Electrolyte disturbance: Difference between revisions
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===The Table of Disturbance=== | ===The Table of Disturbance=== | ||
<table width=" | <table width="100%" border="1" cellspacing="0" cellpadding="0"> | ||
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<td | <td> </td> | ||
<td | <td>'''Blood Level'''</td> | ||
<td | <td>'''Causes'''</td> | ||
<td | <td>'''Symptoms'''</td> | ||
<td | <td>'''Investigations'''</td> | ||
<td | <td>'''Treatment'''</td> | ||
</tr> | </tr> | ||
<tr> | <tr> |
Revision as of 13:37, 11 January 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
Blood Level | Causes | Symptoms | Investigations | Treatment | |
Hyponatraemia | <130mmol/l (<120mmol/L is severe) | Kidney: Addison's, renal failure; Water loss: D&V; Oedema: nephrotic syndrome, heart failure; SIADH | confusion, seizures, hypertension, cardiac failure, oedema, anorexia, nausea, weakness | U+E, urinary Na+ (>, urine osmolality | Fluid restriction, treat cause |
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. Alkalosis causing shift into cells. | At first, muscle weakness and pain from rhabdomylolysis, 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+ suggests secondary hyppoaldosteronism. | 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. Then calcium resonium. |
Hypocalcaemia | <2.12mmol/L | Para/thyroid surgery; PO4-↑: chronic renal failure, hypoparathyroidism, pseudohypoparathyroidism; 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 | >2.56 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. | Fluids. Diuretics. 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. | Oral magnesium, or IV magnesium sulphate (MgSO4) |