Various types of Sodium & Potassium Issues

Hypovolemic Hyponatremia

• volume depletion

• caused by: diuretics, burns, excessive vomiting

• Tx = isotonic fluids

Hypervolemic Hyponatremia

• volume overload

• kidneys do not extcrete water effectively

• caused by: CHF, kidney injury

• Tx: sodium, fluid restriction, diuretic therapy

Euvolemic Hyponatremia

• normal water content with low sodium

• SIADH - over stimulation of anti-diuretic hormone = stopping volume coming out

• normal BUN & Cr values

• urine specific gravity will be high >1,030

• Tx: fluid restriction, lasix, hypertonic solution = raise sodium (0.5 mEq per hour)

  • Key = no volume resus

Hypovolemic Hypernatremia

• caused by sweating or diarrhea

• urine Na+ will be <10

• Tx: isotonic fluids

Hypervolemic Hypernatremia

• Na+ renention

• causes: resus with NSS, Cushing’s syndrome, aldosterone, urine sodium > 20, Sodium Bicarb admin

• Tx: hypotonic solution therapy, diuretic therapy

Euvolemic Hypernatremia

• normal water content with increased Na+

• DIABETES INSIPIDUS

• impaired thirst mechanism (think vent/sedated patients)

• Tx: DDAVP, fluid replacement

Hyperkalemia

• causes: adrenal insufficiency, kidney dysfunction, tissue damage, excessive K+ intake, hemolysis, metabolic acidosis

• Symptoms: fatigue, metabolic acidosis, paresthesia/paralysis, palpitations, bradycardia, New 2nd or 3rd degree HB, decreased DTRs, slow V-Tach with QRS > 0.20

Hypokalemia

• often seen in DKA patients

• symptoms: hypotension, ventricular arrhythmias, respiratory arrest, lethargy, decreased muscle strength or tetany, decrease DTRs

• EKG findings: T-wave flattening, inverted T-waves, prominent U waves, ventricular/atrial arrhythmias