TAEM10:Electrolyte emergency

Electrolyte Emergency Khrongwong Musikatavorn M.D. Emergency Unit King Chulalongkorn Memorial Hospital and Faculty of Medicine Chulalongkorn University February 10 th 2009

Common life-threatening Electrolyte disturbances ,[object Object],[object Object],[object Object],[object Object]

Sodium homeostasis ,[object Object],[object Object],[object Object],[object Object],[object Object]

Hyponatremia ,[object Object],[object Object],[object Object],[object Object],[object Object]

Hyponatremia ,[object Object],[object Object],[object Object],[object Object],[object Object],N Engl J Med 2000;342:1581-9

Hyponatremia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],N Engl J Med 2000;342:1581-9

Hyponatremia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],N Engl J Med 2000;342:1581-9

Signs and Symptoms of hyponatremia ,[object Object],[object Object],[object Object],[object Object]

Evaluation of hyponatremia ,[object Object],[object Object],[object Object],[object Object],[object Object],1. N Engl J Med 2007; 356: 2064-72

Evaluation of hyponatremia ,[object Object],[object Object],[object Object],[object Object],[object Object],N Engl J Med 2007; 356: 2064-72

Treatment of hyponatremia ,[object Object],[object Object],[object Object],[object Object],[object Object]

Symptomatic hyponatremia “an emergency condition” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Correction of hyponatremia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],J Neurol Neurosurg Psychiatry 2004;75(Suppl III):iii22–iii28

Calculation of sodium deficit ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Calculation of sodium deficit N Engl J Med 2007; 356: 2064-72

Syndrome of Inappropriate Antidiuresis (SIAD) ,[object Object],[object Object],[object Object],[object Object]

Causes of SIAD ,[object Object],[object Object],[object Object],[object Object],[object Object]

Diagnosis of SIAD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment of SIAD ,[object Object],[object Object],[object Object],[object Object],[object Object]

Hypernatremia ,[object Object],[object Object],[object Object],[object Object]

Signs and symptoms of hypernatremia ,[object Object],[object Object],[object Object],[object Object]

Treatment of hypernatremia ,[object Object],[object Object],[object Object]

Hypotonic fluid administration ,[object Object],[object Object],[object Object],[object Object],[object Object]

Calculation of water deficit N Engl J Med 2000;342:1493-9

Calculation of water deficit ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Calculation of water deficit ,[object Object],[object Object],[object Object],[object Object],[object Object]

Potassium [K + ] homeostasis ,[object Object],[object Object],[object Object],[object Object],[object Object]

Hyperkalemia ,[object Object],[object Object],[object Object],[object Object],[object Object],Circulation 2005; 112: IV-121-IV-125

Signs and Symptoms of Hyperkalemia ,[object Object],[object Object],[object Object],[object Object]

EKG abnormalities of Hyperkalemia ,[object Object],[object Object],[object Object],[object Object],[object Object],1. Br Med J 2002;324:1320-4

EKG abnormalities of Hyperkalemia

EKG abnormalities of Hyperkalemia Tall peaked T wave

EKG abnormalities of Hyperkalemia Tented T waves, loss of P waves and a wide QRS complex a sinewave pattern

EKG abnormalities of Hyperkalemia Severe bradycardia Ventricular tachycardia

Arrhythmia from hyperkalemia ,[object Object],[object Object],[object Object],[object Object],1. Resuscitation 2004;62:119-20 2. Semin Dial 2000;13:279-80 3. Am Heart J 1974;88:360-71 4. Inten Care Med 1989;15:325-6 5. Crit Care Med 1981;9:556-7 6. Intensive Care Med 1994;20:287-90

Treatment of hyperkalemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment of hyperkalemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1. Nephrol Dial Transplant 2003;18:2215-8

Treatment of hyperkalemia ,[object Object],[object Object],[object Object]

Indication for emergency hemodialysis in hyperkalemia ,[object Object],[object Object],J Crit Care 2006;21: 316-21

Indication for hospital admission in hyperkalemia ,[object Object],[object Object],[object Object],[object Object],Arch Intern Med 2000;160: 1605-11

Hypokalemia ,[object Object],[object Object],[object Object],[object Object]

Causes of hypokalemia Resuscitation 2006;70: 10-25

Signs and Symptoms of hypokalemia ,[object Object],[object Object],[object Object]

EKG abnormalities in hypokalemia ,[object Object],[object Object],[object Object]

EKG abnormalities in hypokalemia T wave flattening, prominent U wave, ST segment changes in Hypokalemia

EKG abnormalities in hypokalemia Prominent U wave (arrow) in hypokalemia

Treatment of hypokalemia ,[object Object],[object Object],[object Object],[object Object],[object Object],1. New Eng J Med 1998;339:451-8

Treatment of hypokalemia ,[object Object],[object Object],[object Object],[object Object],[object Object],Resuscitation 2006;70: 10-25

Calcium homeostasis ,[object Object],[object Object],[object Object],[object Object],[object Object]

Hypercalcemia ,[object Object],[object Object],[object Object],[object Object]

Signs and Symptoms of hypercalcemia ,[object Object],[object Object],[object Object],[object Object]

Causes of hypercalcemia ,[object Object],[object Object],[object Object],[object Object],[object Object]

Differential diagnosis of hypercalcemia ,[object Object],[object Object]

Emergency treatment of hypercalcemia ,[object Object],[object Object],[object Object],[object Object]

Emergency treatment of hypercalcemia Rev Endocr Metab Disord. 2003; 4: 167-75

Emergency treatment of hypercalcemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Emergency treatment of hypercalcemia ,[object Object],[object Object],[object Object]

Emergency treatment of hypercalcemia ,[object Object],[object Object],[object Object],[object Object],[object Object]

Hypocalcemia ,[object Object],[object Object]

Signs and Symptoms of hypocalcemia ,[object Object],[object Object],[object Object],[object Object]

Signs and Symptoms of hypocalcemia ,[object Object],[object Object],Chvostek’s sign Trousseau’s sign Br Med J 2008;336;1298-1302

Treatment of hypocalcemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Br Med J 2008;336;1298-1302

Calcium replacement for hypocalcemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Br Med J 2008;336;1298-1302 Oxford textbook of medicine. 4th ed. Oxford: Oxford University Press, 2003

Hypomagnesemia ,[object Object],[object Object],[object Object]

Signs and symptoms of hypomagnesemia ,[object Object],[object Object],[object Object]

Dysrhythmias in hypomagnesemia QT prolongation (QTc = 0.513 msec)

Dysrhythmias in hypomagnesemia Torsade de pointes

Treatment of hypomagnesemia ,[object Object],[object Object],[object Object],[object Object],[object Object],Magnesium. 1989;8:201-212 J Intensive Care Med 2005; 20: 3-17

Treatment of hypomagnesemia ,[object Object],[object Object],[object Object],[object Object],[object Object],Pharmacol Rev. 1977;29:273-300 J Intensive Care Med 2005; 20: 3-17

TAEM10:Electrolyte emergency

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TAEM10:Electrolyte emergency