electrolyte imbalance Flashcards
severe hyponatremia
<125
hyponatremia correction rate
<0.5 mEq/L/hr
risk of central pontine myolinolysis
most common type of hyponatremia
hypotonic
tx for hypotonic hypervolemic hyponatremia
fluid restriction
tx for hypotonic hypovolemic hyponatremia
0.9% saline
hypernatremia tx
calculate free water deficit & resuscitate with IVF
free water deficit
0.4 * kg * ((serum Na/140) -1)
calcium and acid base
acidosis - hypercalcemia
alkalosis - hypocalcemia
hyponatremia symptomatology
CNS symptoms!
lethargy
malaise
nausea
seizures
coma
may be chronic and asymptomatic
hypernatremia symptomatology
CNS symptoms
lethargy
irritability
weakness
confusion
delirium
coma
may be chronic and asymptomatic
hypoK symptomatology
most asymptomatic
MS symptoms in severe hypoK
EKG - decreased amp, broad T, prominent U, QT prolong, PVCs, CT
hypoK treatment
KCl
max rate 20/hr IV
10 mEq will generally raise by 0.1
check mag! deficit will impair correction
consider kphos or kbicarb
hyperK symptomatology
weakness
nausea
diarrhea
fatigue
EKG - palpitations, peaked T, heart block, loss of P waves, sine wave, wide QRS
hyperK treatment
many lab errors - recheck
EKG
goal - stabilize cardiac cell membranes!
> 6 or ekg change requires treatment
calcium gluconate/chloride
insulin + D50W (fastest & largest reduction)
bicarb (if accompanying metabolic acidosis)
B2 agonist (albuterol) w insulin
kayexalate (not emergency)
diuretics
HD
calcium ranges
total 8.5-10.2 (bound & unbound, influenced by albumin)
ionized 4.5-5.3
