Electrolytes EMERGENCY MEDICINE SUMMER SCHOOL 2017 Electrolyte - PowerPoint PPT Presentation

Electrolytes EMERGENCY MEDICINE SUMMER SCHOOL 2017

Electrolyte disturbances POTASSIUM [KALIUM] u Hyperkalemia u Hypokalemia SODIUM [NATRIUM] u Hypernatremia u Hyponatremia

Hyperkalemia

Hyperkalemia CAUSES u Kidney failure, diabetic nephropathy u Tissue damage: rhabdomyolysis, tumor lysis syndrome, burn wounds u Medication: potassium-sparing diuretics, ACE-inhibitors, NSAIDs u Hypoaldosteronism: Addison’s disease u Pseudohyperkalemia

Hyperkalemia COMMON SYMPTOMS u Asymptomatic u Weakness and fatigue u Dyspnea, palpitations and chest pain u Nausea, vomiting u Muscle paralysis, paresthesias

Hyperkalemia CLINICAL FINDINGS u Often normal vital signs. Occasionally bradycardia u Depressed or absent deep tendon reflexes u ECG-changes: Cardiac arrhythmias, cardiac arrest

Hypokalemia

Hypokalemia CAUSES u Diarrhea, vomiting, laxatives u Hyperaldosteronism, Cushing’s syndrome u Diuretic- or steroid therapy u Diabetes mellitus u Inadequate intake: anorexia, alcoholism, poverty

Hypokalemia COMMON SYMPTOMS u Weakness and fatigue u Polyuria u Palpitations u Psychological (psychosis, delirium, hallucinations, depression) u Muscle cramps and pain (severe cases)

Hypokalemia CLINICAL FINDINGS u Occasional tachycardia, irregular beats u Depressed or absent deep-tendon reflexes u Constipation, abdominal distention, ileus. u Hyper-/hypotension

Hypernatremia – “THE WATER PROBLEM”

Hypernatremia CAUSES u Dehydration – insufficient fluid intake u Extra renal fluid loss: fever, diarrhea, vomiting, burns, sweating u Renal fluid loss: u Diabetes mellitus u Diabetes insipidus u Chronic kidney failure u Diuretic therapy u Hypertonic sodium gain: Iatrogenic, seawater ingestion.

Hypernatremia COMMON SYMPTOMS u Cognitive dysfunction Confusion, abnormal speech, irritability, seizures. u Dehydration Palpitations, oliguria, dry oral mucosa, polydipsia. u Weight loss u Generalized weakness

Hypernatremia CLINICAL FINDINGS u Low blood pressure and tachycardia u Dry oral mucosa, abnormal skin turgor u Recent change in consciousness (GCS/AVPU) u Nystagmus and myoclonic jerks.

Hyponatremia

Hyponatremia CAUSES u Hypervolemic: heart-, liver- or kidney failure. Water intoxication u Hypovolemic: haemorrhage, vomiting/diarrhea, thiazide diuretics u Euvolemic (very common): u SIADH u Severe hypothyroidism. u Malnutrition (anorexia, beer drinker’s potomania) u Translocational: hyperglycemia

Hyponatremia COMMON SYMPTOMS u Nausea u Headache u Changes in consciousness u Seizures, coma

Hyponatremia CLINICAL FINDINGS u Changes in urinary sodium concentration and urine- and serum osmolality u Decreased level of consciousness (GCS/AVPU) u Signs of hypervolemia: ascites, pulmonary- or peripheral edema. u Signs of hypovolemia: orthostatic/ low blood pressure, tachycardia.

OSMOTIC DEMYELINATION SYNDROME AND CEREBRAL EDEMA u Caused by CNS adaptation to changes in serum osmolality u Symptoms: lethargy, confusion, seizures, paralysis, coma, death u Maximum correction of serum sodium: 4-8 mmol/L per day u Patients at high risk: Severe hyponatremia, liver cirrhosis, alcoholism, anorexia, hypokalemia

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