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Electrolyte Emergencies

Electrolyte Emergencies. Hyponatremia. Decreased serum sodium Na+ <135 mEq/L. Hyponatremia. Causes Loss of salt and water Diuretics Addison’s disease Osmotic diuresis (DKA) Vomiting Diarrhea Diaphoresis. Hyponatremia. Causes Increase in body water (dilutional hyponatremia)

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Electrolyte Emergencies

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  1. Electrolyte Emergencies

  2. Hyponatremia Decreased serum sodium Na+ <135 mEq/L

  3. Hyponatremia • Causes • Loss of salt and water • Diuretics • Addison’s 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 • Addison’s 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 • Trousseau’s sign: • Carpopedal spasm following BP cuff compression of arm

  26. Hypocalcemia • Signs/Symptoms • Chvostek’s 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 • Addison’s 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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