hypercalcemia
Fatigue, insomnia, decreased muscle strength, nausea, vomiting, constipation
Replenish blood volume Loop diuretics, corticosteroids, dialysis
hypocalcemia
Blood calcium <2.25mmol/l
Cause
VD deficiency, parathyroid dysfunction, acute pancreatitis
Tetany, numbness in the hands and feet, restlessness, laryngeal spasm
10% Calcium Gluconate 10-20ml diluted intravenously
Hypermagnesemia
Serum magnesium＞1.25mmol/l
belching, vomiting, constipation, urinary retention
10% Calcium Gluconate 10-20 times intravenously
hypomagnesemia
Serum magnesium <0.75mmol/l
25% magnesium sulfate 5-10ml 5%GS intravenous drip
Dizziness, ataxia, myotremor, tetany, grand mal epilepsy
Calcium and magnesium metabolism disorders
PH⬇️,AB,SB,BB⬇️,AB＜SB, negative BE⬆, secondary to PaCO2⬇️
treat
severe
0.1-0.2mmol/l dilute hydrochloric acid [1mmol/l hydrochloric acid, normal saline 1000ml]
PH⬆️,AB,SB,BB⬆️,AB>SB, BE positive⬆️, PaCO2 secondary⬆️
diagnosis
compensatory period
PH may be normal, but HC03 and BE may be elevated
decompensation period
pH⬆️, HC03⬆️, PaC02 are normal
Generally asymptomatic (the primary disease is masked)
Cause
①Excessive loss of acidic substances
Vomiting, gastrointestinal decompression
②Excessive intake of alkaline substances
Rise in pH caused by increase in extracellular fluid and/or loss of H
Plasma primary HC03-increased
treat
Prevent primary disease and eliminate hyperventilation
Hold your breath repeatedly and cover your mouth and nose with a plastic bag
PH⬆️,PaCO2⬇️,AB,SB,BB⬇️,AB＜SB,BE negative⬆️
Dizziness, apathy, disorder of consciousness
clinical manifestations
Shortness of breath, fast heart rate,
Neuromuscular excitability ⬆️
Numbness and tremor of hands and feet, twitching of hands and feet
Cause
①Central system diseases
Encephalitis, brain trauma, tumors, hysterical attacks
②Drug effects
Salicylic acid, ammonium salt
③Hypermetabolism
High fever, hyperthyroidism, pain, G-bacteria sepsis
Characterized by a primary decrease in plasma H2C03 concentration
Alveolar hyperventilation: pH⬆️, PaCO2⬆️
PH⬇️,PaCO2⬆️,AB,SB,BB⬆️,AB>SB,BE is positive⬆️
Shortness of breath, difficulty breathing, neurological symptoms
Decreased extracellular fluid combined with hypernatremia
But total body sodium is normal or increased (hypervolemic hyponatremia)
Serum Na concentration <130mmol/L, plasma osmotic pressure <280mmol/L
localized edema
local inflammation of organs and tissues
Blockage of veins or lymphatic vessels
generalized edema
Nephrotic syndrome and nephritis
Cause
①Excessive secretion of antidiuretic hormone
② Continuous drinking of large amounts of water or excessive mental drinking
③ Intravenous infusion of too much fluid without salt or too little salt too quickly
Amount of sodium supplement required (mmol)
[Normal value of blood sodium - measured value of blood sodium] × weight (kg) x0.6 (0.5 for women)
Intravenous infusion of saline solution or hypertonic saline
Sodium loss > water loss
Serum Na + concentration <135mmol/L
Plasma osmotic pressure <280m0sm/L, accompanied by reduced extracellular fluid volume
Correct the hypotonic state of extracellular fluid and replenish blood volume
degree
Mild
<135
Fatigue, dizziness, numbness of hands and feet
Moderate
<130
Nausea and vomiting, thready pulse, blood pressure ⬇️, blurred vision
Severe
<120
Apathy, muscle spasm, difficulty breathing, coma
Cause
1. Only add water after loss of digestive juices/profuse sweating/burn
2. Ascites, pleural effusion
3. Potassium excretion and diuresis (furosemide, thiazides)
hypotonic dehydration
Decreased extracellular fluid combined with hyponatremia
Decreased extracellular fluid and normal serum sodium
Water and sodium are lost proportionally
Blood volume is reduced but serum Na concentration and plasma osmolality are still within the normal range
Intravenous infusion of balanced salt solution or isotonic saline
Nausea, anorexia, fatigue, oliguria, etc., no thirst
degree
5% of body weight
Thin and rapid pulse, clammy and cold limbs, blood pressure ⬇️ insufficient blood volume
At 6% to 7% of body weight
clinical manifestations
physical signs
Dry tongue, sunken eye sockets, dry and loose skin, etc.
Cause
①Acute loss of digestive juices
Enteroenteric fistula, massive vomiting, diarrhea, etc.
②Loss of body fluids in the infected area or soft tissue
Intra-abdominal/retroperitoneal infection, intestinal obstruction
③Drain large amounts of pleural effusion, ascites, large area burns, etc.
Water loss > Sodium loss
Serum Na+ concentration＞150mmol/L, plasma osmotic pressure＞310m0sm/L
Decrease in both extracellular and intracellular fluid volume (hypovolemic hypernatremia)
treat
severe hypernatremia
1. Quickly correct the lack of extracellular fluid volume
2. Correct water deficiency
Amount of fluid required
1. Estimated water loss as a percentage of body weight
2. Replenish 400-500ml of fluid for every 1% of body weight loss
3. Principle of fluid replenishment
4. Oral administration is preferred. Oral infusion of 5% sugar is not possible.
5. Speed ≤0.5～1.0mmol/(L·h)
degree
Mild
2% to 4% of body weight
No other symptoms except thirst
Moderate
4% to 6% of body weight
Fatigue, oliguria, dry lips and tongue
Severe
Mania, hallucinations, confusion, delirium, convulsions, coma
Severe cases include tachycardia, body weight, and blood pressure⬇️
Cause
①Insufficient water intake
② Excessive water loss, vomiting, diarrhea and gastrointestinal drainage, etc.
③Renal causes
hypotonic urine
central or nephrogenic diabetes insipidus
solute diuresis
Use lots of dehydrating agents
④Hyperventilation caused by any reason
Characterized by a primary increase in plasma H2C03 concentration
treat
Remove causes of ventilation disorders
clinical manifestations
Early: Headache, restlessness-tremor, delirium, coma
Cause
①C02 excretion obstacles
Brain injury, ventilator, anesthesia
②Acute
Laryngeal spasm or edema, foreign bodies blocking the trachea, and drowning
③ Ventilation disorder
Cardiogenic acute pulmonary edema, severe emphysema
Severe pneumonia, extensive pulmonary fibrosis
④The concentration of CO2 in the environment is too high and too much CO2 is inhaled
C02 excretion disorder or excessive inhalation: pH drops
5%NaHC03 solution 100～250ml
diagnosis
compensatory period
pH can be normal, but HC03, BE and PaC02 are reduced
decompensation period
Blood pH<7.35, HC03-significantly decreased
Breathing quickens and deepens
Typical is called Kussmaul breathing
Cause
① Excessive loss of alkaline substances
Severe diarrhea, intestinal fistula, pancreatic fistula, biliary drainage
② Kidney acid excretion and alkali retention dysfunction
Renal failure, renal tubular poisoning
Carbonic anhydrase inhibitor (acetazolamide)
③Excessive acidic substances
Hypoxia/tissue hypoperfusion
Diabetes, severe hunger, or alcoholism
④Excessive intake of exogenous fixed acid
⑤Hyperkalemia
Various reasons cause increased K+ in extracellular fluid
Plasma Primary HC03 - Decreased (most common)
Increase in extracellular fluid H and/or decrease in pH caused by loss of HC03
treat
Treat primary disease
lactic acidosis
Correct circulation disorders and control infections
diabetic ketoacidosis
Infusions and insulin should be administered promptly
Lighter (HC03-: 16～18mmol/L)
Severe disease (HC03＜10mmol/L)
Immediate infusion and alkaline treatment
Prevent low calcium and low potassium
clinical manifestations
severe
Fatigue, dizziness, drowsiness, feeling sluggish or irritable
People with ketoacidosis
Breathing smells like ketosis, cheeks flush, heart rate increases, and blood pressure is often low
Tendon reflexes weaken or disappear, confusion, coma, arrhythmia, acute renal insufficiency and shock
Principles of potassium supplementation
Not suitable for silent promotion
Not too early
See urine for potassium supplementation (urine output >40ml/h)
treat
1. Promote W to be transferred into cells
①Calcium equal amount of glucose
10% Calcium Gluconate 10～20ml equivalent to 25%GS
②Hypertonic alkaline solution
250ml of 5% NaHC03 solution intravenously
③Insulin Glucose
Add 10URI to 10% GS300~500ml for intravenous drip
Promote potassium excretion
2. Diuretics
Loop diuretics such as furosemide 40 to 100 mg or thiazide diuretics
3.Cation exchange resin
Potassium reducing resin 15gBID
4. Dialysis therapy
The fastest and most effective
symptom
Muscle tremors, limb weakness
Visceral reflexes decrease or disappear, delayed paralysis
EKG changes
Early changes include high and sharp T waves and shortened Q-T interval.
The QRS wave widens with a decrease in amplitude, and the P wave amplitude decreases and gradually disappears.
Atrioventricular block, tachyarrhythmia
Most dangerous: ventricular fibrillation or cardiac arrest
treat
Oral potassium supplement
Intravenous potassium supplementation
Earliest: Myasthenia
Limbs—trunk, respiratory muscles
symptom
Soft paralysis, decreased tendon reflexes or disappearance
digestive symptoms
Anorexia, nausea, vomiting and bloating, loss of bowel movements (intestinal paralysis)
cardiac involvement
Sinus tachycardia, conduction block, and dysrhythmias
EKG changes
Early ST segment depression, T wave decrease, widening or inversion
Subsequent QT prolongation and U wave
In severe cases, P wave amplitude increases and QRS widens.
Supraventricular or ventricular tachycardia, atrial fibrillation
Cause
①Insufficient potassium intake
Digestive tract obstruction, long-term fasting, coma, anorexia nervosa
② Loss of a large amount of potassium through the digestive tract
Severe vomiting, sustained gastrointestinal decompression, intestinal fistula
③The kidneys excrete too much potassium
Long-term use of furosemide or thiazide diuretics
Acute renal failure polyuria stage
④Long-term infusion of liquids that do not contain potassium salts, or insufficient potassium supplementation in parenteral nutrition solutions
⑤Transfer of potassium into tissues
Massive infusion of glucose and insulin
Metabolic and respiratory alkalosis
Cause
①Excessive intake
Enter banked blood with a longer shelf life
Too much oral/intravenous potassium supplementation
② Decreased renal potassium excretion function
Acute and chronic renal failure
Apply potassium-sparing diuretics (spironolactone, triamterene)
Mineralocorticoid deficiency
③Movement of intracellular potassium
Hemolysis, tissue damage, acidosis
Hyperkalemia: serum potassium concentration >5.5mmol/L
Hypokalemia: serum potassium concentration <3.5mmol/L
Potassium metabolism disorders
Water and sodium metabolism disorders
water intoxication and edema
Wondershare EdrawMind
