Hypovolemia / Fluids and Electrolytes

Question 1

Hyponatraemia may be due to?

Answer 1

Excessive water intake or water retention, excessive sodium losses or a combination of both.

Question 2

Water retention may occur in situations with?

Answer 2

high ADH levels such as meningitis, sepsis or post surgery

Question 3

Clinical signs of Hyponatraemia?

Answer 3

Clinical signs are primarily neurological.

headache, nausea and vomiting and lethargy.

Severe and rapid hyponatraemia may cause seizures.

Question 4

The principles of treatment of hypoNA are

Answer 4

1) Treat seizures with hypertonic saline
2) Calculate maintenance fluid and deficit
3) Aim to raise serum sodium by no more than 8mmol per day
4) Check potassium, chloride, creatinine and glucose levels
5) Monitor electrolytes frequently
6) Assess hydration and weight frequently

Question 5

Hypernatraemia may be due to ?

Answer 5

loss of water in excess of sodium (diabetes insipidus, diarrhoea) excessive sodium intake (poisoning) or a combination of both (child with gastroenteritis given excessive sodium in rehydration fluids)

Question 6

Clinical signs of hyperNa

Answer 6

Primarily neurological: lethargy, irritability, ataxia, hyperrelexia and seizures.

Question 7

The principles of treatment of HYPER natraemia are:

Answer 7

1) Treat shock first
2) Calculate the maintenance fluid and estimate the fluid deficit carefully
3) Aim to lower the serum sodium at a rate of no more than 0.5 mmol/h
4) Check the calcium and glucose levels also
5) Monitor the electrolytes frequently
6) Clinically assess hydration and weigh frequently

Question 8

What can happen if you correct hyperNa too quickly

Answer 8

cerebral oedema, convulsions and permanent neurological damage.

Question 9

HypoKa can be caused by?

Answer 9

Potassium losses from acute diarrhoeal illnesses or inadequate intake. It may also occur in:

1) Alkalosis
2) Volume depletion
3) Primary hyperaldosteronism
4) Salbutamol or diuretic use

Question 10

How is HypoK treated

Answer 10

IV or oral replacement

Question 11

HyperKa can be caused by?

Why do we worry about it?

Answer 11

1) Acute or chronic renal failure
2) Iatrogenic potassium administration
3) Potassium release from cells in burns or trauma
4) Acidosis
5) Hypoaldosteronism and hypoadrenalism

**It may cause life threatening cardiac arrhythmias.

Question 12

How is hyperKa treated?

Answer 12

Via this protocol

Question 13

HypoCa may be from..

Answer 13

may occur in the setting of any severe illness particularly septicaemia. Specifically it may be caused by:

1) rickets
2) hypoparathyroidism
3) pancreatitis
4) rhabdomyolysis
5) Acute and chronic renal failure

Question 14

HypoCa may present as?

Answer 14

1) weakness
2) tetany
3) convulsions
4) hypotension
5) arrhythmias

Question 15

How do you treat hypoCa

Answer 15

It is treated primarily by treating the underlying condition with the cautious use of IV calcium.

Question 16

Hyper Ca is caused by

Answer 16

1) hyperparathyroidism
2) hypervitaminosis D or A
3) idiopathic hypercalcaemia of infancy
4) Skeletal disorders

Question 17

HyperCa may present as?

Answer 17

1) Anorexia, malaise and weight loss
2) Failure to thrive
3) Renal stones

Question 18

How is hyperCa treated?

Answer 18

It is treated initially with rehydration and volume expansion with normal saline