Fluid and Electrolyte Imbalances: Causes and Treatments

Written on January 14, 2025 in English with a size of 14.34 KB

H2O (-)

*Hypovolemic*	*Euvolemic*	*Hypervolemic*
Causes: Decreased intake Increased hypotonic loss (Skin, Lungs, GI, Kidney)	Causes: Burns Bleeding Fistula Diarrhea Vomiting + Parkland Formula	Causes: Increased Na loss (Skin, GI, Kidney) Decreased intake + Formula

Loop Diuretics (Potassium losing)

Indications	Contraindications	Adverse Drug Reactions
Pulmonary Edema Edema Calcium increase Renal Failure (Potassium increase) Ion increase	Sulfonamide Allergy	Potassium decrease Magnesium decrease Hypovolemia Urine increase Ototoxicity

H2O (+)

Hypernatremia	Euvolemic Hypernatremia	Hyponatremia
Increased sodium intake Renal Failure Increased mineralocorticoids	Heart Failure Cirrhosis Renal Failure	Heart Failure Sodium Retention Diuretic use Renal Failure
Thirst Edema CNS dysfunction	Ascites Hydrothorax Insufficiency	CNS dysfunction

Clinical Findings Osmolality > 320 mOsm/kg Sodium > 150 mEq/L	Clinical Findings Osmolality = Normal Sodium = Normal	Clinical Findings Osmolality < 280 mOsm/kg Sodium < 130 mEq/L
Correct Cause Limit Sodium Loop Diuretics Hemodialysis	Correct Cause Limit H2O (750-1200 ml) Diuretics Hemodialysis	Correct underlying problem Restrict H2O (500-1000 ml) Replace Sodium/Potassium deficit Severe Sodium < 115 mEq/L: Slowly infuse hypertonic 5.85% saline (1420 mEq/L Sodium) x 0.2 (Ideal Body Weight) Increase sodium within 10 mmol/24 hours

Potassium Imbalances

Hypokalemia (Potassium decrease)	Hyperkalemia (Potassium increase)
Decreased intake Urine loss Intracellular shift (Insulin/Stimulation) Renal Wasting	Potassium in (Intake/Bleeding/Burn/Injury/Rhabdomyolysis) Potassium out (Acidosis/Glucose increase) Medications (ACE inhibitors/NSAIDs/Beta Blockers)
2-2.5 mEq/L = Cramps/Fasciculations Heart problems	> 5.5 mEq/L Weakness Flaccid Paralysis Cardiac (Short QT interval, Wide QRS complex)

Hypokalemia Treatment

Potassium < 2.5 mEq/L	0.9% NaCl (40-60 mmol/L)	20-40 mmol/hour
Potassium 2.5-3 mEq/L	0.9% NaCl, 5% Dextrose (20-40 mmol/L)	10-20 mmol/hour

Hyperkalemia Treatment

Stop potassium use
Calcium (10 ml 10% Calcium chloride or Calcium gluconate)
Regular insulin (5-10 units)
Beta-agonist 10-20 mg inhaled in 10 minutes
Sodium bicarbonate
Loop diuretics
Hemodialysis

Acidosis/Alkalosis

How to Determine Acidosis or Alkalosis

Metabolic Acidosis

Sodium bicarbonate

Respiratory Acidosis

Correct Cause
Mechanical Ventilation

Metabolic Alkalosis

Correct Cause
Replacement (Sodium/Potassium/Chloride)
If there is vomiting (H2 Blocker, Antiemetic)

Respiratory Alkalosis

Rebreathing, Paper Bag

Calcium Imbalances

Hypocalcemia	Hypercalcemia
Decreased Parathyroid hormone Radiation Calcium Receptor Problem
Neuromuscular irritability Seizure Tetany Paresthesia	Nausea and vomiting Coma Stupor Asthenia Fatigue

Acute: 10% Calcium Gluconate 10-20 ml
Long term:

If decreased Parathyroid hormone: Vitamin D/Calcitriol/Calcium supplement

If increased Parathyroid hormone: Surgery
Malignancy cause: Rehydrate isotonic 200-300 ml, Loop Diuretic to increase calcium excretion

Magnesium Imbalances

Hypomagnesemia	Hypermagnesemia
Cause: GI + Renal GI (surgery) Medications Vomiting, Diarrhea, Malabsorption, Steatorrhea Proton Pump Inhibitors, Alcoholism, Thyroid removal
Potassium decrease <---> Calcium decrease <---> Magnesium decrease <---> Phosphate decrease Nerve, Heart, Lung Increased QRS duration Increased PR interval High T wave Atrial + Ventricular arrhythmia Muscle Weakness, Tremor, Seizure, Confusion, Delirium, Coma Bone fracture
Treatment: Severe < 0.4 mEq/L Moderate 0.7-0.8 mEq/L Always treat the cause Unstable Patients: 1 g Magnesium Sulfate in 15 minutes Asymptomatic: Magnesium oxide 800-1600 mg orally

I. (Fever + Perspiration) + (No Food) + (Low H2O) (Dehydration = H2O Loss > H2O Intake) (Electrolyte problem)

II. (Hypertonic Dehydration) ------------ (Dyspnea/Fever/Diarrhea) ----------- (Sodium increase, Potassium decrease)

III. Cancer + Treatment ------> Metabolic Alkalosis! ----> Hypotonic Dehydration, Potassium decrease ----> Cardiac Arrest!

IV. Renal Failure ----> Potassium increase (Cannot be Excreted) and cause Cardiac Arrest, Creatinine increase, Other Electrolyte problems

ANYTIME YOU HAVE Potassium increase/decrease, Calcium increase/decrease, Magnesium increase/decrease

V. Acute Renal Failure ------> Potassium increase --------> ECG Changes (present) & Cardiac Arrest! Potassium increase is due to <---- Bleeding + Acute Renal Failure

VI. Burns ---> Volume decrease ----> Loss of Isotonic fluid, Dehydration Signs: Increased RBC/Hb/Hematocrit/Decreased Blood Pressure

VII. Brown Stool (Diarrhea) ------> Volume decrease ----> Lead to Renal Failure ----> Abnormal Electrolyte!

VIII. COPD (Hypercapnic Respiratory Failure) --------> Ventilation increase, Complication of Respiratory Acidosis (Cerebral Edema), Compensated Metabolic Alkalosis Later

Insensible water loss = Normal requirement (Calculated) – Water intake (Daily, Given)

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