Electrolytes Flashcards
hypokalaemia ecg changes
- u waves
- tall tented p waves
- increased pr interval
hypokalaemia presentation
- muscle cramps and weakness
- lethargy
- palpitations
hypokalaemia drug causes
- insulin
- salbutamol
- loop and thiazide diuretics
- laxatives
- steroids
hypokalaemia other causes
- cushings
- conns
- d and v
- villous adenoma
- gitelmans syndrome
- barterrs syndrome
- liddles syndrome
hypokalaemia management
- greater than 2.5 oral replacement
- less than 2.5 iv replacement
hyperkalaemia ecg changes
- tall tented t waves
- sine wave appearance
- absent/small p waves
- broad qrs
- vf
hyperkalaemia presentation
- arrhythmias
- palpitations
- chest pain
- constipation
- weakness
hyperkalaemia drug causes
- spironolactone
- ace inhibitors
- suxamethonium
- blood transfusion
- excessive replacement
hyperkalaemia other causes
- addisons disease
- dm with metabolic acidosis
- rhabdomyolysis
- renal tubular acidosis types 1 and 2
- burns
hyperkalaemia management
- stabilise myocardium
- drive potassium in to cells
- sodium bicarbonate
- careful fluid resuscitation
hyponatraemia presentation
- nausea and malaise
- headache
- irritability
- confusion
- seizures
- coma and death
hyponatraemia causes (hypervolaemic)
- nephrotic syndrome
- cardiac failure
- liver cirrhosis
- renal failure
hyponatraemia causes (euvolemic - urine osmolality >100)
- siadh
hyponatraemia causes (euvolemic - urine osmolality <100)
- water overload
- severe hypothyroidism
- glucocorticoid insufficiency
hyponatraemia causes (hypovolaemic - urinary sodium >20mmol/l)
- renal failure
- diuretic excess
- osmolar diuresis (increased glucose/urea)
hyponatraemia causes (hypovolemic - urinary sodium <20 mmol/l)
- diarrhoea
- vomiting
- fistulae
- small bowel obstruction
- cardiac failure
hyponatraemia management
- involve seniors, endocrine team and itu early on
dependent on cause; - hypovolaemia; 0.9% saline slowly. check u and es bd and aim not to exceed increasing sodium by greater than 10mmol in 24 hours
- hypervolaemia; fluid restrict and give furosemide
- euvolaemic; fluid restrict and consider further drugs
- risk of central pontine myelinosis if sodium level falls fast/replacement too quick so monitor gcs
hypernatraemia presentation
- lethargy
- thirst
- weakness
- irritability
- confusion
- seizures
- coma and death
hypernatraemia causes
- diarrhoea, vomiting, burns
- diabetes insipidus
- diabetic coma
- iatrogenic; excessive saline
hypernatraemia management
- oral water
- if hypovolaemic can give 0.9% saline slowly, or consider 5% dextrose with senior
- risk of central pontine myelinosis if sodium level falls fast/replacement too quick so monitor gcs
hypocalcaemia ecg changes
- prolonged qt interval
hypocalcaemia presentation
- spasms; trousseau’s sign
- perioral paraesthesia
- anxious, irritable, irrational
- seizures
- muscle tone increased; smooth muscle wheeze
- orientation impairment
- dermatitis
- impetigo herpeteformis
- chvostek’s sign/cataracts/cm/choreoathetosis
hypocalcaemia management
- mild symptoms; oral calcium
- kidney disease and vitamin d deficiency; alfacalcidol
- severe symptoms; 10ml 10% calcium gluconate over 20 minutes
- monitor patient with ecg
hypocalcaemia causes
- drugs; furosemide
- hypoparathyroidism
- pseudohypoparathyroidism
- vitamin d deficiency
- acute pancreatitis
- acute rhabdomyolysis
hypercalcaemia ecg changes
nil specific
hypercalcaemia presentation
- bone pain and fractures
- renal stones
- polydipsia
- polyuria
- depression and irritability
- abdominal pain
- constipation
- spasms
hypercalcaemia causes
- drugs; thiazide diuretics and vitamin d
- malignancy
- primary hyperparathyroidism
hypercalcaemia management
- correct dehydration
- bisphosphonates 60 mg pamidronate infusion
- furosemide; although dehydration may worsen hypercalcaemia
- monitor patient with ecg
- early involvement of endocrine team
