Final fluid and electrolytes

Sodium range

135-145

Hyponatremia causes

1. SIADH

2. Excess fluid accumulation: CHF, PO

3. Meds: diuretics, PPIs, SSRIs Neurotin, ARBs, lithum

4. vomiting, diarrhea, gi suctioning

Acute hyponatremia cause

RESULT OF FLUID OVERLOAD OF A SURGICAL PATIENT

Hyponatremia hallmark s/s

• Headache

• Confusion

• irritability

• restlessness

• Lethargy (very sleepy)

• Seizures in severe cases

• cerebral edema

• stupor

• coma

• death

• poor skin turgor

• decreased BP

• dry mucosa

• decreased salivation

Hyponatremia tx

• restriction of water intake to 1000 ml/day

• food high in sodium

• moderate/severe-hypertonic 3% solution slowly

• NaCl tablet

• Assessment of I&Os, daily wt, lab values, and CNS changes

• monitor fluid intake

Hypernatremia causes

1. DI

2. hypertonic solution

3. cushings

4. M: Medications, meals

   O: Osmotic diuretics

   D: Diabetes Insipidus

   E: Excessive H2O LOSS

   L: Low H2O Intake

Hypernatremia hallmark s/s

• Intense thirst

• sticky mucous membranes

• swollen dry tongue

• elevated body temperature, pulse, bp

• Restlessness or irritability

• lethargy

• hallucinations

• hyperflexia

• twitching

• Seizures in severe cases

Hypernatremia Tx

• DI: desmopressin/ddavp

• hypovolemic: iv/po water

• hypervolemic: diuretics/dialysis

• slow replacement to avoid cerebral edema

Hypokalemia causes

• vomiting, diarrhea, gi suction, sweating

• insulin: pushes k back onto cell

• malnutrition (rare)

• renal stenosis

• meds: laxatives, aminogylcosides, presidone

Hypokalemia s/s

• Skeletal muscle weakness/cramps/parenthesia

• palpitation/dysrythmias

• Respiratory failure (severe)

• Cardiac death (severe)

• psychosis (severe)

• abd cramping

• flattened T wave, prominent U wave

Hypokalemia Tx

• cardiac telementry monitoring/pacing

• emergency pharm meds

• IV K replacement - no more than 10-20 mEq thru central line

• NS: bolus or maintenance fluids

• can be painful at IV site

Hyperkalemia causes

• Acute/chronic kidney failure

• crush injury/burns

• succinylcholine

• spirolactone

• metabolic acidosis

• hypoaldosterone

Hyperkalemia S/S

• palpitations/arrhythmias

• weakness/parenthesia

• paralysis

• Respiratory muscle weakness

• Tall, peaked T waves widen QRS

Hyperkalemia Tx

Dextrose 50 iv

Insulin ivp and amp dextrose

Calcium chloride/gluconate

Kayxeolate: sodium polystyrene sulfonate/ sodium ziricromium po binds k+ in gut, excreted in stool (not a good choice for acute)

Emergency:

iv calcium gluconate, sodium bicarbonate, insulin with dextrose.

• loop diuretics, beta-2 agonists, dialysis

Calcium range

8.5-10.5

ionized ca range

4.25-5.1

responsible for muscle contraction, blood clotting

Hypocalcemia causes

• hypoparathyroid

• hyperphos

• vitamin d deficiency

• osteoblastic metastasis

• copious amount of prbc transfusions

• pancreatitis

• acute kidney injury

• meds: aluminum-containing antacids, aminoglycosides, corticosteriods

Hypocalcemia S/S

• tetany,

• circumoral numbness,

• hyperactive DTRS

• trousseau sign,

• chvostek sign,

• seizures,

• respiratory symptoms of dyspnea and laryngospasm,

• abnormal clotting,

• Hyperactive bowel sounds, dry/brittle hair and nails

• prolonged QT interval

Hypocalcemia Tx

• ca glucocate iv

• ca bicarbonate po

• vitamin D

• watch for high phos and low mg

Hypercalcemia causes

• Malignancies: breast CA, multiple myeloma, lung CA, chemo

• Hyperparathyroid

• Meds: thiazide diuretics, lithium bicarbonate, vitamin A and D

Hypercalcemia S/S

Bones, groans, psychiatric moans

• skeletal muscle weakness/aches/twitching

• renal calculi - abd/flank pain

• Altered mental status, H/A

• constipation

Hypercalcemia Tx

• calcitonin IV

• Hydrate with NS with loop diuretics: hemodilution and increased renal excretion

• IV furosemide, phosphates, biphosphates

• Partial parathyroidectomy

• fiber

• increase mobility