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Download Fluids and Electrolytes Handout by Keith Torrey
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Cost & contents of labs at UH Test Contents Cost Worth it? BMP The standard “Chem 8”: Na/K/Cl/HCO3/BUN/Cr/Glu/Ca $206 Nope, better deals below! CMP BMP + TProt, Alb, Alk Phos, AST/ALT, TBili $297 First shot, sure RFP All of BMP + Phos, Alb $96 Yes $193 If needed HFP TProt, Alb, Alk Phos, AST/ALT, TBili, DBili Na $78 K $78 Cl $51 Phos $32 Mg $90 Ca (ionized) $140 • http://www.uhhospitals.org/case/patients-and-visitors/billing-insurance-and-medical-records/patient-pricing-information Sodium What to ponder Hypo Hyper Most common Sx/situations Lab findings, nausea, HA Lab findings, irritability Most dangerous Sx/situations Seizures, cerebral edema Hemorrhage, Coma Most common causes Sweat, diuretics, meds, SIADH Sweat, diuretics, renal dz Most dangerous causes CHF/Cirrhosis/Renal failure plus an acute issue to decompensate Burns, Endocrine issues Best ways to fix Fluid management Fluid management Potassium What to ponder Hypo Hyper Most common Sx/situations Weakness, ileus Irritability Most dangerous Sx/situations Arrhythmia, death VT, death Most common causes Diarrhea, diuretics, insulin Renal failure Most dangerous causes Alkalosis, severe GI losses Tumor lysis, Rhabdo Best ways to fix PO=IV, pick your poison based on the speed and person Shift, then think total stores Magnesium What to ponder Hypo Hyper Most common Sx/situations Confusion, HypoK, HypoCa Flushing, headache Most dangerous Sx/situations Tremor, Sz, Torsades, Death Respiratory failure, heart block Most common causes Renal and GI losses Renal failure, or Iatrogenic Most dangerous causes Alcoholism w/ Renal, GI losses Renal failure, adrenal insuff Best ways to fix Replete, IV if possible, PO gently IV Ca, low intake, high urine Chloride What to ponder Hypo Hyper Most common Sx/situations Agitation, labs off Weakness, labs off Most dangerous Sx/situations Coma, Arrhythmia LOC, Coma Most common causes Hypotonic fluids, dehydration Hypertonic fluids, meds Most dangerous causes Metabolic alkalosis (hypochloremic versions) Metabolic Acidosis Best ways to fix Salty intake, Tx underlying Dx Limit salt, consider diuretics Calcium What to ponder Hypo Hyper Most common Sx/situations Circumoral numbness Weakness, constip, stones Most dangerous Sx/situations Prolonged QT Ventricular arrhythmias Most common causes Diuresis, CKD, Vit D def Bone release Most dangerous causes Tumor lysis, rhabdomyolysis Bone release—malig Best ways to fix Supplements, Tx underlying Dx Hydration, Phos, Diuresis, HD Make sure you fix Mg, Vit D Phosphate What to ponder Hypo Hyper Most common Sx/situations Muscle weakness Oliguria, Hypocalcemia Most dangerous Sx/situations Respiratory depression Irregular HR, Calcifications Most common causes Alcoholism, burns Renal failure Most dangerous causes Refeeding syndrome Rhabdomyolysis, tumor lysis Best ways to fix High intake, repletion Low intake, High fluids, HD Couples of quick conclusions • Sodium: Easy for the body; body in trouble = so is your brain • Process: Timeline, Volume Status, (All Osmoles), and Body’s Response • Potassium: Heart wants you to know that it’s all about balance • ICF-ECF balance is crucial; Shifts vs Depletion/Overload; PO upset, IV burns • Magnesium: Potassium’s cousin. Acts like it, moves with it. • Measure when having K troubles; POdiarrhea, Slow IV drip is best • Chloride: Sodium’s shadow, tells you secrets about HCO3 • America loves salt. IV fluids: Not thinking about solution=part of the problem • Calcium: Musculoskeletal master, whole body deal, loves proteins • Low? Replete. High? Dilute, distract, dump. But you need to find a diagnosis • Phosphate: Frenemy of calcium but lets you breathe, move. • Comes with an RFP; make sure it stays normal; use the diet
