Electro lyte Na

Etiology 6 Ds: WATER loss Diuresis Dehydration Diabetes insipidus (DI) Docs iatrogenic Diarrhea Disease kidney Also: Hypertonic Na gain aldosteron/ADH Pure water loss DI Hypotonic fluid loss intake, diarrhea, burns, osmotic dieresis ( mannitol, glucose in DKA)

S/sx Thirst Oliguria Polyuria DI Neurologic sx Doughy skin

Labs Na > 145 mEq/L

Treatment Hypotonic Saline D5Q Oral water GRADUALLY over 48 72 hrs to prevent cerebral edema

Na

ADH Osmolality: High > 295 hyperglycemia, hypertonic infusion Normal 280 - 295 triglyceride Low < 280 Volume: 1. Hypervolemic renal failure, nephrotic syndrome, cirrhosis, CHF, hypothyroidism, 2. Euvolemic SIADH, renal failure, drugs 3. Hypovolemic Diuretics ( HCTZ), diarrhea, vomiting, third spacing, dehydration, DKA, 1 adrenal insufficiency Hemolysis Excretion renal insufficiency, drugs (spironolactone, ACEI, NSAIDS), hypoaldosteronism, renal tubular acidosis Cellular shifts rhabdomyolysis, insulin deficiency, acidosis, drugs (digitalis, BB) exercise Iatrogenic

Asymptomatic Confusion Lethargy Muscle cramps reflexes

Na < 135

Hypotonic + : 1. Hypervolemic Water restriction, diuretics 2. Euvolemic water restriction 3. Hypovolemic NS If tx to rapidly central pontine myelinolysis

N/V Intestinal colic Areflexia Weakness Flaccid paralysis Paresthesias

K>5 ECG TALL, peaked T waves, wide QRS, PR prolongation, loss P waves cardiac arrest

C BIG K (mnemonic) Calcium gluconate ECG cardiac cell membrane stabilization Bicarbonate Insulin Glucose Kayexalate remove K + Albuterol Dialysis if severe

Transcellular shifts insulin, BB, alkalosis GI losses diarrhea, chronic laxative, vomiting, NG suction Renal losses diuretics, DKA, Mg CHIMPANZEES MALIGNANCY, PTH Calcium supplementation Hyperparathyroidism/hyperthyroi dism Iatrogenic/Immobility Milk alkali syndrome Pagets disease Adrenal insufficiency/Acromegaly Neoplasm Zollinger Ellison syndrome Excess vit A Excess vit D Sarcoidosis PTH MG Vit D Acute pancreatitis DiGeorges syndrome infants + tetany

Ca

Muscle weakness Cramps Ileus Hypotension Reflexes Fatigue BONES osteopenia, fractures STONES kidney GROANES constipation Psych OVERTONE weakness, fatigue, MS

K < 3.6 24 hrs UA ECG U waves, T wave flatting, ST depression, AV block arrest >10.2 ECG Q - T

K repletion + Mg repletion

IV hydration followed by Furosemide (Loops lose calcium) Severe calcitonin, bisphosphonates, glucocorticoids, dialysis AVOID HCTZ b/c Ca tubular reabsorption

Ca

Ca < 8.5 Abdominal cramps Tetany Perioral + acral paresthesias CHVOSTEKS sign facial spasm from tapping of the facial nerve TROUSSEAUS sign carpal spasm after arterial occlusion by BP cuff ECG prolonged QT Recalculate Ca for low Albumin

Tx underlying d/o Mg repletion Ca supplements

Mg

intake loss diuretics, diarrhea, vomiting, Ca, alcoholism

Sx related to K Ca Muscles cramps

< 1.5 K Ca ECG prolonged

IV or oral supplements

DKA Pancreatitis

N/V Weakness Severe tetany

PR and QT