SLIDE 1
Electrolytes
EMERGENCY MEDICINE SUMMER SCHOOL 2017
Electrolyte disturbances
POTASSIUM [KALIUM]
u Hyperkalemia u Hypokalemia
SODIUM [NATRIUM]
u Hypernatremia u Hyponatremia
Electrolytes EMERGENCY MEDICINE SUMMER SCHOOL 2017 Electrolyte - - PowerPoint PPT Presentation
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
SLIDE 2
SLIDE 3
Hyperkalemia
SLIDE 4
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
SLIDE 5
Hyperkalemia
COMMON SYMPTOMS
u Asymptomatic u Weakness and fatigue u Dyspnea, palpitations and chest pain u Nausea, vomiting u Muscle paralysis, paresthesias
SLIDE 6
Hyperkalemia
CLINICAL FINDINGS
u Often normal vital signs. Occasionally bradycardia u Depressed or absent deep tendon reflexes u ECG-changes: Cardiac arrhythmias, cardiac arrest
SLIDE 7
SLIDE 8
SLIDE 9
SLIDE 10
Hypokalemia
SLIDE 11
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
SLIDE 12
Hypokalemia
COMMON SYMPTOMS
u Weakness and fatigue u Polyuria u Palpitations u Psychological (psychosis, delirium, hallucinations, depression) u Muscle cramps and pain (severe cases)
SLIDE 13
Hypokalemia
CLINICAL FINDINGS
u Occasional tachycardia, irregular beats u Depressed or absent deep-tendon reflexes u Constipation, abdominal distention, ileus. u Hyper-/hypotension
SLIDE 14
SLIDE 15
Hypernatremia – “THE WATER PROBLEM”
SLIDE 16
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.
SLIDE 17
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
SLIDE 18
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.
SLIDE 19
Hyponatremia
SLIDE 20
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
SLIDE 21
Hyponatremia
COMMON SYMPTOMS
u Nausea u Headache u Changes in consciousness u Seizures, coma
SLIDE 22
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.
SLIDE 23
SLIDE 24
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
SLIDE 25
SLIDE 26
THE POCKET CARD
SLIDE 27
THE POCKET CARD
1 2 3
SLIDE 28
THE POCKET CARD
1
SLIDE 29
THE POCKET CARD
2
SLIDE 30
THE POCKET CARD
SLIDE 31