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Electrolytesdisorders 100329234501-phpapp02
- 1. ELECTROLYTE DISORDERS EMPA Residency UTHSCSA K + + Na Mg 2+ 2+ Ca 4 PO - - Cl
- 3. ELECTROLYTE DISORDERS Total fluid volume 42 liters ECF 33% --- 1) Plasma 7% 2) Interstitial Fluid 26% 3) Lymph <1% ICF 67% Body Fluid Composition mEqui per liter Cations Plasma ISF Cell Na + 142.0 145.1 12 K + 4.3 4.4 150 Ca 2+ 5 2.4 4 Mg 2+ 3 1.5 34 Total 154 153.0 200 Anions Plasma ISF Cell Cl - 104 117.4 4 HCO 3 - 24 27.1 12 Phosphates 2 2.3 40 Proteins 14 0.0 54 Other 5.9 6.2 90 Total 149.9 153.0 200
- 4. ELECTROLYTE DISORDERS Fluid Compartments
- 90. ELECTROLYTE DISORDERS Questions K + + Na Mg 2+ 2+ Ca 4 PO - - Cl
Notes de l'éditeur
- Osmotic gradient develops across blood brain barrier causing water to move into brain. -Two protective mechanisms: - Movement of interstitial fluid into the CSF - Loss of cellular potassium and organic osmolytes Acute hyponatremia (Na < 120) developing < 24 hours OR rate of fall of > 0.5 meq/L per hour: -Muscular twitching, seizures, coma Acute severe hyponatremia with CNS changes – mortality rate 50%. CPM – correction of hyponatremia faster than the brain can recover solute.
- Protective mechanism – ADH - Released in response to decreased blood volume - Increased ADH present in almost all hyponatremic conditions - Increases water reabsorption by renal tubules (seems counterproductive) - Potent vasoconstrictor: - Increased peripheral vascular resistance - Increased blood flow to liver and kidneys at expense of skin and muscle
- Movement of water from ICF to ECF dilutes the ECF. Volume replacement with sodium containing fluids.
- Hyperproteinemia Multiple Myeloma Waldenstrom Macroglobulinemia
- Results in intracellular volume expansion with derangement of cellular function. Obtain serum and urine electrolytes Obtain plasma and urine osmolality
- Clinical manifestations due to volume deficit rather than hyponatremia.
- Unequal loss of electrolyte and water loss produces a contracted ECF volume with hyponatremia. Maintained by effect of volume depletion on kidneys inhibiting free water excretion. - Decreased GFR. - Increased proximal tubular resorption of solute and water. - Decreased deliver of fluid to the diluting segment of the nephron. - ADH released by nonosmotic stimuli.
- Slightly expanded ECF No clinical edema, near normal total body Na Sx usually relative to CNS hypotonicity
- CHF – perceived as low flow state, stimulates ADH Nephrotic Syndrome – low serum protein due to urinary loss Cirrhosis – low intravascular oncotic pressure due to decreased protein production
- Comatose or bedridden patients susceptible since they are unable to obtain adequate fluid. All hypernatremic states are hyperosmolar.
- ADH response to low volume and hypertonicity UO < 20 mL/h
- Doughy abdominal skin when pinched between fingers Accumulation of amino acids in the brain
- Iatrogenic Na – NaHCO3, hypertonic saline Mineralocorticoid/Glucocorticoid excess Primary aldosternoism Cushing’s syndrome Ectopic ACTH hormone production
- Iatrogenic Na – NaHCO3, hypertonic saline Mineralocorticoid/Glucocorticoid excess Primary aldosternoism Cushing’s syndrome Ectopic ACTH hormone production
- Mortality rate Overall 10% 25 to 50% if plasma osmolality > 350
- Mortality rate Overall 10% 25 to 50% if plasma osmolality > 350
- Cerebral edema due to presence of idiogenic osmoles
- 6.5 to 7.5 meq/L 7.5 to 8.0 meq/L 10 to 12 meq/L
- Membrane stabilization Effect w/in 1 to 3 min, active for 1 hour Central line Glucose/Insulin 50 g glucose with 5-10 units regular insulin Onset 30 min, durastion 4 to 6 hrs NaHCO3 Onset 5 to 10 min, duration 1 to 2 hrs
- Membrane stabilization Effect w/in 1 to 3 min, active for 1 hour Central line Glucose/Insulin 50 g glucose with 5-10 units regular insulin Onset 30 min, durastion 4 to 6 hrs NaHCO3 Onset 5 to 10 min, duration 1 to 2 hrs Kaexalate Given with Sorbital to avoid constipating effects and speed bowel transit time
- Most abundant mineral in the body
- In presence of albumin, total Ca may be low but ionized Ca remains normal Vit D deficiency Sunlight/dietary deficiency Malabsorption (Gastrectomy)
- Chvostek – Twitch at corner of mouth when tapped over facial nerve just in front of ear. Trosseau – Carpal spasm produced when BP cuff to upper arm maintains a pressure above systolic for 3 min. Fingers spastically extend at the IP joints and flex at the MCP joints. Wrist flexed, forearm pronated,
- Give over 10 to 20 min, then drip 1g CaCl over 6-12 hrs
- Hypo K, Hypo Mg will worsen with diuresis