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Electrolyte Disturbance

Electrolyte Disturbance. Dr.Alaa Mohammed Fouad Mousli Surgical Demonstrator. Hyponatremia Causes of SIADH. Infections (meningitis TB Pneumonia ) Neoplasm Drugs (Crbamazepine , cytoxan, tricyclic ) Postoperative Subarachnoid haemorrhage. Hyponatraemia. Sever when below 120 mmol/l

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Electrolyte Disturbance

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  1. Electrolyte Disturbance Dr.Alaa Mohammed FouadMousli Surgical Demonstrator

  2. Hyponatremia Causes of SIADH • Infections (meningitis TB Pneumonia ) • Neoplasm • Drugs (Crbamazepine , cytoxan, tricyclic ) • Postoperative • Subarachnoid haemorrhage

  3. Hyponatraemia • Sever when below 120 mmol/l • Symptoms depend on severity and rapidity of decline in serum sodium • Chronic hyponatraemia is less symptomatic but should be corrected with great caution

  4. Hyponatremiasymptoms • May be asymptomatic • Weakness lethargy dizziness and decreased concentration • Seizures confusion and even coma can be seen in sever cases particularly if developed quickly

  5. Hyponatremia • Deficient can be calculated by • ( Desired Na – Serum Na ) *(wt*.6) • Correction should at a rate of 1-2 mmol/l • Correction should be to mild hyponatremia • Central pontine myelonysis is mainly seen in alcoholics

  6. Hyponatremiainvestigations • Plsma osmolality • Urine osmolality • Urine Na concentration

  7. Hyponatremiatreatment • Normal saline is indicated in • volume depletion • Diuretics induced • Water restriction indicated in • SIADH Oedema renal failure • Hypertonic saline indicated in sever symptomatic hyponatremia

  8. Hyponatremiatreatment of SIADH • Acute • Water restriction • Hypertonic saline • Loop diuretics • Chronic • Water restriction • Loop diuretic • Demeclocycline

  9. Hypernatremia causes • Water loss (sweating Burns ) • Renal loss • GI losses • Hypothalamic disorders • DI

  10. Hypernatremiasymptoms • Mainly neurological • Lethargy weakness and irritability are early symptoms which can progress to seizures coma and death • Symptoms are more with acute oncet

  11. Hypernatremiatreatment Dextrose infusion

  12. Hpokalemiasymptoms • Weakness lethargy • If chronic may lead to polyuria • Can lead to sever alkalosis • May trigger cardiac arrhythmia in patients with ischemic heart disease or recent myocardial infarction

  13. Hypokalemia Treatment • K supplement either oral or intravenous • K deficiency can not be calculated • Usual requirement in the range of 60 mEq/24 hours • Rapid KCL infusion is fatal • IV KCL can be given in a maximum rate of 10 – 20 mEq/h this may require a central line

  14. Hypocalcemiatreatment • Calcium and vitamin D supplement • If symptomatic then intravenous Ca gluconate should be used ( Ca <0.7 mmol/l ) • Mg should be checked since if hypomagnesaemia present hypocalcemia can not be corrected

  15. Hypomagnesaemiacauses • Diuretics • Alcohol • Hypercalcemia • Nephrotoxins (cisplatinum Amphotiricin B) • Tubular disorders

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