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Electrolytes Disturbances

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Electrolytes Disturbances

  1. 1. Electrolytes Disturbances
  2. 2. Sodium <ul><li>Major cation of the ECF </li></ul><ul><li>The total body Na – 5000 mmol. </li></ul>
  3. 3. <ul><li>Plasma Na conc. 137 – 147 mmol/l </li></ul><ul><li>ICF conc. – 5 mmol/l </li></ul>
  4. 4. Distribution <ul><li>44% in ECF </li></ul><ul><li>47% in bone </li></ul><ul><li>9% in ECF. </li></ul>
  5. 5. Sodium <ul><li>Daily intake – 3 – 5g.(50 –90 mEq ) </li></ul><ul><li>Normal urinary loss 10 – 90 mEq/day </li></ul><ul><li>< 1 mEq/ day in conditions of reduced intake or extra renal loss </li></ul>
  6. 6. Other sources of Na loss <ul><li>Sweat 10 – 60 mEq/ day </li></ul><ul><li>300 mEq in individuals unacclaimatised to hot climates </li></ul><ul><li>Intestine 0 – 20 mEq/day </li></ul>
  7. 7. Hyponatraemia <ul><li>Common causes </li></ul><ul><li>1) GI loss e.g. obstruction </li></ul><ul><li>2)Inappropriate ADH secretion </li></ul>
  8. 8. GI loss <ul><li>obstruction </li></ul><ul><li>H+ ion Paralytic ileus </li></ul><ul><li>K+ ion loss Fistulae </li></ul><ul><li>Diarrhoea </li></ul>
  9. 9. Inappropriate ADH secretion <ul><li>Oat cell Ca </li></ul><ul><li>CNS tumours </li></ul><ul><li>Trauma </li></ul>
  10. 10. Hyponatraemia – C. F. <ul><li>Neurological – irritability, </li></ul><ul><li>lethargy, c convulsions, </li></ul><ul><li>coma </li></ul><ul><li>Associated water loss-dehydration </li></ul>
  11. 11. . Investigations <ul><li>Hct, </li></ul><ul><li>plasma proteins, </li></ul><ul><li>creatinine, </li></ul><ul><li>urea </li></ul>
  12. 12. Investigations <ul><li>Plasma Na low or normal </li></ul><ul><li>Urinary Na </li></ul><ul><li>< 10mmol/l in extra renal loss, </li></ul><ul><li>>20mmol/l in renal loss. </li></ul>
  13. 13. Treatment <ul><li>oral </li></ul><ul><li>Isotonic saline </li></ul><ul><li>Hypertonic saline </li></ul>
  14. 14. Hypernatraemia <ul><li>Causes </li></ul><ul><li>Over infusion of saline </li></ul><ul><li>Water loss </li></ul>
  15. 15. Water loss <ul><li>increased sweating </li></ul><ul><li>Diabetes insipidus </li></ul><ul><li>Hyperadrenalism </li></ul>
  16. 16. Hypernatraemia – C.F. <ul><li>Facial puffiness, </li></ul><ul><li>edema, </li></ul><ul><li>weight gain, </li></ul><ul><li>CCF, </li></ul><ul><li>increased osmalality </li></ul>
  17. 17. <ul><li>ICF dehydration </li></ul><ul><li>brain - confusion </li></ul><ul><li>irritability, </li></ul><ul><li>convulsions </li></ul><ul><li>coma </li></ul>
  18. 18. Treatment <ul><li>P/O period stop saline, </li></ul><ul><li>if due to lack of water, infuse 5% Dextrose </li></ul>
  19. 19. Potassium <ul><li>ICF cation </li></ul><ul><li>Total body K(TBK) = 2500 mmol, </li></ul>
  20. 20. <ul><li>98% ICF – 160 mmol/l, </li></ul><ul><li>2% ECF </li></ul>
  21. 21. <ul><li>Plasma K is an important determinant of TBK , </li></ul><ul><li>reduction of 1mmol/l = 200 – 300mmol of TBK </li></ul>
  22. 22. Potassium <ul><li>Commonest site – skeletal muscle </li></ul><ul><li>ECF K- important for neuromuscular function </li></ul>
  23. 23. <ul><li>Acidosis - </li></ul><ul><li>K out of the cell – </li></ul><ul><li>hyperkalaemia </li></ul><ul><li>Alkalosis - hypokalaemia </li></ul>
  24. 24. Potassium <ul><li>Daily intake – 50 – 100 mmol </li></ul><ul><li>Sources – fruits, </li></ul><ul><li>milk, </li></ul><ul><li>honey </li></ul>
  25. 25. <ul><li>K excreted through kidney </li></ul><ul><li>Renal response to K depletion slower </li></ul>
  26. 26. <ul><li>Alkalosis - increased renal loss </li></ul><ul><li>Acidosis - decreased renal loss </li></ul><ul><li>Trauma - increased K excretion </li></ul>
  27. 27. Hypokalaemia <ul><li>Causes: </li></ul><ul><li>Loss through the GI excretions – diarrhoea, </li></ul><ul><li>fistulas, </li></ul><ul><li>villous adenomas, </li></ul><ul><li>ureterosigmoidostomy </li></ul>
  28. 28. <ul><li>Deficient administration – IVfluids </li></ul><ul><li>Hyperaldosteronism </li></ul><ul><li>Insulin administration </li></ul>
  29. 29. Hypokalaemia . C . F. <ul><li>Neuromuscular > muscular weakness </li></ul><ul><li>Arrhythmias </li></ul><ul><li>Ileus </li></ul>
  30. 30. <ul><li>Polyuria </li></ul><ul><li>ECG > flattening of T waves, prominent U waves, sagging of ST segment </li></ul>
  31. 31. Treatment <ul><li>oral K, </li></ul><ul><li>I/V should not exceed 20 mmols/hour </li></ul>
  32. 32. Hyperkalaemia <ul><li>Inadequate excretion – </li></ul><ul><li>renal </li></ul>
  33. 33. C.F <ul><li>GI symptoms </li></ul><ul><li>CVS – peaked T, wide T, cardiac arrest </li></ul>
  34. 34. GI symptoms <ul><li>nausea, </li></ul><ul><li>vomiting, </li></ul><ul><li>int. colic, </li></ul><ul><li>diarrhoea </li></ul>
  35. 35. CVS <ul><li>peaked T, </li></ul><ul><li>wide T, </li></ul><ul><li>cardiac arrest </li></ul>
  36. 36. Treatment <ul><li>I/V Ca, </li></ul><ul><li>combination of HCO3, glucose and insulin, </li></ul><ul><li>dialysis </li></ul>
  37. 37. Magnesium <ul><li>Intracellular divalent cation </li></ul><ul><li>Normal serum Mg. – 0.8 to 1.2 mmol/l </li></ul><ul><li>Total – 1000 mmols. </li></ul><ul><li>Slowly exchangeable </li></ul>
  38. 38. Distribution <ul><li>Bone – 67%, </li></ul><ul><li>ICF – 31%, </li></ul><ul><li>ECF – 1% </li></ul>
  39. 39. Magnesium <ul><li>Absorbed </li></ul><ul><li>jejunum </li></ul><ul><li>ileum </li></ul>
  40. 40. <ul><li>Excretion – kidney. Kidney has remarkable ability to conserve </li></ul><ul><li>Function –most of the enzyme systems </li></ul><ul><li>Deficiency – along with K & Ca deficiency </li></ul>
  41. 41. <ul><li>Normal daily intake – 10 mmol </li></ul><ul><li>Sources – nuts, </li></ul><ul><li>peas </li></ul><ul><li>seed gram </li></ul>
  42. 42. Hypomagnesemia <ul><li>Causes: </li></ul><ul><li>Malabsorption, </li></ul><ul><li>intestinal fistula, </li></ul><ul><li>pancreatic insufficiency, </li></ul><ul><li>massive bowel resection, </li></ul>
  43. 43. Causes: <ul><li>biliary diversion, </li></ul><ul><li>prolonged N/G suction, </li></ul><ul><li>hypoparathyroidism, </li></ul><ul><li>TPN </li></ul>
  44. 44. <ul><li>Severe hypomagnesemia - blocks release of PTH – hypocalcaemia </li></ul><ul><li>Increased aldosterone - K loss -hypokalaemia </li></ul>
  45. 45. Hypomagnesemia C. F. <ul><li>Paraesthesia, </li></ul><ul><li>irritability, </li></ul><ul><li>mental confusion </li></ul>
  46. 46. <ul><li>Hypocalcaemic features </li></ul><ul><li>Hypokalaemic features – arrhythmia etc </li></ul><ul><li>Hypermagnesmia in severe renal failure. </li></ul>
  47. 47. Treatment <ul><li>hypokalaemia & hypocalcaemia to be corrected. </li></ul><ul><li>TPN – supplement Mg. </li></ul>
  48. 48. Trace elements <ul><li>Copper, </li></ul><ul><li>Manganese, </li></ul><ul><li>Zinc, </li></ul><ul><li>Selenium </li></ul>
  49. 49. Trace elements <ul><li>Exact role not defined </li></ul><ul><li>Deficiency > rash in TPN patients </li></ul><ul><li>Supplementation required in TPN </li></ul>
  50. 50. Replacement of ongoing losses Composition of GI secretions 40 100 5 145 500 Biliary Fistula 120 75 5 140 700 Pancreatic Fistula 15 90 15 60 1500 Gastric Juice (Fasting) 30 10 25 10 1500 Saliva HCO 3 (mg mol/l) Cl (mg mol/l) K (mg mol/l) Na (mg mol/l) Vol (ml) Locality
  51. 51. Replacement of ongoing losses Composition of GI secretions 45 90 25 120 500- 15000 Diarrhoeal Stool HCO 3 (mg mol/l) Cl (mg mol/l) K (mg mol/l) Na (mg mol/l) Vol (ml) Locality 30 45 20 80 300 Prox.Colostomy 30 45 8 115 500 Ileostomy

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