Electrolyte and Metabolic Disturbances：电解质代谢紊乱.ppt

Electrolyte and Metabolic Disturbances AHMED GHALI MD Lecture Objectives Review clinical manifestations and management of severe electrolyte disturbances Recognize acute adrenal insufficiency and appropriate treatment Describe management of hyperglycemic disturbances Electrolyte Changes – The Principles Implies an underlying disease process and may produce manifestations Treat the electrolyte change, but seek the cause Clinical manifestations usually not specific to a particular electrolyte change, e.g., seizures, arrhythmias Electrolyte Changes – The Principles Changes in ion concentrations affect intracellular reactions, membrane potentialsand movement of H2O Symptoms occur most often in tissues/organsdependent upon membrane potentials, e.g., cardiac, neurologic, muscle, GI, etc. Electrolyte Changes – The Principles Clinical manifestations determine urgency of treatment, not laboratory number Speed and magnitude of correction dependent upon clinical circumstances Recheck electrolytes frequently during correction Hypokalemia Etiology – renal loss, extrarenal loss, transcellular shift, decreased intake Deficit poorly estimated by serum levels Manifestations – nonspecific cardiac, neuromuscular, gastrointestinal Hypokalemia Titrate administration of K+ against serum level and manifestations ECG monitoring with emergent administration Allowable maximum iv dose per hour controversial Treat hypokalemia urgently in acidosis Hyperkalemia Etiology – renal failure, transcellular shifts, cell death, drugs, pseudohyperkalemia Manifestations – cardiac, neuromuscular Hyperkalemia – Treatment Stop intake Give calcium for cardiac toxicity Shift K+ into cell – NaHCO3, glucose + insulin, inhaled ?-agonist Remove from body – diuretics, dialysis, sodium polystyrene sulfonate Hyponatremia Etiology – euvolemic, hypovolemic, hypervolemic, pseudohyponatremia Manifestations – nonspecific neurologic, muscular, gastrointestinal Hyponatremia – Treatment Hypovolemic ??Na – give