Restrict free water intake • Increase free water loss • Normal or hypertonic saline • Correct slowly due to possibility of demyelinating syndromes

  12. Hyponatremia > > >

  13. Hypernatremia • Etiology –  H2O loss, H2O intake, Na intake • Manifestations – neurologic, muscular • H2O deficit (L) = [ 0.6  wt (kg) ]  [ obs Na - 1 ]140

  14. Hypernatremia – Treatment • Provide intravascular volume replacement • Consider giving one-half of free H2O deficit initially • Reduce Na cautiously: 0.5-1.0 mmol/L/hr • Secondary neurologic syndromes with rapid correction

  15. Hypernatremia

  16. Other Electrolyte DeficitsCa, PO4, Mg • May produce serious but nonspecific cardiac, neuromuscular, respiratory, and other effects • All are primarily intracellular ions, so deficits difficult to estimate • Titrate replacement against clinical findings

  17. Other Electrolyte Disorders • Hypocalcemia • Calcium chloride or gluconate • Bolus + continuous infusion • Hypercalcemia • Rehydration with normal saline • Loop diuretics

  18. Other Electrolyte Disorders • Hypophosphatemia • IV replacement for level < 1 mg/dL (0.32 mmol/l) • Hypomagnesemia • Emergent administration over 5–10 mins • Less urgent administration over 10–60 mins

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