lab results for salts

which way does sodium and potassium move

• sodium is extracellular - moves out

• potassium is intracellular - moves in

what is hypernatraemia

high sodium

symptoms of high sodium if:

• >150mmol/L

• >170mmol/L

• thirst

• lethary

• irritability

• headache

if >170mmol/L:

• seizures

• coma

• death

cause of high sodium

• loss of body water

• gain in body sodium

symptoms of loss of body water

• dehydration

• vomiting

• diarrhoea

• burns

• diseases like diabetes inspidus

• diabetic ketoacidosis

how could their be gain in body sodium

through drugs like

• antacids

• antibiotics

• mieralocorticoid effects of steroids

• oestrogen

• lactulose

treatment of high sodium

• drink water if loss of water

• restrict sodium intake

• IV (glucose 5%) if severe water loss

• diuretics if sodium overload

what is hyponatraemia

low sodium

how can low sodium occur

• loss of body sodium

  • GI losses through vomiting or diarrhoea

  • salt losses in kidney disorders

  • Addison’s disease - adrenal insuffiency

• gain in body water

  • drugs like ACEI

  • after surgery or injury

  • renal decrease

  • congestive heart failure

  • cirrhosis with ascites

  • very young/old

causes of hyponatraemia

• sodium loss

• water gain

treatment for low sodium

orally

• fluid restriction or slow sodium tablets

• diuretic

• IV if more severe (<120mmol/L or water intoxication)

symptoms of low sodium

usually occur <130mmol/L

• weakness

• lethargy

• headache

• postural hypotension

what is hyperkalaemia

high potassium

symptoms of high potassium

• excitability of muscle like cardiac arrhythmias, cardiac arrest

• muscle weakness

causes of high potassium

• drugs - K sparing diuretics, ACEI and ARBs

• renal impairment

• acidosis

• tissue breakdown from surgery, trauma, severe infection

treatment for high potassium

• mild or moderate - ion exchange resins e.g. calcium resonium

• severe - IV insulin, salbutamol, calcium gluconate

why is hyperkalaemia considered a medical emergency

because of the risk of sudden death

• stabilise the heart first and then sort out potassium

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what is hypokalaemia

low potassium

what are the symptoms of low potassium

• muscle weakness

• excess fatigue

• confusion

• low blood pressure

• arrhythmias

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what are the causes of low potassium

• drugs - diuretics (furosemide, thiazides)

• GI losses

• renal impairment

what are the treatments for low potassium

• mild - moderate: orally - sando K effervescent tablets

• severe - IV mixed sodium chloride with potassium

what are the symptoms of high calcium

• muscle weakness

• anorexia

• constipation

• fatigue

• headache

what are the causes of high calcium

• hyper parathyroidism

• cancer

• excessive vit D dose

• bone disease e.g. Paget’s

treatment for high calcium

increase fluid intake (flushes out excess calcium for mild cases)

• if mild, do this orally

• if severe - IV sodium chloride 0.9% to promote calcium duiresis

what are the symptoms for low calcium

• neuromuscular excitability

• cramps

• paraesthesia

• tetany

• convulsions

• ECG changes

causes of low calcium

• hypoparathyroidism

• renal disease

• vit D defiency

• excessive phosphate administration

treatment of low calcium

• oral calcium tablets

• if acute tetany present - IV calcium gluconate if severe

what is hyperphosphatemia

high phosphate

what are the symptoms of high phosphate

none

causes of high phosphate

• renal failure

• cell damage

• drugs like calcium, excess vit D, bisphosphonates

what is the treatment for high phosphates

• reduce phosphate intake

• phosphate binding salts e.g. calcium, aluminium

what is hypophosphatemia

low phosphate

symptoms of low phosphate

• muscle weakness

• rhabdomyolysis

• rickets

• cardiac and respiratory problems

• confusion

• seizures

causes of low phosphate

• drugs like antacids

• malnutrition

• alcoholism

• re-feeding syndrome

treatment for low phosphate

• IV potassium phosphate infusion for mild cases

• oral phosphate for severe cases

what are the symptoms of high magnesium

• muscle weakness

• CNS and respiratory depression

• cardiac problems like slow heart beat, cardiac arrest

what are the causes of high magnesium

drugs e.g. laxative or antacid use especially if high doses in renal impairment

treatment for high magnesium

• fluids (possibly add furosemide) - to promote renal clearance of Mg

• haemodialysis if renal impairment

• in severe cases - treatment of cardiac and respiratory depression e.g. IV calcium gluconate

symptoms of low magnesium

• muscle weakness

• contractions

• tetany

• tremor

• convulsions

causes of low magnesium

• drugs: alcohol, diuretics,

• renal impairment or GI issues e.g. chronic diarrhoea

treatment of low magnesium

• oral or IV Mg

• Mg rich food e.g. bananas, spinach, wheat, nuts

what does high levels of urea indicate

• dehydration

• renal failure

• catabolism - tissue breakdown - fever, starvation, surgery

• GI bleeding

• high protein diet

what do high levels of creatinine indicate

• renal failure

• reduced renal perfusion (drop in BP, heart failure, fluid loss)

• drug induced