Electrolyte Disorders：电解质紊乱.ppt

Case 9, Hypophosphatemia Case 9 Hyperphosphatemia Classic presentation of Hypophosphatemic rhabdomyolysis. Prolonged NPO status/starvation Resp failure requiring reintubation after extubation or surgery. Due to resp muscle weakness. Phos goes very low, then suddenly climbs without any supplementation. Associated with high K and Low calcium. Creatinine climbs more than 1.0 mg/dl/day, suggesting increased creatinine production Reference Narins. Fluid and Electrolyte Disorders: Am journal of Medicine, 1982 Electrolyte Disorders Dom Colao, DO November 2011 Review of Electrolyte disorders HypoNatremia Hypernatremia HypoKalemia HyperKalemia Calcium Magnesium Phosphorus Overview of Disorders The differential for any lab abnormality: Lab error Lab error Lab error Polypharmacy Iatrogenic Real disease In that order! Always consider the potential for a confounding variable Was the blood drawn above a running IV? Did it sit too long before the test was run? Is it your patients blood? Is there a pattern of abnormalities in numerous patients on the same day? Over view of Sodium Disorders Pseudo-hyponatremia Due to high concentrations of other solutes in the blood - Mannitol in a pt with cerebral edema, Glucose in a diabetic. Then look at the patient’s volume status Hypervolemic/Euvolemic/Hypovolemic Hyponatremia Hypervolemic: HypOvolemic: Euvolemic: Hyponatremia Hypervolemic: CHF, Cirrhosis, Pregnancy, Nephrotic syndrome In these conditions, total body sodium is up, but total body WATER is up even more. Due to reduced Effective Arterial Blood Volume, (EABV) leading to increased ADH secretion. Hyponatremia Hypervolemic: CHF, Cirrhosis, Pregnancy, Nephrotic syndrome HypOvolemic: GI losses (diarrhea, Vomiting, NG suction) Renal Losses (diuretics, Salt wasting nephropathy, recovery phase from ATN or obstruction). Due to true depletion of water and sodium, leading to increased secretion of Aldosterone AND ADH Hyponatremia Hyperv