What is a common cause of hyponatremia related to plasma osmolarity?
Hypotonic, hypertonic, and isotonic conditions.
p.1
Clinical Features of Hyponatremia
What are some clinical features of hyponatremia?
Nausea, vomiting, headache, confusion, seizures, and coma.
What are some causes of hypokalemia related to decreased intake?
Drip arm effect and decreased dietary intake.
What types of drugs can lead to hyperkalemia?
Potassium-sparing diuretics and indomethacin.
p.3
Treatment of Hyponatremia
How is the water deficit calculated?
Water deficit = 0.5 x BW x (plasma Na/140 – 1).
p.8
Clinical Features of Hypermagnesemia
What are the plasma concentration ranges for hypermagnesaemia and their effects?
0.7-1.0 mmol/L (normal), 2.0-3.0 mmol/L (therapeutic), 3.0-3.5 mmol/L (ECG changes), 4.0-6.0 mmol/L (areflexia), 6.0-7.0 mmol/L (respiratory arrest), 10.0-12.5 mmol/L (cardiac arrest).
p.10
Treatment of Hypernatremia
What is the recommended dose for calcium acetate tablets?
2 tablets three times a day (tid).
What gastrointestinal losses can lead to hypokalemia?
Vomiting, huge gastric aspirate, diarrhea, and fistula.
Which renal conditions can cause hypokalemia?
Primary and secondary hyperaldosteronism, excess mineralocorticoids, chronic pyelonephritis, and renal tubular acidosis.
What are some causes of hypomagnesaemia?
GI loss, reduced intake, reduced absorption, renal loss, drug-induced loss, burns, sepsis, cardiopulmonary bypass, Mg-free dialysate.
p.4
Clinical Features of Hypokalemia
What are some clinical features of hypokalemia related to the cardiovascular system?
ECG changes (flattening of T waves, ST depression, U waves, prolonged QT) and arrhythmias (SVT, VT, torsades).
p.10
Clinical Features of Hypernatremia
What is a potential complication of hyperphosphatemia?
Nephrocalcinosis, nephrolithiasis, and band keratopathy.
p.5
Clinical Features of Hyperkalemia
What is a common clinical feature of hyperkalemia related to the cardiovascular system?
ECG changes such as tall T waves and prolonged QRS.
p.10
Clinical Features of Hypernatremia
What is a common symptom associated with hyperphosphatemia?
Symptoms are usually caused by accompanying hypocalcemia.
What are some endogenous causes of hyperkalemia?
Burns, trauma, rhabdomyolysis, and tumor lysis.
Which condition is associated with decreased renal excretion of potassium?
Addison’s disease and hypoaldosteronism.
p.8
Clinical Features of Hypomagnesemia
What clinical features are associated with hypomagnesaemia?
Arrhythmia, coronary artery spasm, congestive heart failure, anorexia, dysphagia, muscle weakness, lethargy, seizures, confusion, irritability.
p.5
Treatment of Hyperkalemia
What is the first step in treating hyperkalemia?
Treat the underlying cause.
p.1
Treatment of Hyponatremia
When is rapid correction of hyponatremia indicated?
In symptomatic patients, such as those experiencing convulsions.
What is vitamin D toxicity associated with in terms of phosphate balance?
It can lead to a positive phosphate balance due to increased phosphate absorption.
p.10
Treatment of Hypernatremia
What is the primary aim of treatment for hyperphosphatemia?
To correct the underlying hypocalcemia.
p.3
Treatment of Hyponatremia
What solutions can be used to replace water deficit?
Water orally, ½ saline, D5 solution.
p.8
Treatment of Hypermagnesemia
What is the first step in treating hypermagnesaemia?
Stop magnesium supplementation.
p.8
Treatment of Hypermagnesemia
What can be used to antagonize neuromuscular effects of hypermagnesaemia?
10 ml of 10% calcium gluconate.
p.7
Clinical Features of Hypercalcemia
What muscular symptoms can be seen in hypercalcaemia?
Weakness, areflexia, atrophy.
p.5
Clinical Features of Hyperkalemia
What serious arrhythmia can occur due to hyperkalemia?
Ventricular fibrillation (VF).
p.5
Treatment of Hyperkalemia
What is a method to enhance potassium excretion?
Using resonium A (sodium polystyrene sulphonate) or resonium C (calcium polystyrene sulphonate).
p.2
Treatment of Hyponatremia
What is the formula to estimate sodium deficit?
0.6 x BW x (desired – current Na).
p.7
Treatment of Hypercalcemia
What medication can be used to decrease bone resorption in hypercalcaemia?
Calcitonin, glucocorticoids, bisphosphonates, mithramycin (after specialist advice).
p.9
Clinical Features of Hypokalemia
What is a skeletal clinical feature of hypophosphataemia?
Muscle weakness and rhabdomyolysis.
p.10
Treatment of Hypernatremia
What are two approaches to correct hyperphosphatemia?
1. Promote phosphate binding in the upper GI tract. 2. Enhance phosphate clearance.
p.3
Clinical Features of Hyponatremia
What is the primary effect of pure water depletion?
Large increase in sodium and osmolarity.
p.8
Treatment of Hypomagnesemia
What is the treatment for asymptomatic hypomagnesaemia?
10 mmol MgSO4 over 2 hours.
p.4
Treatment of Hypokalemia
What is the oral potassium supplement dosage for hypokalemia?
Syrup KCL: 1G = 13.4mmol; slow K: 600mg = 8mmol.
p.5
Treatment of Hyperkalemia
How can potassium shift to cells be enhanced in hyperkalemia treatment?
By administering 10 units of actrapid with 50 ml of 50% D50 over 20 minutes.
p.2
Treatment of Hyponatremia
What is the maximum rate of sodium correction for acute hyponatremia?
No greater than 2 mmol/l/hr.
p.6
Calcium and Magnesium Abnormalities
Which form of calcium is more physiologically important?
Ionized calcium is more important than total calcium.
p.6
Clinical Features of Hypokalemia
What are some clinical features of hypocalcaemia related to the cardiovascular system?
Hypotension, bradycardia, insensitivity to catecholamines and digoxin, ECG changes (QT/ST prolongation).
p.10
Treatment of Hypernatremia
What medications can promote phosphate binding in the upper GI tract?
Sucralfate, aluminium-containing antacids, and calcium acetate tablets.
What medications can contribute to hypokalemia?
Diuretics, amphotericin, and gentamicin.
p.3
Treatment of Hyponatremia
What is the treatment for pure water depletion?
Depends on the underlying cause; correct systemic hemodynamics and water deficit.
p.4
Clinical Features of Hypokalemia
What central nervous system symptoms can occur due to hypokalemia?
Cramps, paresthesia, weakness, tetany, and rhabdomyolysis.
p.1
Treatment of Hyponatremia
What is the recommended sodium correction rate for symptomatic hyponatremia?
100 mmol – 250 mmol Na over 10 minutes, followed by a slow correction.
p.8
Treatment of Hypermagnesemia
What is a potential treatment for hypermagnesaemia in patients with renal failure?
Dialysis may be necessary.
p.2
Clinical Features of Hyponatremia
What should be assumed if the duration of hyponatremia is uncertain?
Assume it has developed chronically.
p.6
Calcium and Magnesium Abnormalities
What is the formula for adjusted calcium?
Adjusted Ca = (40 – albumin)/40 + measured Ca.
p.7
Treatment of Hypercalcemia
What is the first step in the treatment of hypercalcaemia?
Remove the offending cause and treat the underlying condition.
What renal factors can lead to hypophosphataemia?
Increased loss due to diuretics, steroids, and haemodialysis.
p.9
Treatment of Hypokalemia
What should be monitored after treating hypophosphataemia?
Check potassium (K), phosphate (PO4), and calcium (Ca) levels.
p.8
Treatment of Hypomagnesemia
What is the treatment for severe symptomatic hypomagnesaemia?
10 mmol MgSO4 over 5 minutes.
p.7
Clinical Features of Hypercalcemia
What gastrointestinal symptoms can occur due to hypercalcaemia?
Anorexia, constipation, peptic ulcer, pancreatitis.
p.6
Clinical Features of Hypokalemia
What neuromuscular symptoms can occur due to hypocalcaemia?
Anxiety, psychosis, confusion, seizures, tetany, cramps, paresthesia, laryngospasm, bronchospasm.
p.3
Clinical Features of Hyponatremia
What are some clinical features of pure water depletion?
Thirst, lethargy, seizures, and coma.
p.4
Treatment of Hypokalemia
What is a key treatment approach for hypokalemia?
Treat the underlying cause, such as replacing magnesium or correcting alkalosis.
p.10
Treatment of Hypernatremia
What is the role of hemodialysis in treating hyperphosphatemia?
It enhances phosphate clearance, especially in patients with renal failure.
p.5
Treatment of Hyperkalemia
What urgent treatment can be administered for hyperkalemia?
50-100 ml of 8.4% NaHCO3 IV.
p.2
Treatment of Hyponatremia
What is the maximum sodium increase allowed in 24 hours for chronic hyponatremia?
Do not raise Na >12 mmol/24 hours.
p.7
Clinical Features of Hypercalcemia
What cardiovascular symptoms are associated with hypercalcaemia?
Hypertension, arrhythmia, ECG changes (QT shortening).
Name some other causes of hypophosphataemia.
Hyperparathyroidism, vitamin D deficiency, alcoholism, treatment of DKA, refeeding syndrome, burns, and alkalosis.
p.2
Treatment of Hyponatremia
Why should sodium be corrected slowly?
To reduce the risk of central pontine myelinolysis.
p.7
Clinical Features of Hypercalcemia
What central nervous system symptoms are associated with hypercalcaemia?
Depression, retardation, coma, seizure.
p.7
Clinical Features of Hypercalcemia
What renal problems can arise from hypercalcaemia?
Nephrocalcinosis, tubular dysfunction, diabetes insipidus.
What are some gastrointestinal causes of hypophosphataemia?
Decreased oral intake, malabsorption, fistula, and diarrhoea.
p.9
Clinical Features of Hypokalemia
What cardiovascular clinical features are associated with hypophosphataemia?
Myocardial depression, hypotension, and heart failure.
p.3
Treatment of Hyponatremia
Why must plasma sodium be monitored closely?
To prevent possible cerebral edema.
What are the causes of hypernatremia?
Iatrogenic, hypovolemia, euvolemia, hypervolemia, hypotonic fluid depletion, pure water depletion, salt gain.
p.6
Treatment of Hypokalemia
When do most experts recommend treating ionized calcium levels?
When levels are <0.8 mmol/L or if symptoms develop.
p.9
Hyperkalemia Causes and Treatment
What are some causes of hyperphosphataemia?
Factitious causes like haemolysis and sample separation delay, and redistribution due to trauma, rhabdomyolysis, and acidosis.
p.4
Treatment of Hypokalemia
What is the intravenous potassium supplementation dosage for hypokalemia?
10-20 mmol in 100 ml NS/D5 over 1 hour.
p.2
Treatment of Hyponatremia
What should be discussed with the ICU senior if hypertonic saline is to be used?
The use of hypertonic saline.
What happens during isotonic fluid loss from the extracellular component?
Minimal fluid shift and a small increase in sodium and osmolarity.
p.7
Treatment of Hypercalcemia
What is the recommended saline infusion for increasing calcium excretion?
2-3L over 3-6 hours, maintaining urine output of 200ml/hour.
p.9
Clinical Features of Hypokalemia
What central nervous system symptoms can occur due to hypophosphataemia?
Confusion, delirium, and seizures.
What does hypotonic fluid depletion include?
Isotonic fluid loss and pure fluid loss.
p.7
Treatment of Hypercalcemia
What hydration strategy is recommended in treating hypercalcaemia?
Hydration to achieve a dilution effect.
p.9
Treatment of Hypokalemia
What is the treatment for severe or symptomatic hypophosphataemia?
KH2PO4/K2HPO4 10ml = 14.5mmol PO4, replace 5-10ml in maintenance fluid over 6 hours.
p.6
Treatment of Hypokalemia
What is the emergency treatment for hypocalcaemia?
Bolus 2.5-5 mmol over 10 minutes intravenously.
