ELECTROLYTE DISORDERS

Question 1

Approach to Hyponatremia

Answer 1

Definition: Na < 130

Severe: seizures, mental status change, hyporeflexia

3% saline 4 ml / kg over 30 min

Not severe: 20 ml / kg bolus NS

Further correction slowly over 48 hrs

Question 2

Approach to Hyperkalemia

Answer 2

Get an ECG: peaked T waves, prolong PR, widening of QRS

If Severe of ECG changes:
Calcium Gluconate 10% 1 ml / kg IV at 1 ml/min

Insulin 0.1 U / kg
PLUS
D25 2 cc / kg

Salbutamol 8 puff

Furosemide 1-2 mg / kg IV

Question 3

Approach to Hypokalemia

Answer 3

Muscle weakness, ileus

Severe: 0.2 mEq/kg/h of KCl / 1/2 NS + 20 mEq/L KCL

Question 4

Approach to Hypercalcemia

Answer 4

Fatigue, irritability, anorexia, constipation

IV NS 20 ml /kg

Consider furosemide 1-2 mg / kg IV

Question 5

Approach to Hypocalcemia

Answer 5

Vomiting, irritability, muscle weakness, tetany, seizures

Calcium gluconate 10% 1 ml / kg IV no faster than 1 ml/min

Question 6

Approach to Hypomagnesemia

Answer 6

Get an ECG stat: prolonged PR and QTc, torsades do pointes

Muscles spasm, weakness, ataxia, nystagmus, seizures

For seizures or dysrhythmia: IV mag sulfate 1 mEq / kg slowly over 4 hrs

Question 7

Approach to hypermagnesemia

Answer 7

Severe: calcium gluconate 10% 1 ml / kg IV no faster than 1 ml / min