Renal - ELECTROLYTE ABNORMALITIES!!

Calcium - HYPOcalcemia (s/s, causes, treatments)

• S/S: anxiety/irritability, TWITCHING around mouth, laryngospasm, seizures, torsades VT, CHVOSTEK’S sign (spasm of lip/cheek); TROUSSEAU’S sign (carpopedal spasm)

• causes: acute pancreatitis, hyperkalemia, HYPOparathyroidism, Vit D deficiency, hypoalbuminemia, chronic renal failure, alkalotic states (hyperventilation, prolonged vomiting), massive infection of subcutaneous tissues

• treatment: IV fluids (NS), calcium gluconate or chloride, Vit D, correct alkalosis

Calcium - HYPERcalcemia (s/s, causes, treatments)

• S/S - lethargy/fatigued/AMS, DTRs decreased or absent, abdominal pain/constipation, muscle weakness, N/V, “metallic taste”, anorexia/weight loss, kidney stones

• causes - renal disease, hypokalemia, HYPERparathyroidism, prolonged immobilization/bed rest, malignancies

• treatments: IV NS to promote diuresis; promote renal excretion (furosemide) [RULE OUT HYPOKALEMIA FIRST!!], glucocorticoids (decrease GI absorption of calcium), Mithracin IV, calcitonin, or etidronate (DECREASES calcium release from bones)

Potassium - HYPOkalemia (s/s, causes, treatments)

• S/S - muscle weakness; decreased reflexes; N/V; paralytic ileus or abdominal distension/gas; shallow respirations; mental depression; ECG CHANGES (V-tach, V-fib)

• causes - diuretics; hypochloremic metabolic alkalosis; acute alcoholism; uncontrolled diabetes; excessive perspiration; excess production of aldosterone (promotes K excretion); cirrhosis

• treatments - KCl, correct alkalosis by replacing chloride, IV LR, correct hypomagnesemia (low mag causes kidneys to waste potassium)

Potassium - HYPERkalemia (s/s, causes, treatments)

• S/S - muscle weakness; irritability; nausea, diarrhea, muscle cramps/pain; ECG CHANGES (peaked T waves, QRS widening, loss of P-waves, bradycardia, PEA)

• causes - renal failure; burns (EARLY); massive crush injuries (K is intracellular; crush injuries PUSH POTASSIUM OUT); excessive intake; metabolic acidosis; adrenocortical insufficiency

• treatments - calcium chloride (or gluconate), sodium bicarbonate, insulin/glucose, albuterol, elimination of potassium intake; correct acidosis; kayexalate; dialysis

Sodium - HYPOnatremia (s/s, causes, treatments)

• S/S - edema; fatigue, muscle cramps, weakness; abdominal cramps; diarrhea; lethargy/confusion; DECREASED DTRs, seizures/coma/brain herniation

• causes - fluid overload (heart failure, cirrhosis); excessive water ingestion; excessive infusion of D5W; SIADH

• treatments - water restriction (if hypervolemic or euvolemic); loop diuretics; treat dehydration with NS; water intoxication? → water restriction, avoid hypotonic fluids; ACUTE/severe? → 3% normal saline in small amounts

Sodium - HYPERnatremia (s/s, causes, treatments)

• S/S - classic signs of hypovolemic hypernatremia (thirst, tachycardia, orthostasis, hypotension) may be present; dry, sticky mucous membranes; restlessness/irritability; LATER: obtundation, stupor, coma

• causes - insensible losses/dehydration; osmotic diuresis (mannitol); DKA; HHS; diabetes insipidus

• treatments - IDENTIFY CAUSE; evaluate urine sodium (the urine sodium will be >20 mEq/L if the patient is HYPERvolemic; urine sodium will vary with other causes of hypernatremia)

Magnesium - HYPOmagnesemia (s/s, causes, treatments)

• S/S - HYPERREFLEXIA (chvostek’s, trousseau’s); ventricular arrhythmias, PSVT; sensitivity to digoxin; insulin resistance, hypokalemia, hypocalcemia, hypophosphatemia; agitation/confusion; impedes the correction of LOW POTASSIUM

• causes - CHRONIC ALCOHOLISM (most common cause); vomiting/diarrhea/NG suction; malabsorption; post-CABG or acute MI; DKA/HHS/hyperthyroidism; nephrotic syndome; DRUGS: aminoglycosides, diuretics, ETOH, digoxin, cisplatin; MALNUTRITION, enteral/parenteral feedings

• treatments - MgSO4 (magnesium sulfate) generally max of 1g/min

Magnesium - HYPERmagnesemia (s/s, causes, treatments)

• S/S - decreased DTRs, respiratory depression, respiratory arrest; bradyarrhythmias, hypotension; lethargy/coma; nausea/vomiting; flushing

• causes - renal failure, magnesium-containing laxatives/antacid abuse; iatrogenic OD

• treatments - stop magnesium substances; give calcium as for hyperkalemia; give furosemide as for hypercalcemia if renal function is OK; patient may need dialysis

Phosphate - HYPOphosphatemia (s/s, causes, treatments)

• S/S - similar to hypercalcemia; lethargy/fatigued/AMS; DTRs are decreased/absent; abdominal pain, peptic ulcers; constipation; muscle weakness; hypoventilation

• causes - due to INCREASED cellular uptake of phosphate with TPN administration; increased GLUCOSE administration (TPN); alcoholism

• treatments - oral or IV phosphate supplement

Phosphate - HYPERphosphate (s/s, causes, treatments)

• S/S - similar to hypocalcemia; anxiety/irritability; twitching around the mouth; laryngospasm; seizures

• causes - due to DECREASED renal excretion and/or renal failure

• treatments - phosphate binders (aluminum hydroxide (Amphojel, Basagel); calcium carbonate (Caltrate)

ELECTROLYTE NORMAL RANGES

• Calcium - 8.5 - 10.5

• Potassium - 3.5 - 5

• Sodium - 135 -145

• Magnesium - 1.5 - 2.5

• Phosphate - 3.0 - 4.5