electrolyte emergencies 1

8/2/2019 Electrolyte Emergencies 1

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Decreased serum sodium

Na+


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Causes

Loss of salt and water

Diuretics

Addisons disease

Osmotic diuresis (DKA)

Vomiting

Diarrhea

Diaphoresis


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Causes

Increase in body water (dilutional hyponatremia)

Excess water intake (water intoxication)

CHF Renal failure

Cirrhosis


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Signs/Symptoms

Lethargy, apathy secondary to cerebral edema

Headache

Muscle twitching, cramps Seizures

Na+ < 110 mEq/L


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Treatment

NS infused at a rate to restore normal sodium

over 48 hours


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Elevated serum sodium

Na+ >150 mEq/L


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Causes

Pure water loss

Diabetes insipidus

Pure solute gain NaHCO3 administration


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Causes

Water loss > Solute loss

Diarrhea

Vomiting

Sweating

Osmotic diuresis


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Signs/Symptoms

Irritability, restlessness

Coma

Intracranial hemorrhage Blood sludging - thrombosis

Seizures

Thirst, dry mucus membranes, poor skin turgor


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Treatment

Infusion of D5W (free water) to correct water

deficit over 48 hours


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Decreased serum potassium

K+ < 3.5 mEq/L


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Causes Gastrointestinal losses

Diarrhea

Vomiting

NG suction Urinary losses

Diuretics

Osmotic diuresis


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Causes

Intracellular shifts

Alkalosis

agents

Theophylline

Inadequate intake


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Signs/Symptoms

Weakness, hyporeflexia, paresthesias

Decreased GI motility

Nausea, vomiting Increased sensitivity to digitalis


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Signs/Symptoms

EKG changes

Flat to inverted T waves

U waves

ST segment depression

Cardiac arrhythmias

Ventricular ectopy

V-Fib


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Treatment

Correct underlying cause

10 mEq KCL IV over 1 hour, repeated until serum

K+ > 3.5 mEq/L


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Elevated serum potassium

K+ > 5.5 mEq/L

K+ > 6 mEq/L - Emergency

K+ > 7 mEq/L - Life Threat


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Causes

Decreased excretion

Renal failure

Addisons disease

- blockers

Hyperglycemia

Acidosis


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Causes

Increased intake

Crush injury, burns, sepsis

Massive hemolysis

Blood transfusion

High-dose penicillin

Increased oral intake


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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


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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


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Decreased serum calcium

Ca2+ < 8.5 mg/100ml


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Causes

Hypoparathyroidism

Vitamin D deficiency

Decreased dietary intake Alkalosis

Massive blood transfusion

Citrate toxicity


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Signs/Symptoms Paresthesias

Hyperreflexia, carpopedal spasm, tetany

Seizures

Trousseaus sign:

Carpopedal spasm following BP cuff compression of arm


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Signs/Symptoms

Chvosteks sign

Contraction of facial muscles when face is tapped at

angle of jaw

Laryngospasms

Prolonged QT interval

Increased ventricular irritability


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Management

Calcium chloride

1g over 10 - 20 minutes

Overly rapid administration of calcium can cause

bradycardia, hypotension, and cardiac arrest


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Increased serum calcium

Ca2+ > 10.5 mg/100ml


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Causes

Malignancies

Skeletal, breast, lungs

Hyperparathyroidism

Vitamin D toxicity

Addisons disease

Milk/alkali syndrome


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Signs/Symptoms

Apathy, fatigue, depression, coma

Muscle weakness

Hypertension Anorexia, nausea, abdominal pain


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Signs/Symptoms

Kidney stones

Short QT interval, heart block, cardiac arrest

Bones, Stones, Hypertones, Abdominal moans


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Treatment

1 - 2 liters NS over 1 hour

Decrease Ca2+ reabsorption

Furosemide 40 mg IV

Inhibits Ca2+ reabsorption

Calcitonin

Directly lowers Ca2+

electrolyte emergencies 1

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