Electrolyte Emergencies :Electrolyte Emergencies


Hyponatremia :Hyponatremia Decreased serum sodium Na+ <135 mEq/L


Hyponatremia :Hyponatremia Causes Loss of salt and water Diuretics Addison’s disease Osmotic diuresis (DKA) Vomiting Diarrhea Diaphoresis


Hyponatremia :Hyponatremia Causes Increase in body water (dilutional hyponatremia) Excess water intake (water intoxication) CHF Renal failure Cirrhosis


Hyponatremia :Hyponatremia Signs/Symptoms Lethargy, apathy secondary to cerebral edema Headache Muscle twitching, cramps Seizures Na+ < 110 mEq/L


Hyponatremia :Hyponatremia Treatment NS infused at a rate to restore normal sodium over 48 hours


Hypernatremia :Hypernatremia Elevated serum sodium Na+ >150 mEq/L


Hypernatremia :Hypernatremia Causes Pure water loss Diabetes insipidus Pure solute gain NaHCO3 administration


Hypernatremia :Hypernatremia Causes Water loss > Solute loss Diarrhea Vomiting Sweating Osmotic diuresis


Hypernatremia :Hypernatremia Signs/Symptoms Irritability, restlessness Coma Intracranial hemorrhage Blood sludging - thrombosis Seizures Thirst, dry mucus membranes, poor skin turgor


Hypernatremia :Hypernatremia Treatment Infusion of D5W (free water) to correct water deficit over 48 hours


Hypokalemia :Hypokalemia Decreased serum potassium K+ < 3.5 mEq/L


Hypokalemia :Hypokalemia Causes Gastrointestinal losses Diarrhea Vomiting NG suction Urinary losses Diuretics Osmotic diuresis


Hypokalemia :Hypokalemia Causes Intracellular shifts Alkalosis  agents Theophylline Inadequate intake


Hypokalemia :Hypokalemia Signs/Symptoms Weakness, hyporeflexia, paresthesias Decreased GI motility Nausea, vomiting Increased sensitivity to digitalis


Hypokalemia :Hypokalemia Signs/Symptoms EKG changes Flat to inverted T waves U waves ST segment depression Cardiac arrhythmias Ventricular ectopy V-Fib


Hypokalemia :Hypokalemia Treatment Correct underlying cause 10 mEq KCL IV over 1 hour, repeated until serum K+ > 3.5 mEq/L


Hyperkalemia :Hyperkalemia Elevated serum potassium K+ > 5.5 mEq/L K+ > 6 mEq/L - Emergency K+ > 7 mEq/L - Life Threat


Hyperkalemia :Hyperkalemia Causes Decreased excretion Renal failure Addison’s disease  - blockers Hyperglycemia Acidosis


Hyperkalemia :Hyperkalemia Causes Increased intake Crush injury, burns, sepsis Massive hemolysis Blood transfusion High-dose penicillin Increased oral intake


Hyperkalemia :Hyperkalemia Signs/Symptoms Muscle weakness Numbness, tingling EKG changes Tall, peaked T waves Broadening of QRS; decreased P wave size “Sine wave” leading to V-Fib then asystole


Hyperkalemia :Hyperkalemia Treatment Calcium - 0.5 - 1.0g Antagonizes cardiac toxicity NaHCO3 - 50 mEq Drives K+ into cells D50W (25g)/insulin (10 units regular) Drives K+ into cells


Hypocalcemia :Hypocalcemia Decreased serum calcium Ca2+ < 8.5 mg/100ml


Hypocalcemia :Hypocalcemia Causes Hypoparathyroidism Vitamin D deficiency Decreased dietary intake Alkalosis Massive blood transfusion Citrate toxicity


Hypocalcemia :Hypocalcemia Signs/Symptoms Paresthesias Hyperreflexia, carpopedal spasm, tetany Seizures Trousseau’s sign: Carpopedal spasm following BP cuff compression of arm


Hypocalcemia :Hypocalcemia Signs/Symptoms Chvostek’s sign Contraction of facial muscles when face is tapped at angle of jaw Laryngospasms Prolonged QT interval Increased ventricular irritability


Hypocalcemia :Hypocalcemia Management Calcium chloride 1g over 10 - 20 minutes Overly rapid administration of calcium can cause bradycardia, hypotension, and cardiac arrest


Hypercalcemia :Hypercalcemia Increased serum calcium Ca2+ > 10.5 mg/100ml


Hypercalcemia :Hypercalcemia Causes Malignancies Skeletal, breast, lungs Hyperparathyroidism Vitamin D toxicity Addison’s disease Milk/alkali syndrome


Hypercalcemia :Hypercalcemia Signs/Symptoms Apathy, fatigue, depression, coma Muscle weakness Hypertension Anorexia, nausea, abdominal pain


Hypercalcemia :Hypercalcemia Signs/Symptoms Kidney stones Short QT interval, heart block, cardiac arrest “Bones, Stones, Hypertones, Abdominal moans”


Hypercalcemia :Hypercalcemia Treatment 1 - 2 liters NS over 1 hour Decrease Ca2+ reabsorption Furosemide 40 mg IV Inhibits Ca2+ reabsorption Calcitonin Directly lowers Ca2+