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Sunday, May 20, 2012

Major Fluid and Electrolytes Imbalances

Major Fluid and Electrolyte Imbalances   


Contributing Factors

Signs and Symptoms / Laboratory Findings

Potassium deficit

Serum potassium
 < 3.5 mEq/L

·     Diarrhea, vomiting
·     Gastric suction
·     Corticosteroid administration
·     Diuretics
·     Hyperaldosteronism
·     Alkalosis
·     Carbenicillin, Amphotericin B
·     Bulimia, starvation
·     Osmotic diuresis
·     Digoxin toxicity

Fatigue, anorexia, nausea and vomiting, muscle weakness, polyuria, decreased bowel motility, ventricular asystole or fibrillation, parethesias, leg cramps, â BP, ileus, abdominal distention, hypoactive reflexes

Flattened T waves, prominent U waves, ST depression, prolonged PR interval

Potassium excess

Serum potassium
 > 5.0 mEq/L

·     Pseudohyperkalemia
·     Oliguric renal failure
·     Use of potassium-conserving diuretics in pts. with renal insufficiency
·     Metabolic acidosis
·     Addison’s dse
·     Crush injury
·     Burns
·     Stored bank blood transfusions
·     Rapid IV administration of potassium

Vague muscular weakness, tachycardia à bradycardia, dysrhythmias, flaccid paralysis, paresthesias, intestinal colic, cramps, irritability, anxiety

Tall tented T waves, prolonged PR interval and QRS duration, absent P waves, ST depression
Major Fluid and Electrolyte Imbalances   


Contributing Factors

Signs and Symptoms / Laboratory Findings

Calcium deficit

Serum calcium
 < 8.5 mg/dL

·     Hypoparathyroidism (may follow thyroid surgery or radical neck dissection)
·     Malabsorption
·     Pancreatitis
·     Alkalosis
·     Vitamin D deficiency
·     Massive SQ infection
·     Generalized peritonitis
·     Massive transfusion of citrated blood
·     Chronic diarrhea
·     Diuretic phase of renal failure
·     Decreased PTH, á PO4
·     Fistulas, Burns

Numbness, tingling of fingers, toes, and circumoral region; positive Trousseau’s sign and Chvostek’s sign; seizures, carpopedal spasms, hyperactive deep tendon reflexes, irritability, bronchospasms, anxiety, impaired clotting time, â prothrombin

Prolonged QT interval and lengthened ST

Lab findings:
â Mg++

Calcium excess

Serum calcium
 > 10.5 mg/dL

·     Hyperparathyroidism
·     Malignant neoplastic dse
·     Prolonged immobilization
·     Overuse of calcium supplements
·     Vitamin D excess
·     Oliguric phase of renal failure
·     Acidosis
·     Corticosteroid therapy
·     Thiazide diuretic use
·     Increased PTH
·     Digoxin toxicity

Muscular weakness, constipation, anorexia, nausea and vomiting, polyuria, polydipsia, dehydration, hypoactive deep tendon reflexes, lethargy, deep bone pain, pathologic fractures, flank pain, and calcium stones

Shortened ST segment and QT interval, bradycardia, heart blocks
Major Fluid and Electrolyte Imbalances   


Contributing Factors

Signs and Symptoms / Laboratory Findings

Magnesium deficit

Serum magnesium
 < 1.8 mg/dL

·     Chronic alcoholism
·     Hyperparathyroidism
·     Hyperaldosteronism
·     Diuretic phase of renal failure
·     Malabsorptive disorders
·     Diabetic ketoacidosis
·     Refeeding after starvation
·     Parenteral nutrition
·     Chronic laxative use
·     Diarrhea
·     Acute MI, heart failure
·     Decreased serum K+ and Ca++
·     Certain pharmacologic agents (gentamicin, cisplatin, cyclosporine)

Neuromuscular irritability, positive Trousseau’s and Chvostek’s signs, insomnia, mood changes, anorexia, vomiting, increased tendon reflexes, á BP

PVCs, flat or inverted T waves, depressed ST segment, prolonged PR interval and widened QRS

Magnesium excess

Serum magnesium
 > 2.7 mg/dL

·     Oliguric phase of renal failure (particularly when magnesium-containing medications are administered)
·     Adrenal insufficiency
·     Excessive IV magnesium administration
·     DKA
·     hypothyroidism

Flushing, hypotension, drowsiness, hypoactive reflexes, depressed respirations, cardiac arrest and coma, diaphoresis

Tachycardia à  bradycardia, prolonged PR interval and QRS
Major Fluid and Electrolyte Imbalances   


Contributing Factors

Signs and Symptoms / Laboratory Findings

Chlorine deficit

Serum chloride < 96 mEq/L

·     Addison’s disease
·     Reduced chloride intake or absorption
·     Untreated diabetic ketoacidosis
·     Chronic respiratory acidosis
·     Excessive sweating
·     Vomiting, diarrhea
·     Gastric suction
·     Sodium and potassium deficiency
·     Metabolic alkalosis
·     Loop, osmotic, or thiazide diuretic use
·     Overuse of bicarbonate
·     Rapid removal of ascitic fluid w/ high Na content
·     IVF that lack chloride (dextrose and water)
·     Draining fistulas and ileostomies
·     Heart failure
·     Cystic fibrosis

Agitation, irritability, tremors, muscle cramps, hyperactive deep tendon reflexes, hypertonicity, tetany, slow shallow respirations, seizures, dysrhytmias, coma

Lab findings:
â serum chloride, â serum sodium, á pH,
á serum bicarbonate, á total carbon dioxide content, â urine chloride level, â serum potassium

Chloride excess

Serum chloride
 > 108 mEq/L

·     Excessive sodium chloride infusions with water loss
·     Head injury (sodium retention)
·     Hypernatremia
·     Renal failure
·     Corticosteroid use
·     Dehydration
·     Sever diarrhea (loss of bicarbonate)
·     Respiratory and metabolic alkalosis
·     Administration of diuretics
·     Overdose of salicylates (Kayexalate, Acetazolamide, phenylbutazone and ammonium chloride)
·     Hyperparathyroidism

Tachypnea, lethargy, weakness, deep rapid respirations, decline in cognitive status, decreased CO, dyspnea, tachycardia, pitting edema, dysrhythmias, coma

Labs indicate:
á serum chloride, á serum potassium and sodium, â serum pH, â serum bicarbonate,
á urinary chloride level

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