5. Approach Guideline of HypoNa True Hyponatremia (exclude hyperglycemia) Assess ECF volume status TBW , TBNa + NaCl replacement H 2 O restriction Diuretics, H 2 O / Na restriction Hypovolemia TBW , TBNa + Hypervolemia TBW , TBNa + Normovolemia U [Na] > 20 < 20 > 20 > 20 < 20 Renal loss Extrarenal loss Renal failure Edematous state SIADH Endocrinopathy Rx Rx Rx
6.
7.
8.
9.
10.
11.
12. Approach Guideline of HyperNa Rx Rx Rx Istonic + Hypotonic NaCl replacement H 2 O replacement Diuretics H 2 O replacement Assess ECF volume status U [Na] > 20 < 20 U sp gr low high U [Na] > 20 Renal loss Extrarenal loss Renal loss Extrarenal loss Sodium gain TBW , TBNa + Hypovolemia TBW , TBNa + Hypervolemia TBW , TBNa + Normovolemia
13.
14.
15.
16.
17.
18.
19. Approach Guideline of HyperK Increased serum [K] production - Rhabdomyolysis - Intravasc hemolysis excretion - Renal failure - dRTA type IV - Adrenal insufficiency - Drugs: ACEI K-sparing diuretics NSAID Heparin, etc. Redistribution - Acidosis - Insulin insufficiency - Drugs: -blocker succinylcholine Digitalis intox Renal K excretion: vary low high (>10) * TTKG = Urine K / Serum K Urine osm / Serum osm
38. Diagnostic Algorithm of Metabolic Alkalosis urine pH Metabolic alkalosis Is the GFR very low? Yes Alkali intake Iron exchange resin Milk-alkali syndrome Vomiting No Is the ECF volume contracted? Yes No Hyperaldosteronism Cushing syndrome Exogenous mineralo- corticoids Liddle syndrome Is the urine Cl low? low, <10 high, >20 Gastric fluid loss Remote diuretics Other rare causes Current diuretics Bartter’s syndrome Mg ++ depletion Recent Remote high low high UNa low UNa
![[object Object],[object Object],[object Object],Emergency Management in Electrolyte and Acid-Base Disorders](https://image.slidesharecdn.com/acidbasedisordersextern2-111218094441-phpapp02/85/acid-base-disorders-extern2-1-320.jpg)
![Scope ,[object Object],[object Object],[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)