Electrolyte disturbance: Difference between revisions

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===The Table of Disturbance===
===The Table of Disturbance===
<table width="100%" border="1" cellspacing="0" cellpadding="0">
{| style="word-wrap: break-word;" border="1"
  <tr>
|
    <td>&nbsp;</td>
| '''Causes'''
    <td>'''Blood Level'''</td>
| '''Symptoms'''
    <td>'''Causes'''</td>
| '''Investigations'''
    <td>'''Symptoms'''</td>
| '''Treatment'''
    <td>'''Investigations'''</td>
|-
    <td>'''Treatment'''</td>
| '''Hyponatraemia''' <135mmol/l (<120mmol/L is severe)
  </tr>
| ''Kidney'': [[Addison's]], [[renal failure]], [[diuretics]]; ''Water loss'': [[D&V]]; ''Oedema'': [[nephrotic syndrome]], [[heart failure]]; [[SIADH]]
  <tr>
| [[confusion]], [[seizures]], [[hypertension]], [[cardiac failure]], [[oedema]], [[anorexia]], [[nausea]], [[weakness]]
    <td>'''Hyponatraemia'''</td>
| [[U+E]], urinary Na<sup>+</sup>>20mmol/L, urine osmolality
    <td><135mmol/l (<120mmol/L is severe)</td>
| Treat cause. ''Hypovolaemia'': isotonic saline relacement. ''Normovolaemic'': fluid restriction. ''Hypervolaemia'': furosemide, ACE inhibitor, fluid restriction
    <td>''Kidney'': [[Addison's]], [[renal failure]]; ''Water loss'': [[D&V]]; ''Oedema'': [[nephrotic syndrome]], [[heart failure]]; [[SIADH]]</td>
|-
    <td>[[confusion]], [[seizures]], [[hypertension]], [[cardiac failure]], [[oedema]], [[anorexia]], [[nausea]], [[weakness]]</td>
| '''Hypernatraemia''' >145mmol/L
    <td>[[U+E]], urinary Na<sup>+</sup> (>, urine osmolality</td>
| ''Not enough water'': poor intake, [[diuretics]], [[diabetes insipidus]].
    <td>Fluid restriction, treat cause</td>
| [[thirst]], [[confusion]], [[coma]], [[seizures]] + [[signs of dehydration]]
  </tr>
| [[U+E]] raised urea and albumin
  <tr>
| Water orally or 5% dextrose iv (4L/24h). Can use 0.9% saline - do not use hypotonic solutions
    <td>'''Hypernatraemia'''</td>
|-
    <td>>145mmol/L</td>
| '''Hypokalaemia''' <3.5 mmol/l
    <td>''Not enough water'': poor intake, [[diuretics]], [[diabetes insipidus]].</td>
| ''Loss'': thiazide and loop diuretics, [[Cushing's]], [[D&V]], poor dietary intake, ''alkalosis'' causing shift into cells.
    <td>[[thirst]], [[confusion]], [[coma]], [[seizures]] + [[signs of dehydration]]</td>
| At first, muscle weakness, pain from rhabdomylolysis, tetany, [[arrhythmias]] and [[constipation]]. Later paralysis and paraesthaesia.
    <td>[[U+E]] raised urea and albumin</td>
| 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.
    <td>Water orally or 5% dextrose iv (4L/24h). Can use 0.9% saline - do not use hypotonic solutions</td>
| Oral Potassium, or IV KCl of 40 mmol/l, no faster than 20 mmol/hr, or their heart stops.
  </tr>
|-
  <tr>
| '''Hyperkalaemia''' >5.5 mmol/l
    <td>'''Hypokalaemia'''</td>
| ''Renal'': decreased excretion or drugs. Rhabdomyolisis. ''Acidosis'', causing K+ to swap with H+. Potassium sparing [[diuretics]].  
    <td>&lt;3.5 mmol/l</td>
| First nothing. Then weakness and paralysis, then heart arrhythmias. Then shortness of breath. Then death.
    <td>''Loss'': thiazide and loop diuretics, [[Cushing's]], [[D&amp;V]], poor dietary intake, ''alkalosis'' causing shift into cells.</td>
| [[Blood]] and [[ABG]] K+. [[ECG]], looking for tented T waves, prolonged PR and absent P waves.
    <td>At first, muscle weakness, pain from rhabdomylolysis, tetany, [[arrhythmias]] and [[constipation]]. Later paralysis and paraesthaesia.</td>
| Stop potassium intake/sparing. Calcium gluconate, plus insulin and glucose. Nebulised salbutamol. Then calcium resonium.
    <td>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.</td>
|-
    <td>Oral Potassium, or IV KCl of 40 mmol/l, no faster than 20 mmol/hr, or their heart stops.</td>
| '''Hypocalcaemia''' <2.12mmol/L
  </tr>
| Para/thyroid surgery; ''PO<sup>4-</sup>↑'': [[chronic renal failure]], [[hypoparathyroidism]], [[pseudohypoparathyroidism|pseudohypo...]]; ''PO<sup>4-</sup>↓↔'': [[osteomalacia]], [[pancreatitis]], overhydration, [[rhabdomyolysis]]; [[respiratory alkalosis]]
  <tr>
| tetany, [[depression]], perioral [[paraesthesia]], carpo-pedal spasm (esp. with BP measuring), neuromuscular excitability (tap facical nerve, muscles twitch), [[cataract]] chronically
    <td>'''Hyperkalaemia'''</td>
| ECG: prolonged Q-T interval
    <td>&gt;5.5 mmol/l</td>
| ''Mild'': Ca<sup>2+</sup> 5mmol. ''Severe'': calcium gluconate 10mL 10%ivi 30min, repeat.
    <td>''Renal'': decreased excretion or drugs. Rhabdomyolisis. ''Acidosis'', causing K+ to swap with H+. Potassium sparing [[diuretics]].
|-
</td>
| '''Hypercalcaemia''' 2.65 mmol/l
    <td>First nothing. Then weakness and paralysis, then heart arrhythmias. Then shortness of breath. Then death.</td>
| Hyperparathyroidism, or cancer. And Lithium use. Pretty much it.
    <td>[[Blood]] and [[ABG]] K+. [[ECG]], looking for tented T waves, prolonged PR and absent P waves.</td>
| Confusion, constipation, polyuria, nausea. Chronic causes stones.
    <td>Stop potassium intake/sparing. Calcium gluconate, plus insulin and glucose. Nebulised salbutamol. Then calcium resonium.</td>
| U+Es for serum calcium. And magnesium, albumin, phosphate and creatinine. ''ECG'': prolonged Q-T
  </tr>
| Fluids. Furosemide. Pamidronate (a bisphosphonate).
  <tr>
|-
    <td>'''Hypocalcaemia'''</td>
| '''Hypomagnesaemia''' <0.7 mmol/l
    <td><2.12mmol/L</td>
| Diuretics, [[Alcohol abuse]], [[D&V]], [[Malnutrition]], [[Aminoglycosides]] (gentamicin, tobramycin) and Post MI.
    <td>Para/thyroid surgery; ''PO<sup>4-</sup>↑'': [[chronic renal failure]], [[hypoparathyroidism]], [[pseudohypoparathyroidism]]; ''PO<sup>4-</sup>↓↔'': [[osteomalacia]], [[pancreatitis]], overhydration, [[rhabdomyolysis]]; [[respiratory alkalosis]]</td>
| [[Arrhythmias]], [[Tetany]], Irritability
    <td>tetany, [[depression]], perioral [[paraesthesia]], carpo-pedal spasm (esp. with BP measuring), neuromuscular excitability (tap facical nerve, muscles twitch), [[cataract]] chronically</td>
| Blood test. 40% will have hypocalcaemia and 60% will have hypokalaemia. ECG will show a prolonged QT and/or [[Torsades]]
    <td>ECG: prolonged Q-T interval</td>
| Oral magnesium, or IV magnesium sulphate (MgSO4)
    <td>''Mild'': Ca<sup>2+</sup> 5mmol. ''Severe'': calcium gluconate 10mL 10%ivi 30min, repeat.</td>
|}
  </tr>
  <tr>
    <td>'''Hypercalcaemia'''</td>
    <td>2.65 mmol/l</td>
    <td>Hyperparathyroidism, or cancer. And Lithium use. Pretty much it.</td>
    <td>Confusion, constipation, polyuria, nausea. Chronic causes stones.</td>
    <td>U+Es for serum calcium. And magnesium, albumin, phosphate and creatinine.</td>
    <td>Fluids. Furosemide. Pamidronate (a bisphosphonate).</td>
  </tr>
  <tr>
    <td>'''Hypomagnesaemia'''</td>
    <td>&lt;0.7 mmol/l</td>
    <td>Diuretics, [[Alcohol abuse]], [[D&amp;V]], [[Malnutrition]], [[Aminoglycosides]] (gentamicin, tobramycin) and Post MI.</td>
    <td>[[Arrhythmias]], [[Tetany]], Irritability</td>
    <td>Blood test. 40% will have hypocalcaemia and 60% will have hypokalaemia. ECG will show a prolonged QT and/or [[Torsades]]</td>
    <td>Oral magnesium, or IV magnesium sulphate (MgSO4) </td>
  </tr>
</table>

Latest revision as of 11:23, 22 May 2010

Important disturbances

The big uns are:

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)
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