Electrolytes internal

Question 1

Chloride

Answer 1

Vitreous humor chloride has similar behavior to sodium
Conc minimal fall during early postmortem interval
number of investigators has established the normal range to be 115-125 mEq/L for children and adults
slightly lower for infants
as with sodium, abnormalities in antemortem serum chloride are reflected in postmortem vitreous values
possible to Dx electrolyte imbalances while pt was alive

Question 2

Potassium time of death

Answer 2

potassium begins to leave the cells of the body rapidly after death and serum K+ rises very quickly, thus it is impossible to evaluate the status of perimortem K+ levels
vitreous K+ levels gradually rise linearly following the death
numerous investigators have studied vitreous potassium-PMS correlations

Question 3

Factors that influence the rate of rise of vitreous K after death

Answer 3

most significant external factor is the temperature of the body during the postmortem interval
infants rise faster than adults
K+ values dying from acute traumatic events
Madea et al (1989) found K+ increases much steeper in pt with significant urea nitrogen retention

Question 4

Do most people test vitreous potassium

Answer 4

No
Due to those and other factors, most have abandoned vitreous potassium conc for determining the postmortem interval

Question 5

Four common patterns of electrolytes TEST QUESTION

Answer 5

Dehydration pattern (hypertonic pattern)
Uremic pattern
Low-salt pattern (hypotonic pattern)
Decomposition pattern

Question 6

Dehydration Hypertonic

Answer 6

Characterized by a concomitant rise in sodium and chloride
Moderate elevation of urea nitrogen

Question 7

Uremic pattern

Answer 7

Differs from dehydration pattern
Urea nitrogen and creatinine levels appreciably increased
Without an increase in sodium or chloride values

Question 8

Low salt

Answer 8

Characterized by low sodium and chloride levels
With a low potassium value [<15 mEq/L]

Question 9

Decomposition

Answer 9

Like low salt pattern; low sodium and chloride values BUT
High potassium levels [>20 mEq/L]
Important to measure [K+] to differentiate between decomp/low salt patterns

Question 10

Pediatric

Answer 10

Dehydration manifested by hypernatremia and uremia in infants with symptoms of gastrointestinal infection
Dehydration with hypernatremia alone may be due to hyperosmolar formulas
Hypochloremia in prolonged vomiting

Question 11

Adults

Answer 11

Common cause of Low Salt pattern is fatty metamorphosis or cirrhosis of the liver
Cannabinoid Hyperemesis Syndrome

Question 12

Cannabinoid Hyperemesis syndrome

Answer 12

CHS variant of cyclical nausea and vomiting
First described in 2004 as an adverse effect of prolonged excessive cannabis consumption
Vomiting up to 20x/hr
Daily use
2 years
Hx of repetitive and compulsive taking of hot showers
Relief of vomiting episodes by sustained cessation of cannabis use
Pathogeneses not well established
Paradoxically – cannabis is used to tx nausea