12. Electrolyte Emergencies

know these labs

hypernatremia sx

increased activity

• Mild (< 375 Osm): Restlessness, irritability

• Moderate (< 400 Osm): Tremulousness, ataxia

• Severe (< 430 Osm): Hyperreflexia, spasticity

• Fatal (> 430 Osm): Seizure, coma, death

hypernatremia tx

hyponatremia sx

decreased activity

• Mild: Gait disturbances, cognitive deficits, recurrent falls, decreased concentration

• Moderate: Nausea, confusion, headaches

• Severe: Vomiting, somnolence, cardiorespiratory distress

• Fatal: Seizure, coma, death

Pseudohyponatremia tx

• Isotonic hyponatremia: address underlying pathology

• Hypertonic hyponatremia: address underlying pathology

Hypotonic hypovolemic hyponatremia tx

• Normal Saline (0.9%)

• Correct 5mEq/L adjustment per day

• Do not correct serum Na > 10mEq/L per day

Hypotonic hypervolemic hyponatremia tx

• Loop Diuretic (Furosemide)

• Indication: congestive heart failure origin, diuresis volume overload

• Albumin infusion

• Indication: severe cirrhosis related hyponatremia < 120

• Hypertonic Saline (3%)

• Indication: severe cirrhosis related hyponatremia < 120

Hypotonic Euvolemic hyponatremia tx

• Syndrome of Inappropriate ADH Secretion

• Fluid Restriction

• Free water diuresis (aquaresis)

• Oral Urea

• Furosemide plus Salt Tablets

• Vaptans (Tolvaptan or Conivaptan)

• Glucocorticoids (hydrocortisone)

• Indication: hormone mediated hyponatremia

• Levothyroxine

• Indication: hypothyroidism induced hyponatremia