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Electrolyte Disorders

Electrolyte Disorders. Dom Colao, DO November 2011. Review of Electrolyte disorders. HypoNatremia Hypernatremia HypoKalemia HyperKalemia Calcium Magnesium Phosphorus. Overview of Disorders. The differential for any lab abnormality: Lab error Lab error Lab error Polypharmacy

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Electrolyte Disorders

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  1. Electrolyte Disorders Dom Colao, DO November 2011

  2. Review of Electrolyte disorders • HypoNatremia • Hypernatremia • HypoKalemia • HyperKalemia • Calcium • Magnesium • Phosphorus

  3. Overview of Disorders • The differential for any lab abnormality: • Lab error • Lab error • Lab error • Polypharmacy • Iatrogenic • Real disease • In that order!

  4. Always consider the potential for a confounding variable • Was the blood drawn above a running IV? • Did it sit too long before the test was run? • Is it your patients blood? • Is there a pattern of abnormalities in numerous patients on the same day?

  5. Over view of Sodium Disorders • Pseudo-hyponatremia • Due to high concentrations of other solutes in the blood - Mannitol in a pt with cerebral edema, Glucose in a diabetic. • Then look at the patient’s volume status • Hypervolemic/Euvolemic/Hypovolemic

  6. Hyponatremia • Hypervolemic: • HypOvolemic: • Euvolemic:

  7. Hyponatremia • Hypervolemic: • CHF, • Cirrhosis, • Pregnancy, • Nephrotic syndrome • In these conditions, total body sodium is up, but total body WATER is up even more. • Due to reduced Effective Arterial Blood Volume, (EABV) leading to increased ADH secretion.

  8. Hyponatremia • Hypervolemic: • CHF, Cirrhosis, Pregnancy, Nephrotic syndrome • HypOvolemic: • GI losses (diarrhea, Vomiting, NG suction) • Renal Losses (diuretics, Salt wasting nephropathy, recovery phase from ATN or obstruction). • Due to true depletion of water and sodium, leading to increased secretion of Aldosterone AND ADH

  9. Hyponatremia • Hypervolemic: • CHF, Cirrhosis, Pregnancy, Nephrotic syndrome • HypOvolemic: • GI losses (diarrhea, Vomiting, NG suction) • Renal Losses (diuretics, Salt wasting nephropathy, recovery phase from ATN or obstruction). • Euvolemic: • Medication effects, Endocrine syndromes, Excessive water intake, reset osmostat, SIADH

  10. Hyponatremia • Euvolemic: • Medication effects • ACE/ ARB/Tekturna/Spironolactone/HCTZ • Antidepressant and antipsychotic meds • NSAID’s • Endocrine syndromes • Hyper and Hypo thyroid, • Adrenal insufficiency and excess (addison’s / Cushings) • Excessive water intake, • Psychogenic polydipsia, beer potomania • reset osmostat, • Seen in conditions which stimulate tonic ADH secretion from tissues which have Neuroectoderm (brain and Lung) • SIADH

  11. Hyponatremia • Euvolemic: • reset osmostat, • Seen in conditions which stimulate tonic ADH secretion from tissues which have Neuroectoderm (brain and Lung) • Pneumonia, COPD, stroke, brain hemorrhage. • These conditions result in a stable low level of sodium, around which water and sodium regulation are functioning normally, but at a new lower setting. • Confirmed by water loading test. • SIADH - Persistant high production of ADH which does not suppress in the face of water load, usually due to a tumor such as small cell lung carcinoma or brain tumor.

  12. Case 1, Hyponatremia

  13. Case 1b Hyponatremia

  14. Case 1c, Hyponatremia

  15. Pieces of metal in abdominal wall

  16. Can you guess what she swallowed?

  17. Case 2a Hypernatremia

  18. Case 2b Hypernatremia

  19. Case 3a Hypokalemia

  20. Case 3a Hypokalemia

  21. Case 3 b, Hypokalemia

  22. Case 3 b, Hypokalemia

  23. Case 4 Hyperkalemia

  24. Case 4 Hyperkalemia

  25. Case 4 Hyperkalemia

  26. Case 5, Hypercalcemia

  27. Case 6 Hypocalcemia

  28. Case 6 Hypocalcemia

  29. Case 7, Hypomagnesemia

  30. Case 7, Hypomagnesemia

  31. Case 8 Hypermagnesemia • Hypermagnesemia is seen only in patients with renal failure who are supplemented, • or in cases where large amounts of magnesium are infused.

  32. Case 9, Hypophosphatemia

  33. Case 9 Hyperphosphatemia • Classic presentation of Hypophosphatemic rhabdomyolysis. • Prolonged NPO status/starvation • Resp failure requiring reintubation after extubation or surgery. Due to resp muscle weakness. • Phos goes very low, then suddenly climbs without any supplementation. Associated with high K and Low calcium. • Creatinine climbs more than 1.0 mg/dl/day, suggesting increased creatinine production

  34. Reference • Narins. Fluid and Electrolyte Disorders: Am journal of Medicine, 1982

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