ObjectivesReview causes and clinical manifestations of severe
electrolyte disturbancesOutline emergent management of electrolyte
disturbancesRecognize acute adrenal insufciency and appropriate
treatmentDescribe management of severe hyperglycemic
syndromesPrinciples of Electrolyte DisturbancesImplies an
underlying disease process Treat the electrolyte change, but seek
the causeClinical manifestations usually not specific to a
particular electrolyte change, eg, sei!ures, arrhythmiasPrinciples
of Electrolyte DisturbancesClinical manifestations determine
urgency of treatment, not laboratory valuesSpeed and magnitude of
correction dependent on clinical circumstancesFreuent reassessment
of electrolytes reuired"ypokalemia#euromuscular manifestations
$%eakness, fatigue, paralysis, respiratory dysfunction&'I
$constipation, ileusephrogenic DIEC' changes $( %aves, flattened T
%aves&)rrhythmias"ypokalemia*purious hypokalemia+arked
leukocytosis) dose of insulin right before the blood
dra%,edistribution hypokalemia)lkalosis $- decreases . for every /
increase in p"&Increased 0eta1 adrenergic activityTheophylline
to2icity3amilial"ypokalemiaE2trarenal depletiondiarrheala2ative
abuses%eat lossesfasting or inade4uate intake"ypokalemia,enal
potassium depletionurine potassium 5 16 mE4718 hrsspot urine %ith 5
16 mE4 -7gram creatinineclassified %hether they occur %ith a
metabolic alkalosisvomiting7#' suctiondiuretic t2+ineralocorticoid
e2cess syndromes "ypokalemia,enal lossesmetabolic acidosis,T) Type
I and IID-)Carbonic anhydrase inhibitor
therapy(reterosigmoidostomy#o acid9base disorder+g
deficiencyDrugs"yperkalemia*evere hyperkalemia is a medical
emergency#euromuscular signs $%eakness, ascending paralysis,
respiratory failure&Progressive EC' changes $peaked T %aves,
flattened P %aves, prolonged P, interval, idioventricular rhythm
and %idened :,* comple2, ;sine %ave< pattern, =
fib&"yperkalemiaEtiology > renal failure, transcellular
shifts, cell death, drugs, pseudohyperkalemia+anifestations >
cardiac, neuromuscular"yperkalemiaImpaired potassium
secretion)ldosterone deficiencyadrenal failure*yndrome of
hyporeninemic hypoaldosteronism $*""&tubular
unresponsiveness,enal failure'3, ? /6 916@ of
normal"yperkalemiaTreatment*top potassiumA'et and EC'Hyperkalemia
with ECG changes is a medical emergency"yperkalemiaTreatment3irst
phase is emergency treatment to counteract the effects of
hyperkalemiaI= CalciumTempori!ing treatment to drive the potassium
into the cellsglucose plus insulin0eta1
agonist#a"CO."yperkalemiaTreatmentTherapy directed at actual
removal of potassium from the bodysodium polystyrene sulfonate
$-aye2alate&dialysisDetermine and correct the underlying
cause0ody 3luid DistributionBater C#aDC-D$E&
$mmol7E&$mmol7E& EC3=ascular . /86 FInterstitial /G /86
FIC3Intracellular 1. /6 /F6TOT)E 81
