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Special Circumstances Workshop Electrolyte Disorders Learning outcomes By the end of this session the candidate will: • Have a systematic approach to the assess and treat the patient with electrolyte disorders Case study Clinical setting and history • A 60-year-old man presents to the ED with a 2-day history of severe diarrhoea and vomiting. His medication includes furosemide and an ACE inhibitor. Clinical course • ABCDE - A : Clear - B : RR 20 min-1 - C : P 130 min-1, BP 80/50 mmHg - D : Responds to Voice - E : No rashes, looks pale What is your initial treatment? What investigations will you request? Case study (continued) Laboratory results: Na+ K+ bicarbonate urea creatinine 130 mmol l-1 7.9 mmol l-1 11 mmol l-1 29.1 mmol l-1 841 μmol l-1 Approximate normal ranges Na+ 135 -145 mmol l-1 K+ 3.5 - 5.0 mmol l-1 bicarbonate 22 - 26 mmol l-1 urea 3.0 - 7.0 mmol l-1 creatinine 60 - 100 μmol l-1 Case study (continued) Laboratory results: Na+ K+ bicarbonate urea creatinine 130 mmol l-1 7.9 mmol l-1 11 mmol l-1 29.1 mmol l-1 841 μmol l-1 Approximate normal ranges Na+ 135 -145 mmol l-1 K+ 3.5 - 5.0 mmol l-1 bicarbonate 22 - 26 mmol l-1 urea 3.0 - 7.0 mmol l-1 creatinine 60 - 100 μmol l-1 Arterial blood gas results: pH 7.11 PaCO2 3.5 KPa PaO2 18 KPa bicarbonate 9.0 mmol l-1 K+ 8.1 mmol l-1 Na+ 133 mmol l-1 (patient on high-flow oxygen) Approximate normal ranges pH 7.35 - 7.45 PaCO2 4.7 - 6.0 KPa PaO2 > 10 KPa on air bicarbonate 22 - 26 mmol l-1 K+ 3.5 - 5.0 mmol l-1 Na+ 135 - 145 mmol l-1 What is the diagnosis and what treatments will you start? Case study (continued) Clinical course • The patient is starting to look worse • A nurse brings you his 12-lead ECG What does the 12-lead ECG show? Case study (continued) Case study Clinical course • The patient has a cardiac arrest with an initial rhythm of asystole What is the management of cardiac arrest in hyperkalaemia? Hypokalaemia Causes • Dialysis and medications/iatrogenic (including excessive IV fluids) • Severe diarrhoea +/- vomiting Treatment • Treatment depends on severity of hypokalaemia in peri-arrest • In cardiac arrest • IV/IO potassium 5 mmol bolus • IV/IO magnesium 5 mmol bolus Any questions? Advanced Life Support Course Slide set All rights reserved ©Australian Resuscitation Council and Resuscitation Council (UK) 2010