This document discusses electrolyte disorders and provides information on hyponatremia, hypernatremia, hypokalemia, and hyperkalemia. It defines each condition, describes signs and symptoms, discusses causes and diagnostic approaches, and outlines treatment strategies. Key points covered include plasma concentration thresholds for each disorder, mechanisms of generation, common signs seen in different organ systems, diagnostic testing to distinguish causes, and methods for correcting imbalances and replacing electrolytes.

1. ELECTROLYTE DISORDERS CRISBERT I. CUALTEROS, MD http://crisbertcualteros.page.tl

6. Diagnostic Approach Hyponatremia Na and Water Deficit Water Excess Na and Water Excess Hypervolemia Hypovolemia Euvolemia

7. Diagnostic Approach Hyponatremia Hypovolemia Euvolemia Hypervolemia Renal Losses Diuretic excess Mineralcorticoid Deficiency Salt losing nephritis RTA Extrarenal Losses Vomiting Diarrhea Burn Pancreatitis Peritonitis Urine Na >20 Urine Na<10

8. Diagnostic Approach Hyponatremia Hypovolemia Euvolemia Hypervolemia Glucocorticoid Deficiency Hypothyroidism Pain Emotional Stress Drugs SIADH Urine Na >20

9. Diagnostic Approach Hyponatremia Hypovolemia Euvolemia Hypervolemia Nephrotic Syndrome Cardiac Failure Cirrhosis ARF CRF Urine Na <10 Urine Na >20

17. Diagnostic Approach Hypernatremia Na and H2O Deficits H2O losses Na Addition Excess Hypovolemia Euvolemia Hypervolemia

18. Diagnostic Approach Hypernatremia Hypovolemia Euvolemia Hypervolemia Renal losses Osmotic and loop diuretics Post obstruction Extrarenal Losses Sweating Burns Diarrhea Urine Na >20 Urine Na <10

19. Diagnostic Approach Hypernatremia Hypovolemia Euvolemia Hypervolemia Renal Losses Nephrogenic DI Central DI Extrarenal Losses Respiratory and Dermal Incensible Losses Urine Na = Variable Urine Na = Variable

20. Hypernatremia Hypovolemia Euvolemia Hypervolemia Primary Hyperaldoteronism Cushing’s Syndrome Hypertonic Dialysis Hypertonic NaHCO3 NaCl tablets Urine Na >20 mEq/L

32. Diagnostic Approach Hypokalemia Redistribution Extrarenal U K <20 Renal loss U K >20 Metabolic acidosis Diarrhea GI fistulas Laxative abuse Normal Acid-Base Profuse sweating Laxative abuse Gastric fistula Previous vomiting

33. Diagnostic Approach Hypokalemia Redistribution Extrarenal Loss U K <20 Renal Loss U K >20 Hypertensive High Plasma Renin Malignant HPN Renovascular HPN Renin secreting tumors Low Plasma Renin Primary Aldosteronism Cushing’s Syndrome Adrenal hyperplasia

34. Diagnostic Approach Hypokalemia Redistribution Extrarenal Loss U K <20 Renal Loss U K >20 Normotensive Metabolic Alkalosis U Cl <10 Vomiting U Cl >10 Diuretics Mg Depletion Barter syndrome Gittleman syndrome

35. Diagnostic Approach Hypokalemia Redistribution Extrarenal Loss U K <20 Renal Loss U K >20 Normotensive Metabolic acidosis Normal Anion Gap RTA Increase Anion Gap Diabetic Ketoacidosis Ethylene Glycol