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Electrolytes and Fluid Balance :beer_mugs: (Edema :red_flag: (Mechanism (↓…
Electrolytes and Fluid Balance
:beer_mugs:
Edema
:red_flag:
Loop diuretics
Oral : onset within 1 hour, last for 6-8 hours
IV: onset within 5 minutes, last for 2 hours
Post-diuretic sodium retention
Sodium restriction when talking loop diuretics
caused by
cirrhosis
Spironolactone
(aldosterone receptor antagonist)
Prevent hypokalaemia
Mechanism
↓ colloidal pressure
Cirrhosis - low albumin production
Nephrotic syndrome -proteinuria
CKD
↑ capillary hydrostatic pressure
sodium retention
heart failure
Drugs such as NSAIDs, glucocorticoids,vasodilators,CCB-dihyropyridines
↑ capillary permeability
Allergy
Sepsis
Inflammation
Lymphatic obstruction
Non-pitting edema
CCB +ACEI/ARB
induced pedal edema
Sodium :checkered_flag:
Normal: 135-145 mmol/L
Hyponatraemia
Fluid loss through GI, skin,lungs or diuretics
Isotonic saline infusion
Stop diuretics
Treat GI loss
Congestive heart failure,cirrhosis,nephrotic syndrome
Dietary sodium and fluid restriction
Diuretic therapy (all the conditions caused edema)
Renal failure, SIADH, low sodium intake
Fluid restriction
SIADH
excessive release of ADH
Cause natriuresis
Small amount of urine
High urine specific gravity
Caused by anti-epileptic drugs such as carbamazepine
Hypernatraemia
Hypovolemic
Water loss > sodium loss
GI,skin,lung,shock
Normal saline +hypotonic fluid
Hypervolemic
Sodium gain > water gain
Sodium overload
Mineralcorticoid excess
5% dextrose + loop diuretics
Isovolemic
Diabetes insipidus (DI)
Desmopressin
Nephrogenic DI
thiazide
Fluid restriction
Drug-induced DI (by lithium)
amiloride
Potassium
Normal: 3.5-5 mmol/L
Hypokalaemia
:!:
No body adjustment for hypokalaemia - very dangerous
Causes
:black_flag:
↓ potassium intake
↑ entry into cells
Insulin
↑ activity of Na-K ATPase pump
Beta-2 agonist
↑ activity of Na-K ATPase pump
↑ activity of Na-K-2Cl co-transporter
Possibly ↑ activity of insulin
Metabolic alkalosis
↑ activity of H+/K+ pump
↑ red blood cell production
(acute)
Hypokalaemic periodic paralysis
Loss of gastric or intestinal secretions
vomitting
diarrhea
↑ urinary loss
Diuretics
↑ mineralcorticoid activity
Hypomagenesemia
Polyruria
Clinical manifestation
:no_entry:
Severe muscle weakness - respiratory muscle, rhabdomyolysis
ST segment depression
T wave inversion
Glucose intolerance - ↓ insulin secretion
Digoxin toxicity
Treatment
:check:
correct underlying cause
Use potassium-sparing diuretics/aldosterone-receptor antagonist
2.5-3.5 mmol/L: oral potassium replacement
Slow K
<2.5 mmol/L:
IV potassium chloride
- continuous ECG monitoring
hypokalaemia +
metabolic acidosis
- potassium bicarbonate
potassium-rich food
Hyperkalaemia
:warning:
Causes
:black_flag:
Insulin deficiency
Hyperglycemia
Increase in tissue catabolism, Exercise
Use of beta-blockers
Digitalis overdose
Metabolic acidosis
Damaged muscle cells
Renal failure - failed to excrete potassium
Reduced aldosterone (Addison's disease)
ACEI, ARB
Potassium-sparing diuretics
Clinical manifestation
:no_entry:
Paralysis
Shortened QT interval
T wave elevation
Metabolic acidosis
Pseudohyperkalaemia
potassium movement out of the cells when blood specimen is collected
no ECG changes
Treatment
:check:
ECG change :<3:
Calcium gluconate
IV
Protect heart from toxic effects of calcium,
no effect on potassium leve
l
Insulin
slow infusion
add dextrose for non-diabetic patient to prevent hypoglycemic
accompanied by metabolic acidosis
sodium bicarbonate
Loop diuretics -
furosemide
acts on Na-K-2Cl pump
Beta agonist -
salbutamol,albuterol
if resistant to insulin
asthmatic patients
sodium polystyrene sulfonate
non ECG change