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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+