Electrolyte disturbance：.pptVIP

Hyponatremia  Causes of SIADH Infections (meningitis TB Pneumonia ) Neoplasm Drugs (Crbamazepine , cytoxan, tricyclic ) Postoperative Subarachnoid haemorrhage Hyponatraemia Sever when below 120 mmol/l Symptoms depend on severity and rapidity of decline in serum sodium Chronic hyponatraemia is less symptomatic but should be corrected with great caution Hyponatremiasymptoms May be asymptomatic Weakness lethargy dizziness and decreased concentration Seizures confusion and even coma can be seen in sever cases particularly if developed quickly Hyponatremia Deficient can be calculated by ( Desired Na – Serum Na ) *(wt*.6) Correction should at a rate of 1-2 mmol/l Correction should be to mild hyponatremia Central pontine myelonysis is mainly seen in alcoholics Hyponatremiainvestigations Plsma osmolality Urine osmolality Urine Na concentration Hyponatremiatreatment Normal saline is indicated in volume depletion Diuretics induced Water restriction indicated in SIADH Oedema renal failure Hypertonic saline indicated in sever symptomatic hyponatremia Hyponatremiatreatment of SIADH Acute Water restriction Hypertonic saline Loop diuretics Chronic Water restriction Loop diuretic Demeclocycline Hypernatremia causes Water loss (sweating Burns ) Renal loss GI losses Hypothalamic disorders DI Hypernatremiasymptoms Mainly neurological Lethargy weakness and irritability are early symptoms which can progress to seizures coma and death Symptoms are more with acute oncet Hypernatremiatreatment Dextrose infusion Hpokalemiasymptoms Weakness lethargy If chronic may lead to polyuria Can lead to sever alkalosis May trigger cardiac arrhythmia in patients with ischemic heart disease or recent myocardial infarction Hypokalemia Treatment K supplement either oral or intravenous K deficiency can not be calculated Usual requirement in the range of 60 mEq