美国重症医学(FCCM)基础教程电解质代谢紊乱.pptVIP

Electrolyte and Metabolic Disturbances Objectives Review causes and clinical manifestations of severe electrolyte disturbances Outline emergent management of electrolyte disturbances Recognize acute adrenal insufficiency and appropriate treatment Describe management of severe hyperglycemic syndromes Principles of Electrolyte Disturbances Implies an underlying disease process Treat the electrolyte change, but seek the cause Clinical manifestations usually not specific to a particular electrolyte change, e.g., seizures, arrhythmias Principles of Electrolyte Disturbances Clinical manifestations determine urgency of treatment, not laboratory values Speed and magnitude of correction dependent on clinical circumstances Frequent reassessment of electrolytes required Hypokalemia Etiology – renal loss, extrarenal loss, transcellular shift, decreased intake Manifestations – cardiac, neuromuscular, gastrointestinal Deficit poorly estimated by serum levels Hypokalemia Titrate administration of K+ against serum level and manifestations Correct hypomagnesemia 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 – glucose + insulin, NaHCO3, inhaled ?-agonist Remove from body – diuretics, sodium polystyrene sulfonate, dialysis Pediatric Considerations – Potassium Replace at maximum iv rate 1.0 mmol/kg/hr; monitor ECG Hyperkalemia ECG abnormality: calcium gluconate or chloride Shift: NaHCO3, glucose + insulin, inhaled ?-agonists Removal: diuretic, sodium polystyrene sulfonate, dialysis Hyponatremia Hypo-osmolar hyponatremia Euvolemic Hypovolemic Hypervolemic Normo- or hyperosmolar hyponatremia Pseudohyponatremia Manifestations – neurologic, muscular, gastrointestinal