electrolyte emergencies
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Electrolyte Emergencies
Hyponatremia
Decreased serum sodiumDecreased serum sodium
Na+ <135 mEq/LNa+ <135 mEq/L
Hyponatremia CausesCauses
Loss of salt and waterLoss of salt and water DiureticsDiuretics Addison’s diseaseAddison’s disease Osmotic diuresis (DKA)Osmotic diuresis (DKA) VomitingVomiting DiarrheaDiarrhea DiaphoresisDiaphoresis
Hyponatremia CausesCauses
Increase in body water (dilutional Increase in body water (dilutional hyponatremia)hyponatremia) Excess water intake (water intoxication)Excess water intake (water intoxication) CHFCHF Renal failureRenal failure CirrhosisCirrhosis
Hyponatremia
Signs/SymptomsSigns/SymptomsLethargy, apathy secondary to Lethargy, apathy secondary to
cerebral edemacerebral edemaHeadacheHeadacheMuscle twitching, crampsMuscle twitching, crampsSeizures Seizures
NaNa++ < 110 mEq/L < 110 mEq/L
Hyponatremia
TreatmentTreatmentNS infused at a rate to restore normal NS infused at a rate to restore normal
sodium over 48 hourssodium over 48 hours
Hypernatremia
Elevated serum sodiumElevated serum sodium
NaNa+ + >150 mEq/L>150 mEq/L
Hypernatremia
CausesCausesPure water lossPure water loss
Diabetes insipidusDiabetes insipidusPure solute gainPure solute gain
NaHCONaHCO33 administration administration
Hypernatremia
CausesCausesWater loss > Solute lossWater loss > Solute loss
DiarrheaDiarrhea VomitingVomiting SweatingSweating Osmotic diuresisOsmotic diuresis
Hypernatremia Signs/SymptomsSigns/Symptoms
Irritability, restlessnessIrritability, restlessnessComaComaIntracranial hemorrhageIntracranial hemorrhageBlood sludging - thrombosisBlood sludging - thrombosisSeizuresSeizuresThirst, dry mucus membranes, poor skin Thirst, dry mucus membranes, poor skin
turgorturgor
Hypernatremia
TreatmentTreatmentInfusion of D5W (free water) to correct Infusion of D5W (free water) to correct
water deficit over 48 hourswater deficit over 48 hours
Hypokalemia
Decreased serum potassiumDecreased serum potassium
KK++ < 3.5 mEq/L < 3.5 mEq/L
Hypokalemia CausesCauses
Gastrointestinal lossesGastrointestinal losses DiarrheaDiarrhea VomitingVomiting NG suctionNG suction
Urinary lossesUrinary losses DiureticsDiuretics Osmotic diuresisOsmotic diuresis
Hypokalemia
CausesCausesIntracellular shiftsIntracellular shifts
AlkalosisAlkalosis agentsagents TheophyllineTheophylline
Inadequate intakeInadequate intake
Hypokalemia
Signs/SymptomsSigns/SymptomsWeakness, hyporeflexia, paresthesiasWeakness, hyporeflexia, paresthesiasDecreased GI motility Decreased GI motility Nausea, vomitingNausea, vomitingIncreased sensitivity to digitalisIncreased sensitivity to digitalis
Hypokalemia Signs/SymptomsSigns/Symptoms
EKG changesEKG changes Flat to inverted T wavesFlat to inverted T waves U wavesU waves ST segment depressionST segment depression
Cardiac arrhythmiasCardiac arrhythmias Ventricular ectopyVentricular ectopy V-FibV-Fib
Hypokalemia
TreatmentTreatmentCorrect underlying causeCorrect underlying cause10 mEq KCL IV over 1 hour, repeated 10 mEq KCL IV over 1 hour, repeated
until serum Kuntil serum K++ > 3.5 mEq/L > 3.5 mEq/L
Hyperkalemia
Elevated serum potassiumElevated serum potassium
KK++ > 5.5 mEq/L > 5.5 mEq/L
KK++ > 6 mEq/L - > 6 mEq/L - EmergencyEmergency
KK++ > 7 mEq/L - > 7 mEq/L - Life ThreatLife Threat
Hyperkalemia
CausesCausesDecreased excretionDecreased excretion
Renal failureRenal failure Addison’s diseaseAddison’s disease - blockers- blockers HyperglycemiaHyperglycemia AcidosisAcidosis
Hyperkalemia
CausesCausesIncreased intakeIncreased intake
Crush injury, burns, sepsisCrush injury, burns, sepsis Massive hemolysisMassive hemolysis Blood transfusionBlood transfusion High-dose penicillinHigh-dose penicillin Increased oral intakeIncreased oral intake
Hyperkalemia Signs/SymptomsSigns/Symptoms
Muscle weaknessMuscle weaknessNumbness, tinglingNumbness, tinglingEKG changesEKG changes
Tall, peaked T wavesTall, peaked T waves Broadening of QRS; decreased P wave sizeBroadening of QRS; decreased P wave size ““Sine wave” leading to V-Fib then asystoleSine wave” leading to V-Fib then asystole
Hyperkalemia
TreatmentTreatmentCalcium - 0.5 - 1.0g Calcium - 0.5 - 1.0g
Antagonizes cardiac toxicityAntagonizes cardiac toxicityNaHCONaHCO33 - 50 mEq - 50 mEq
Drives KDrives K++ into cells into cellsDD5050W (25g)/insulin (10 units regular)W (25g)/insulin (10 units regular)
Drives KDrives K++ into cells into cells
Hypocalcemia
Decreased serum calciumDecreased serum calcium
CaCa2+2+ < 8.5 mg/100ml < 8.5 mg/100ml
Hypocalcemia
CausesCausesHypoparathyroidismHypoparathyroidismVitamin D deficiencyVitamin D deficiencyDecreased dietary intakeDecreased dietary intakeAlkalosisAlkalosisMassive blood transfusionMassive blood transfusion
Citrate toxicityCitrate toxicity
Hypocalcemia Signs/SymptomsSigns/Symptoms
ParesthesiasParesthesiasHyperreflexia, carpopedal spasm, tetanyHyperreflexia, carpopedal spasm, tetanySeizuresSeizuresTrousseau’s sign:Trousseau’s sign:
Carpopedal spasm following BP cuff Carpopedal spasm following BP cuff compression of armcompression of arm
Hypocalcemia
Signs/SymptomsSigns/SymptomsChvostek’s signChvostek’s sign
Contraction of facial muscles when Contraction of facial muscles when face is tapped at angle of jawface is tapped at angle of jaw
LaryngospasmsLaryngospasmsProlonged QT intervalProlonged QT intervalIncreased ventricular irritabilityIncreased ventricular irritability
Hypocalcemia
ManagementManagementCalcium chlorideCalcium chloride
1g over 10 - 20 minutes1g over 10 - 20 minutesOverly rapid administration of calcium Overly rapid administration of calcium
can cause bradycardia, hypotension, can cause bradycardia, hypotension, and cardiac arrestand cardiac arrest
Hypercalcemia
Increased serum calciumIncreased serum calcium
CaCa2+2+ > 10.5 mg/100ml > 10.5 mg/100ml
Hypercalcemia
CausesCausesMalignanciesMalignancies
Skeletal, breast, lungsSkeletal, breast, lungsHyperparathyroidismHyperparathyroidismVitamin D toxicityVitamin D toxicityAddison’s diseaseAddison’s diseaseMilk/alkali syndromeMilk/alkali syndrome
Hypercalcemia
Signs/SymptomsSigns/SymptomsApathy, fatigue, depression, comaApathy, fatigue, depression, comaMuscle weaknessMuscle weaknessHypertensionHypertensionAnorexia, nausea, abdominal painAnorexia, nausea, abdominal pain
Hypercalcemia
Signs/SymptomsSigns/SymptomsKidney stonesKidney stonesShort QT interval, heart block, cardiac Short QT interval, heart block, cardiac
arrestarrest““Bones, Stones, Hypertones, Bones, Stones, Hypertones,
Abdominal moans”Abdominal moans”
Hypercalcemia
TreatmentTreatment1 - 2 liters NS over 1 hour1 - 2 liters NS over 1 hour
Decrease CaDecrease Ca2+2+ reabsorption reabsorptionFurosemide 40 mg IVFurosemide 40 mg IV
Inhibits CaInhibits Ca2+2+ reabsorption reabsorptionCalcitoninCalcitonin
Directly lowers CaDirectly lowers Ca2+2+
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