Electrolyte disturbance: Difference between revisions
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===The Table of Disturbance=== | ===The Table of Disturbance=== | ||
{| | {| style="word-wrap: break-word;" border="1" | ||
| | | | ||
| '''Causes''' | | '''Causes''' | ||
| '''Symptoms''' | | '''Symptoms''' | ||
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| '''Treatment''' | | '''Treatment''' | ||
|- | |- | ||
| '''Hyponatraemia''' | | '''Hyponatraemia''' <135mmol/l (<120mmol/L is severe) | ||
| ''Kidney'': [[Addison's]], [[renal failure]], [[diuretics]]; ''Water loss'': [[D&V]]; ''Oedema'': [[nephrotic syndrome]], [[heart failure]]; [[SIADH]] | | ''Kidney'': [[Addison's]], [[renal failure]], [[diuretics]]; ''Water loss'': [[D&V]]; ''Oedema'': [[nephrotic syndrome]], [[heart failure]]; [[SIADH]] | ||
| [[confusion]], [[seizures]], [[hypertension]], [[cardiac failure]], [[oedema]], [[anorexia]], [[nausea]], [[weakness]] | | [[confusion]], [[seizures]], [[hypertension]], [[cardiac failure]], [[oedema]], [[anorexia]], [[nausea]], [[weakness]] | ||
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| Treat cause. ''Hypovolaemia'': isotonic saline relacement. ''Normovolaemic'': fluid restriction. ''Hypervolaemia'': furosemide, ACE inhibitor, fluid restriction | | Treat cause. ''Hypovolaemia'': isotonic saline relacement. ''Normovolaemic'': fluid restriction. ''Hypervolaemia'': furosemide, ACE inhibitor, fluid restriction | ||
|- | |- | ||
| '''Hypernatraemia''' | | '''Hypernatraemia''' >145mmol/L | ||
| ''Not enough water'': poor intake, [[diuretics]], [[diabetes insipidus]]. | | ''Not enough water'': poor intake, [[diuretics]], [[diabetes insipidus]]. | ||
| [[thirst]], [[confusion]], [[coma]], [[seizures]] + [[signs of dehydration]] | | [[thirst]], [[confusion]], [[coma]], [[seizures]] + [[signs of dehydration]] | ||
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| Water orally or 5% dextrose iv (4L/24h). Can use 0.9% saline - do not use hypotonic solutions | | Water orally or 5% dextrose iv (4L/24h). Can use 0.9% saline - do not use hypotonic solutions | ||
|- | |- | ||
| '''Hypokalaemia''' | | '''Hypokalaemia''' <3.5 mmol/l | ||
| ''Loss'': thiazide and loop diuretics, [[Cushing's]], [[D&V]], poor dietary intake, ''alkalosis'' causing shift into cells. | | ''Loss'': thiazide and loop diuretics, [[Cushing's]], [[D&V]], poor dietary intake, ''alkalosis'' causing shift into cells. | ||
| At first, muscle weakness, pain from rhabdomylolysis, tetany, [[arrhythmias]] and [[constipation]]. Later paralysis and paraesthaesia. | | At first, muscle weakness, pain from rhabdomylolysis, tetany, [[arrhythmias]] and [[constipation]]. Later paralysis and paraesthaesia. | ||
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| Oral Potassium, or IV KCl of 40 mmol/l, no faster than 20 mmol/hr, or their heart stops. | | Oral Potassium, or IV KCl of 40 mmol/l, no faster than 20 mmol/hr, or their heart stops. | ||
|- | |- | ||
| '''Hyperkalaemia''' | | '''Hyperkalaemia''' >5.5 mmol/l | ||
| ''Renal'': decreased excretion or drugs. Rhabdomyolisis. ''Acidosis'', causing K+ to swap with H+. Potassium sparing [[diuretics]]. | | ''Renal'': decreased excretion or drugs. Rhabdomyolisis. ''Acidosis'', causing K+ to swap with H+. Potassium sparing [[diuretics]]. | ||
| First nothing. Then weakness and paralysis, then heart arrhythmias. Then shortness of breath. Then death. | | First nothing. Then weakness and paralysis, then heart arrhythmias. Then shortness of breath. Then death. | ||
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| Stop potassium intake/sparing. Calcium gluconate, plus insulin and glucose. Nebulised salbutamol. Then calcium resonium. | | Stop potassium intake/sparing. Calcium gluconate, plus insulin and glucose. Nebulised salbutamol. Then calcium resonium. | ||
|- | |- | ||
| '''Hypocalcaemia''' | | '''Hypocalcaemia''' <2.12mmol/L | ||
| Para/thyroid surgery; ''PO<sup>4-</sup>↑'': [[chronic renal failure]], [[hypoparathyroidism]], [[pseudohypoparathyroidism|pseudohypo...]]; ''PO<sup>4-</sup>↓↔'': [[osteomalacia]], [[pancreatitis]], overhydration, [[rhabdomyolysis]]; [[respiratory alkalosis]] | | Para/thyroid surgery; ''PO<sup>4-</sup>↑'': [[chronic renal failure]], [[hypoparathyroidism]], [[pseudohypoparathyroidism|pseudohypo...]]; ''PO<sup>4-</sup>↓↔'': [[osteomalacia]], [[pancreatitis]], overhydration, [[rhabdomyolysis]]; [[respiratory alkalosis]] | ||
| tetany, [[depression]], perioral [[paraesthesia]], carpo-pedal spasm (esp. with BP measuring), neuromuscular excitability (tap facical nerve, muscles twitch), [[cataract]] chronically | | tetany, [[depression]], perioral [[paraesthesia]], carpo-pedal spasm (esp. with BP measuring), neuromuscular excitability (tap facical nerve, muscles twitch), [[cataract]] chronically | ||
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| ''Mild'': Ca<sup>2+</sup> 5mmol. ''Severe'': calcium gluconate 10mL 10%ivi 30min, repeat. | | ''Mild'': Ca<sup>2+</sup> 5mmol. ''Severe'': calcium gluconate 10mL 10%ivi 30min, repeat. | ||
|- | |- | ||
| '''Hypercalcaemia''' | | '''Hypercalcaemia''' 2.65 mmol/l | ||
| Hyperparathyroidism, or cancer. And Lithium use. Pretty much it. | | Hyperparathyroidism, or cancer. And Lithium use. Pretty much it. | ||
| Confusion, constipation, polyuria, nausea. Chronic causes stones. | | Confusion, constipation, polyuria, nausea. Chronic causes stones. | ||
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| Fluids. Furosemide. Pamidronate (a bisphosphonate). | | Fluids. Furosemide. Pamidronate (a bisphosphonate). | ||
|- | |- | ||
| '''Hypomagnesaemia''' | | '''Hypomagnesaemia''' <0.7 mmol/l | ||
| Diuretics, [[Alcohol abuse]], [[D&V]], [[Malnutrition]], [[Aminoglycosides]] (gentamicin, tobramycin) and Post MI. | | Diuretics, [[Alcohol abuse]], [[D&V]], [[Malnutrition]], [[Aminoglycosides]] (gentamicin, tobramycin) and Post MI. | ||
| [[Arrhythmias]], [[Tetany]], Irritability | | [[Arrhythmias]], [[Tetany]], Irritability |
Latest revision as of 11:23, 22 May 2010
Important disturbances
The big uns are:
- Hyponatraemia & Hypernatraemia
- Hypokalaemia & Hyperkalaemia
- Hypocalcaemia & Hypercalcaemia
- Hypomagnesaemia
They mostly have their own pages, just click on them, or for a condensed version, see below.
The Table of Disturbance
Causes | Symptoms | Investigations | Treatment | |
Hyponatraemia <135mmol/l (<120mmol/L is severe) | Kidney: Addison's, renal failure, diuretics; Water loss: D&V; Oedema: nephrotic syndrome, heart failure; SIADH | confusion, seizures, hypertension, cardiac failure, oedema, anorexia, nausea, weakness | U+E, urinary Na+>20mmol/L, urine osmolality | Treat cause. Hypovolaemia: isotonic saline relacement. Normovolaemic: fluid restriction. Hypervolaemia: furosemide, ACE inhibitor, fluid restriction |
Hypernatraemia >145mmol/L | Not enough water: poor intake, diuretics, diabetes insipidus. | thirst, confusion, coma, seizures + signs of dehydration | U+E raised urea and albumin | Water orally or 5% dextrose iv (4L/24h). Can use 0.9% saline - do not use hypotonic solutions |
Hypokalaemia <3.5 mmol/l | Loss: thiazide and loop diuretics, Cushing's, D&V, poor dietary intake, alkalosis causing shift into cells. | At first, muscle weakness, pain from rhabdomylolysis, tetany, arrhythmias and constipation. Later paralysis and paraesthaesia. | Urinary potassium - low suggests poor intake, shift into the intracellular space or GI loss. Where high, suggests renal loss. Urinary sodium - low Na+; high K+ in wee suggests secondary hyperaldosteronism. Prolonged QT. | Oral Potassium, or IV KCl of 40 mmol/l, no faster than 20 mmol/hr, or their heart stops. |
Hyperkalaemia >5.5 mmol/l | Renal: decreased excretion or drugs. Rhabdomyolisis. Acidosis, causing K+ to swap with H+. Potassium sparing diuretics. | First nothing. Then weakness and paralysis, then heart arrhythmias. Then shortness of breath. Then death. | Blood and ABG K+. ECG, looking for tented T waves, prolonged PR and absent P waves. | Stop potassium intake/sparing. Calcium gluconate, plus insulin and glucose. Nebulised salbutamol. Then calcium resonium. |
Hypocalcaemia <2.12mmol/L | Para/thyroid surgery; PO4-↑: chronic renal failure, hypoparathyroidism, pseudohypo...; PO4-↓↔: osteomalacia, pancreatitis, overhydration, rhabdomyolysis; respiratory alkalosis | tetany, depression, perioral paraesthesia, carpo-pedal spasm (esp. with BP measuring), neuromuscular excitability (tap facical nerve, muscles twitch), cataract chronically | ECG: prolonged Q-T interval | Mild: Ca2+ 5mmol. Severe: calcium gluconate 10mL 10%ivi 30min, repeat. |
Hypercalcaemia 2.65 mmol/l | Hyperparathyroidism, or cancer. And Lithium use. Pretty much it. | Confusion, constipation, polyuria, nausea. Chronic causes stones. | U+Es for serum calcium. And magnesium, albumin, phosphate and creatinine. ECG: prolonged Q-T | Fluids. Furosemide. Pamidronate (a bisphosphonate). |
Hypomagnesaemia <0.7 mmol/l | Diuretics, Alcohol abuse, D&V, Malnutrition, Aminoglycosides (gentamicin, tobramycin) and Post MI. | Arrhythmias, Tetany, Irritability | Blood test. 40% will have hypocalcaemia and 60% will have hypokalaemia. ECG will show a prolonged QT and/or Torsades | Oral magnesium, or IV magnesium sulphate (MgSO4) |