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Sodium and Potassium Abnormalities: Presented By: DR - Ram Kumar Moderator: Prof. C. S. Prakash

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Kanchi Mitra Bhargav

This document summarizes abnormalities in sodium and potassium levels. It discusses hyponatremia, its causes and management, including fluid restriction and saline administration. Hypernatremia causes like decreased free water are covered. Hypokalemia signs, causes like diuresis, and oral/IV repletion treatments are outlined. Hyperkalemia causes like renal failure and its cardiac effects and emergency treatments to drive potassium intracellularly or remove it are summarized.

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Sodium and Potassium Abnormalities: Presented By: DR - Ram Kumar Moderator: Prof. C. S. Prakash

Uploaded by

Kanchi Mitra Bhargav
22 views21 pages
This document summarizes abnormalities in sodium and potassium levels. It discusses hyponatremia, its causes and management, including fluid restriction and saline administration. Hypernatremia causes like decreased free water are covered. Hypokalemia signs, causes like diuresis, and oral/IV repletion treatments are outlined. Hyperkalemia causes like renal failure and its cardiac effects and emergency treatments to drive potassium intracellularly or remove it are summarized.

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This document summarizes abnormalities in sodium and potassium levels. It discusses hyponatremia, its causes and management, including fluid restriction and saline administration. Hypernatremia causes like decreased free water are covered. Hypokalemia signs, causes like diuresis, and oral/IV repletion treatments are outlined. Hyperkalemia causes like renal failure and its cardiac effects and emergency treatments to drive potassium intracellularly or remove it are summarized.

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22 views21 pages

Sodium and Potassium Abnormalities: Presented By: DR - Ram Kumar Moderator: Prof. C. S. Prakash

Uploaded by

Kanchi Mitra Bhargav
This document summarizes abnormalities in sodium and potassium levels. It discusses hyponatremia, its causes and management, including fluid restriction and saline administration. Hypernatremia causes like decreased free water are covered. Hypokalemia signs, causes like diuresis, and oral/IV repletion treatments are outlined. Hyperkalemia causes like renal failure and its cardiac effects and emergency treatments to drive potassium intracellularly or remove it are summarized.

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Sodium and Potassium abnormalities

Presented by : Dr . Ram Kumar Moderator : Prof. C. S. Prakash

Hyponatremia: Na+ < 135 meq/L


Symptom severity Degree of change Acuteness of change Severe (< 120 meq/L): neurological Lethargy Disorientation Agitation Seizures/coma

Hyponatremia Causes
Overhydration: free water Iatrogenic administration of hypotonic IV fluids Congestive heart failure Liver failure Dehydration: hypertonic loss GI and third-space losses Diuretic renal losses Euhydration: SIADH

Hyponatremia Management
Assess volume status Address underlying cause (In oliguria) Analyze urine Na+ and osmolality relative to serum Na+ and osmolality urine Na+ and osmolality = renal conservation of sodium and water urine Na+ and osmolality = renal loss of sodium and water

Hyponatremia Management
Overhydration due to hypotonic fluids: discontinue hypotonic fluids, use NS Overhydration due to edematous states Restrict sodium and water intake Improve underlying condition Dehydration: NS volume replacement SIADH Fluid restriction Correction of underlying process

Hyponatremia Management
Severe hyponatremia (acute change or symptomatic) Goal: symptoms resolution or 130 meq/L Correct at 1meq/L/hour with 3% saline Rapid correction Central pontine myelinolysis Flash pulmonary edema Monitored setting essential

Hypernatremia Causes
free water Skin: burns GI: hypotonic diarrhea Renal: central/nephrogenic Diabetes insipidus Na+ Iatrogenic : excess 3%NaCl correction , sodium bicarbonate administration Hyperaldosteronism

Hypernatremia: Na+ > 145 meq/L


Symptoms dependent on rate of change, level, and volume status Neurological Restlessness Hyperreflexia Weakness Delirium

Hypernatremia Management
Assess volume status Determine cause Correct free water deficit with D5W Maximum rate of Na+ correction: 1 meq/L/hr Monitored setting Rapid correction contraindicated: cerebral edema to herniation

Hypernatremia Management
Additional management considerations Central DI: add Desmopressin Nephrogenic DI: sodium restriction ,thiazides , amiloride ,NSAIDS Excess sodium Stop administration Remove with loop diuretic (e.g., Lasix)

Hypokalemia: K+ < 3.5 meq/L


Cardiac Flattened T waves Prominent U waves P-R interval QRS widening Neuromuscular: weakness and lethargy GI: ileus

Hypokalemia Causes
Potassium loss Diuresis Gastrointestinal loss Intracellular displacement Alkalosis Inadequate intake

Hypokalemia Management
Assess Acid-base status Glycemic state Renal function Review Current medications (e.g., diuretics) Nutrition status (potassium intake) Obtain ECG

Hypokalemia Treatment
Replete K+ > 3 meq/L: oral (avoids renal secretion) < 3 meq/L or ECG changes: IV Maximum safe rate: 20 meq/L/hr through a central line in monitored setting

Hyperkalemia: K+ > 5.0 meq/L


Cardiac Peaked T waves Shortening of QT interval QRS widening/ST segment depression Sine wave/cardiac arrest Neuromuscular: lethargy and weakness GI: vomiting and diarrhea

Hyperkalemia Causes
Poor renal excretion Renal failure K+-sparing diuretics Cell death Burns Crush injury/tissue necrosis Acidosis
H E M O L Y S I S

Hyperkalemia Management
Verify the value Stop any K+ administration Obtain ECG Assess Renal function Ischemic tissue

Hyperkalemia Management
Protect the heart: calcium gluconate Drive K+ intracellularly Insulin and glucose Bicarbonate Remove excess K+ If kidneys work: diuretics If kidneys do not work Resins Hemodialysis

THANK YOU

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