electrolyte - cb

30
Electrolyte replacement

Upload: christopher-betts

Post on 16-Apr-2017

114 views

Category:

Documents


3 download

TRANSCRIPT

Page 1: electrolyte - cb

Electrolyte replacement

Page 2: electrolyte - cb

Case

• You’re paged by the ER physician to come see a 75 yo male who experienced a syncopal episode and a traumatic fall that led to a skull fracture. His VSS, neurologic and mental status exam was normal, and his initial labs were w/ normal limits. The proper admission orders and consults were then made. Over the subsequent two days his sodium went from admission being 135 down to 132 and then 129. Rest of his labs show potassium 4.4, Chloride 102, CO2 30, BUN 11, Cr 0.79, glucose 104.

Page 3: electrolyte - cb

Case

• Serum osmolality:• Overall volume status: • Urine osmolality• Urine sodium:

Page 4: electrolyte - cb
Page 5: electrolyte - cb
Page 6: electrolyte - cb

Case

• Acute Hyponatremia – Cerebral Edema (CE) Severe drop in Na leaves

brain hypertonic relative to serum• <130 mEq/L = asymptomatic• 125–130 = N/V, abd Sx• < 120-125= headaches, agitation, confusion• <120 = seizures and coma

– Severe acute hyponatremia = brain damage, brainstem herniation, resp. arrest, & death

Page 7: electrolyte - cb

Case

• You are paged by the ER physician to see a 65 yo female with diabetes insipidus. Her main complaint has been progressive weakness for the past three days. Her sodium is 150, potassium 3.6, chloride 110, CO2 23, glucose 130, BUN 12, Cr 0.77. She was newly diagnosed with DI and is not on any therapy for this. She has been noticing excessive urination for the past week. She weighs 60 kg.

Page 8: electrolyte - cb
Page 9: electrolyte - cb

Patient’s Weight = 60 kgIf her height is for example 5’7” then her IBW should be close to her real weight (61.6 kg).

FWD = 0.4 x (61.6 kg) x [(150/140) -1] = 0.4 x 61.6 x 0.07 = 1.76 L At least 1.7 L of water must be replaced in this patient. During the first twenty four hours at least 850 ml of water should be replaced- Order D5W @ 35 ml/hr for 24 hoursDuring the next 24-48 hours the next 850 ml of water should be replaced- Depending on what the subsequent Na levels show daily: order D5W between a rate of 17 to 35 ml/hr for the next 24 to 48 hours respectively.

Page 10: electrolyte - cb

Case

• 65 yo male has been in the hospital on your service for the past week for CHF exacerbation. The proper management has been done including regular diuresis and close monitoring of his I/O. His potassium has decreased over the past few days from 3.6 to 3.3 to 2.7. His Creatinine has increased from 0.77 to 1.2.

Page 11: electrolyte - cb
Page 12: electrolyte - cb
Page 13: electrolyte - cb

Hypokalemia

Page 14: electrolyte - cb

Hypokalemia

Page 15: electrolyte - cb

Hypokalemia

Page 16: electrolyte - cb

Case

• 45 yo male with history of seizures is admitted after having a status epilepticus. Care taker says she has been refusing to take his antiepileptic meds for the past month. His CK is 1500. His sodium is 143, potassium is 6.2, chloride is 109, CO2 is 22, BUN 24, Cr 1.2, glucose 150. Magnesium is 2.3. Patient is alert and oriented post-ictally but now is c/o palpitations and dizziness.

Page 17: electrolyte - cb
Page 18: electrolyte - cb

Hyperkalemia

Page 19: electrolyte - cb

Hyperkalemia

Page 20: electrolyte - cb

Case

• 65 yo female with chronic alcoholism is admitted for weakness and confusion. Her blood alcohol level was positively elevated. She was started on AWS protocol. During the first twenty-four hours in the unit she experiences acute nausea and vomiting. Labs show Na 135, K 3.2, Cl 99, Co2 24, BUN 26, Cr 1.3, Gluc 100, Mg 1.0

Page 21: electrolyte - cb

Hypomagnesemia

Page 22: electrolyte - cb

Hypomagnesemia

Page 23: electrolyte - cb

Hypomagnesemia

Page 24: electrolyte - cb

Hypermagnesemia

Page 25: electrolyte - cb

Hypermagnesemia

Page 26: electrolyte - cb

Case

• 55 yo female with symptomatic hyperPTH is admitted by endo-surgery for a parathyroidectomy. Her surgery had no complications. One day post-op she begins to complain of muscle aches, cramping, and acts somewhat confused. Her serum Ca7.0 and her albumin is 3.2.

Page 27: electrolyte - cb
Page 28: electrolyte - cb

Hypocalcemia

Page 29: electrolyte - cb

Hypocalcemia

Page 30: electrolyte - cb

Hypocalcemia