Electrolyte Management - Case Western Reserve University ：电解质的管理-凯斯西储大学.pptVIP

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Electrolyte Management - Case Western Reserve University ：电解质的管理-凯斯西储大学.ppt

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Electrolyte Management - Case Western Reserve University ：电解质的管理-凯斯西储大学.ppt

Cases: 68 yo man evaluated for jaw pain and difficulty eating found to have. CT neck shows LUL spiculated lung lesion: Na = 126 Cl = 87 Cr = 0.71 Ca = 11.2 Alb = 2.7 Now what? Cases: 75 yo man admitted to OSH ICU for hepatic encephalopathy. Admission labs notable for elevated ammonia but otherwise unremarkable. He had been in their MICU for 3 d transferred to the floor at the OSH yesterday and now to you on the VA wards. He remains disoriented and minimally responsive on exam. Na = 159 K = 4.2 Cr = 1.2 Now what? Cases: 56 yo man admitted to ICU after tylenol OD who subsequently develops liver and renal failure, but now transferred to the floor and getting intermittant HD only. Last HD was yesterday. K = 6.0 Now what? Cases: 57 yo man admitted to the VA for Na 121 on routine labs at a CBOC. It took him all day to get to the hospital. You notice he is a little shaky when you meet him. Now what? Cases: 55 yo woman with PMH of extensive CAD s/p recent TAH-SAO for large ovarian mass is admitted to CICU POD # 8 for n/v and CP with transient lateral ST depressions K = 2.8 Now what? Cases: 27 yo woman with h/o of medication non-adherance and DM1 is admitted to UH MICU with DKA. K = 5.8 CO2 = 8, AG 20 BG 423 on arrival What should we do about the K? Cases: 85 yo woman with h/o diastolic HF transferred to Hellerstein service for placement after aggressive diuresis in the CICU. Continues to look wet, but Cr has been rising over the last 3 days from 1.0?3.0. She is on a lasix gtt at 10 mg/h. 2 days ago her K was 3.0 and now she is getting standing 40 mEq K each evening while on the gtt. K = 5.2 at 4 AM (not hemolyzed) What should we do about the K? Electrolyte Management Jeff Beamish PGY-3 Intern Bootcamp Lecture Series August 2013 Summary Hyperkalemia Hyponatremia Hypernatremia Hypokalemia Others: Mg, Phos, Ca (briefly only) Cases Disclaimer: this is “boot camp”. I have tried to include the most common issues and management approaches but this lect