plasma [K] < 3.5

loss by intracellular shift, NOT LOW INTAKE

Clinical features of Hypokalemia

K < 2.5 = muscle weakness

<1.5 aneflexic paralysis and resp. depression

Decr. gastric and sm. intestine motility => paralytic ileus

• Premature Vent contraxn
• ectopic tachycardia
• heart failure
• FLAT T wave, U wave
• 1st degree AV block

• decr. intake=Starvation
• Loss of HCL=Vomiting, gastric aspiration
• Defective K absorption-Fistulas
• Incr. intestinal secretion of K-Diarrhea

• Diuretic Therapy **#1 Cause!!!
• Renal Tubular disease
• Magnesium depletion
• Adrenal steroids

• Metabolic, Respiratiory Alkalosis (Tx w/ KCl)
• Infusion of lg amts of glucose or insulin therapy

PO NOT IV

HYPERKalemia

• muscle strength, nerve velocity changes
• cardiac contractility NOT affected but, arrythmias may occur
• Peaked T wave, widening QRS, Sine waves
• Atrial asystole folled by Ventr. Standstill

• Renal failure (acute, chronic)=Kidney fxn #1
• Acidosis
• Mineralcorticoid deficiency
• Hemolysis
• Rhabdomyolysis
• NSAIDS, ACE inhibs, TOO MUCH K= #1

• Stop meds
• Ca
• Glucose and insulin
• Beta agonist (albuterol)
• Exchange resin, diuretic
• Hemodialysis

Decr. in Na

#1 Electrolyte d/o

**Esp in hospitalized pts and Marathon runners

<135 = MORE H20 than Na

Comorbidities=hyperglycemia, CHF;  Incr Stress

• rare symptoms unless < 125
• mild lethargy -> coma
• Anorexia, nausea

• Psuedohyponatremia
• Hypertonic Hyponatremia
• Hypotonic Hyponatremia

-Hypovolemic

-Euvolemia

-Hypervolemia

• H2O restriction
• antagonize renal action of ADH

• Influenced by Osmotic pressure (sensitive to sm. changes in osmolarity)
• Kidneys  sensitive to sm changes in plasma AVP
• Anterior hypothalamus = most sensetive osmoreceptors

• >145
• ALWAYS reflect hyperosmolar state-> Na gain or H2O loss (H2O loss most often)
• Na, H2O metabolism->hypernatremia (iatrogenic)

• fever, high temp
• diabetes insipidis, and osmotic diuresis
• nasuea, vomiting, dyphagia

• Dehydration of brain->confusion to convulsions/coma
• most pts elderly w/ dehydration, tachycardiac, poor skin tugor

***Give FREE WATER

• If we cause->IVF, TF soln, diuretics, meds
• Hypervolemic->Diuretics + D5W
• Hypovolemic->isotonic NaCl then 1/2 NS or D5W

HYPERCalcemia

Primary Hyperparathyroidism

borderline-mild hypercalcemia

<11

1) Asses data and draw PTH level

2)Analyze PTH level (elevated intact PTH=primary hyperparathyroidism or lithium)

3)Analyze PTH related protein=primary indicator

4)Analyze vit D metabolite levels if no other obvious causes

5)Think hard and look for other causes

Tx of hypercalcemia

• Hydration and diuresis
• calcitonin
• hydrocotrisone
• dialysis

Not usu. OUTPATIENT!!

Corrected by Incr. PTH

d/t decr. PTH or chronic def of vit d pppt hypocalcemia

Causes of Hypocalcemia

• Decr albumin
• Acute pancreatitis
• Chronically ill
• Alkalosis
• Meds

• Chvosteks sign (face)
• Trousseaus sign (bp cuff and hand)
• NM irritability, parasthesis
• Tetany
• Seizures

• Ca glutonate
• CaCl
• Magnesium

• vit D supp
• w/ malabsorption->SUNLIGHT

1) Disease (Heart, Lung, Kidney)

2)  Location of Edema

Pulmonary Edema

Associated w/ cardiac and renal disease

w/o indicates cirrhosis, hypoalbuminemia

• Pulmonary Edema
• Central Venous Pressure
• Distribution reflects hemodynamic forces
• Peripheral Edema (pitting after pressure)

indicates lymphatic obstruction or thyroid

#1 Electrolyte d/o

Affects hospitalized pts. and marathon runners