1. Electrolyte Emergencies

2. Decreased serum sodium Na+ <135 mEq/L
Hyponatremia
Decreased serum sodium
Na+ <135 mEq/L

3. Hyponatremia Causes Loss of salt and water Diuretics Addison’s disease
Osmotic diuresis (DKA)
Vomiting
Diarrhea
Diaphoresis

4. Hyponatremia Causes Increase in body water (dilutional hyponatremia)
Excess water intake (water intoxication)
CHF
Renal failure
Cirrhosis

5. Hyponatremia Signs/Symptoms
Lethargy, apathy secondary to cerebral edema
Headache
Muscle twitching, cramps
Seizures
Na+ < 110 mEq/L

6. Hyponatremia Treatment
NS infused at a rate to restore normal sodium over 48 hours

7. Elevated serum sodium Na+ >150 mEq/L
Hypernatremia
Elevated serum sodium
Na+ >150 mEq/L

8. Hypernatremia Causes Pure water loss Diabetes insipidus
Pure solute gain
NaHCO3 administration

9. Hypernatremia Causes Water loss > Solute loss Diarrhea Vomiting
Sweating
Osmotic diuresis

10. Hypernatremia Signs/Symptoms Irritability, restlessness Coma
Intracranial hemorrhage
Blood sludging - thrombosis
Seizures
Thirst, dry mucus membranes, poor skin turgor

11. Hypernatremia Treatment
Infusion of D5W (free water) to correct water deficit over 48 hours

12. Decreased serum potassium K+ < 3.5 mEq/L
Hypokalemia
Decreased serum potassium
K+ < 3.5 mEq/L

13. Hypokalemia Causes Gastrointestinal losses Diarrhea Vomiting
NG suction
Urinary losses
Diuretics
Osmotic diuresis

14. Hypokalemia Causes Intracellular shifts Alkalosis  agents
Theophylline
Inadequate intake

15. Hypokalemia Signs/Symptoms Weakness, hyporeflexia, paresthesias
Decreased GI motility
Nausea, vomiting
Increased sensitivity to digitalis

16. Hypokalemia Signs/Symptoms EKG changes Flat to inverted T waves
U waves
ST segment depression
Cardiac arrhythmias
Ventricular ectopy
V-Fib

17. Hypokalemia Treatment Correct underlying cause
10 mEq KCL IV over 1 hour, repeated until serum K+ > 3.5 mEq/L

18. Hyperkalemia Elevated serum potassium K+ > 5.5 mEq/L
K+ > 6 mEq/L - Emergency
K+ > 7 mEq/L - Life Threat

19. Hyperkalemia Causes Decreased excretion Renal failure
Addison’s disease
 - blockers
Hyperglycemia
Acidosis

20. Hyperkalemia Causes Increased intake Crush injury, burns, sepsis
Massive hemolysis
Blood transfusion
High-dose penicillin
Increased oral intake

21. Hyperkalemia Signs/Symptoms Muscle weakness Numbness, tingling
EKG changes
Tall, peaked T waves
Broadening of QRS; decreased P wave size
“Sine wave” leading to V-Fib then asystole

22. Hyperkalemia Treatment Calcium - 0.5 - 1.0g
Antagonizes cardiac toxicity
NaHCO mEq
Drives K+ into cells
D50W (25g)/insulin (10 units regular)

23. Decreased serum calcium Ca2+ < 8.5 mg/100ml
Hypocalcemia
Decreased serum calcium
Ca2+ < 8.5 mg/100ml

24. Hypocalcemia Causes Hypoparathyroidism Vitamin D deficiency
Decreased dietary intake
Alkalosis
Massive blood transfusion
Citrate toxicity

25. Hypocalcemia Signs/Symptoms Paresthesias
Hyperreflexia, carpopedal spasm, tetany
Seizures
Trousseau’s sign:
Carpopedal spasm following BP cuff compression of arm

26. Hypocalcemia Signs/Symptoms Chvostek’s sign
Contraction of facial muscles when face is tapped at angle of jaw
Laryngospasms
Prolonged QT interval
Increased ventricular irritability

27. Hypocalcemia Management Calcium chloride 1g over 10 - 20 minutes
Overly rapid administration of calcium can cause bradycardia, hypotension, and cardiac arrest

28. Increased serum calcium Ca2+ > 10.5 mg/100ml
Hypercalcemia
Increased serum calcium
Ca2+ > 10.5 mg/100ml

29. Hypercalcemia Causes Malignancies Skeletal, breast, lungs
Hyperparathyroidism
Vitamin D toxicity
Addison’s disease
Milk/alkali syndrome

30. Hypercalcemia Signs/Symptoms Apathy, fatigue, depression, coma
Muscle weakness
Hypertension
Anorexia, nausea, abdominal pain

31. Hypercalcemia Signs/Symptoms Kidney stones
Short QT interval, heart block, cardiac arrest
“Bones, Stones, Hypertones, Abdominal moans”

32. Hypercalcemia Treatment 1 - 2 liters NS over 1 hour
Decrease Ca2+ reabsorption
Furosemide 40 mg IV
Inhibits Ca2+ reabsorption
Calcitonin
Directly lowers Ca2+