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Causes, Symptoms, and Treatments of Electrolyte Abnormalities, Schemes and Mind Maps of Chemistry

Claremont Graduate UniversityChemistry

This document, presented by Dr. Don Beckstead, covers the essentials of fluid and electrolyte disorders, focusing on adult electrolyte issues. It identifies causes, symptoms, and treatment modalities for common electrolyte abnormalities related to sodium, potassium, calcium, and magnesium. The document also discusses the basic principles of electrolyte balance and metabolic profiles.

Typology: Schemes and Mind Maps

2021/2022

Uploaded on 09/12/2022

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1
11/2/18
Don Beckstead M.D.
FLUID&ELECTROLYTE
DISORDERS
63WYCH
Disclosures
•Ihavenothingtodisclose
•Thistalkisintendedtocoveradult
electrolyteissues
2
63WYCH
GOALSANDOBJECTIVES
•Identifycausesofcommonelectrolyte
abnormalitiesfoundinprimarycareoffice
patients.
•Discusssignsandsymptomsfoundinpatients
whohavecommonelectrolyteabnormalities.
•Becomecomfortablewithtreatmentmodalities
thatcanbeusedtocorrectcommonelectrolyte
abnormalities.
3
63WYCH
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Partial preview of the text

Download Causes, Symptoms, and Treatments of Electrolyte Abnormalities and more Schemes and Mind Maps Chemistry in PDF only on Docsity!

11/2/ Don Beckstead M.D.

FLUID & ELECTROLYTE

DISORDERS

63WYCH

Disclosures

  • I have nothing to disclose
  • This talk is intended to cover adult

electrolyte issues

2 63WYCH

GOALS AND OBJECTIVES

  • Identify causes of common electrolyte abnormalities found in primary care office patients.
  • Discuss signs and symptoms found in patients who have common electrolyte abnormalities.
  • Become comfortable with treatment modalities that can be used to correct common electrolyte abnormalities.

3 63WYCH

ELECTROLYTES

  • We will cover:
    • High and low sodium
    • High and low potassium
    • High and low calcium
    • High and low magnesium

4 63WYCH

SOME BASIC PRINCIPLES

  • Kidneys prioritize fluid and electrolyte balance at the possible expense of acid‐base balance.
  • Normally functioning kidneys have a great capacity to handle increased or decreased intake of most electrolytes.
  • Most electrolyte abnormalities found are in asymptomatic patients.
  • Sodium abnormalities are usually actually water abnormalities 5 Text^ 63WYCH^ to^ 828-216-

BASIC METABOLIC PROFILE

 Sodium (Na+ ) 136‐  Chloride (Cl‐) 100‐  Bicarbonate (CO2) 22‐  Potassium (K+) 3.6‐5.  BUN (blood urea nitrogen) 5‐  Creatinine 0.6 ‐ 1.

 Anion Gap (Na+‐ {Cl‐ + CO2}) = ~ 12  Calcium (Ca++) 8.5 – 10.  Magnesium (Mg++) 1.5 ‐ 2.3 6

HYPONATREMIA SYMPTOMS

  • Usually none
  • If not pseudohyponatremia (+ low osmolality), then symptoms are usually related to development of cerebral edema - Nausea/vomiting - Malaise/lethargy - Headache - Seizures/coma/respiratory arrest

10 63WYCH

HYPONATREMIA WORK‐UP

  • Urine osmol.
    • Low (< 100) in primary polydipsia
    • Higher (>100) in renal damage or ADH present)
  • Serum osmol
    • Differentiate from pseudohyponatremia
  • Urine Na+
    • SIADH = > 20‐40 mEq/l
    • Hypovolemia = < 25 mEq/l

11 63WYCH

HYPONATREMIA & MORTALITY

  • Mild hyponatremia (often caused by

severe medical issues) = significantly

higher mortality

  • Severe hyponatremia (often drug

induced) = less higher mortality

12 63WYCH

HYPONATREMIA TREATMENT

  • Assess volume status
  • Check TSH/cortisol?
  • Fluid restriction?
  • Saline or hypertonic saline?
  • Correct slowly (osmotic demyelination) -? Desmopressin
  • Vasopressin (ADH) receptor antagonists
    • Tolvaptan

13 63WYCH

HYPERNATREMIA CAUSES

  • Hypovolemic (common)
    • Diuretic use
    • GI loss (v/d)
    • Insensible loss (sweating, burns)
    • Osmotic diuresis
      • Hyperosmolar non‐ketotic coma
      • Mannitol use

14 63WYCH

HYPERNATREMIA CAUSES

  • Euvolemic
    • Diabetes insipidus
      • Central
      • Nephrogenic
    • Decreased water intake
    • Fever
    • Meds
      • Aminoglycosides
      • Phenytoin
      • Lithium
      • Amphotericin 15

HYPERNATREMIA TREATMENT

  • Correct max rate of 0.5 mEq/hr, 10 mEq/day if slow onset, 1.0 mEq/hr if rapid onset
  • Check serum lytes q every few hrs
  • Add in fluids to replace insensible (30 ‐ mL/hr) and other losses (e.g. N/G tube drainage)
  • Treat orally if possible
  • Often use D5W if IV
  • Treat cause when possible (^19) • Watch for cerebral edema

POTASSIUM

20 63WYCH

HYPOKALEMIA CAUSES

  • Diuretics
  • Beta adrenergic agonists; insulin
  • Inadequate intake
  • Excess sweating
  • Vomiting, diarrhea
  • Metabolic alkalosis
  • Steroids, aldosteronism
  • Renal tubular disease
  • Bartter and Gitelman syndromes 21

HYPOKALEMIA SIGNS/ SYMPTOMS

  • Usually none
  • If severe:
    • Weakness
    • EKG changes (u waves)
    • Palpitations
    • Arrhythmias (usually in pt w/ underlying cardiac disease)

22 63WYCH

HYPOKALEMIA WORK‐UP

  • Assess acid base status if significant
  • Check magnesium
  • Assess trans‐cellular shifts
  • Urine potassium?
  • Potassium/creatinine ratio?

23 63WYCH

HYPOKALEMIA TREATMENT

  • Change to ACE/ARB or K+ sparing diuretic
  • Oral supplementation KCL
  • IV supplementation if urgent or NPO
    • Arrhythmias
    • EKG changes
    • Symptoms

24 63WYCH

HYPERKALEMIA TREATMENT

  • Stop NSAIDs, ACE/ARBs, K+ sparing diuretics
  • Low K+ diet/limit “No‐salt”
  • Thiazide diuretic if no renal disease

28 63WYCH

CALCIUM

29 63WYCH

HYPERCALCEMIA CAUSES

  • Hyperparathyroidism
  • Malignancy
  • Hyperthyroidism
  • Renal failure
  • Sarcoidosis
  • Thiazide diuretics
  • Paget’s disease
  • Familial hypocalciuric hypercalcemia

30 63WYCH

HYPERCALCEMIA SYMPTOMS

  • Nausea/vomiting/constipation
  • Irritability/ fatigue/ muscle weakness
  • Depression
  • Polyuria/polydipsia
  • Kidney stones
  • Lethargy/confusion/coma
  • QT shortening, bradycardia, hypertension
  • Coronary deposits 31

HYPERCALCEMIA TREATMENT

  • IV saline
  • Calcitonin
  • Loop diuretics (furosemide)
  • Bisphosphonates (zoledronic acid)
  • Denosumab
  • Calcimimetics (cinacalcet)
  • Steroids if secondary to sarcoid/lymphomas
  • Dialysis 32

HYPOCALCEMIA CAUSES

  • Vitamin D deficiency
  • Bisphosphonate tx
  • Hyperphosphatemia
  • Abnl magnesium metabolism
  • Hypoparathyroidism
  • Pancreatitis
  • (Check albumin – if low would also expect Ca++ to be low) – can measure ionized

33 63WYCH

HYPOMAGNESEMIA CAUSES

  • Low in:
    • Poor intake
    • Chronic diarrhea
    • Pancreatitis
    • Renal disease
    • Alcoholism
    • Hypercalcemia
    • Diabetes
    • Diuretic tx; PPI tx 37 63WYCH

HYPOMAGNESEMIA SYMPTOMS

  • Tetany
  • Weakness
  • Apathy
  • Tremor
  • Seizures
  • Widened QRS, PR; arrhythmias
  • Delirium/coma
  • (Can cause hypocalcemia & hypokalemia) 38

HYPOMAGNESEMIA TREATMENT

  • Treat mild or no sx PO (200‐ 1000 mg/d)
  • Correct underlying disease
    • If unsure, can calculate fractional excretion of Mag
    • Caution with repletion in renal disease pts
  • Treat severe sx IV while on cardiac monitoring
    • Stat dose 1‐2 gm MgSO4 over 15 minutes if emergent
    • 4‐8 gm/24 hrs MgSO4 if subacute

39 63WYCH

HYPERMAGNESEMIA CAUSES

  • High in:
    • Renal failure
    • Laxative abuse
    • Antacid abuse
    • Enemas
    • DKA
    • Milk‐alkali syndrome
    • Occasionally w/ hyperparathyroidism
    • Tumor lysis syndrome 40

HYPERMAGNESEMIA SYMPTOMS

  • Somnolence
  • Decreased DTR’s
  • Paralysis
  • Hypotension
  • Bradycardia
  • Prolonged PR, QRS, QT; Complete heart block
  • Mild = nausea, headache
  • (Can cause hypocalcemia also) 41

HYPERMAGNESEMIA TREATMENT

  • Saline IV
  • Loop diuretic
  • Dialysis

42 63WYCH