thera electrolyte Tx

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coal
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243687
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thera electrolyte Tx
Updated:
2013-10-29 15:17:07
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thera electrolyte Tx
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thera electrolyte Tx
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  1. symptomatic severe hyponatremia
    • free water restriction
    • IV hypertonic saline - 3%
    • may need to add a loop diuretic
  2. hypovolemic hypotonic hyponatremia
    0.9% NaCl or LR
  3. isovolemic hypotonic hyponatremia non SIADH
    • water restriction
    • mild diuresis with a loop
  4. hypervolemic hypotonic hyponatremia
    • optimize underlying cause
    •    cardiac, renal or hepatic insufficiency
    • Na & fluid restrictions (1000-1500 mL/day)
    • diuresis with a loop
  5. isotonic hyponatremia
    correct hyperlipidemia
  6. hypertonic hyponatremia
    • correct hyperglycemia
    •   insulin and avoid carbs
  7. hypovolemic hypernatremia hemodynamically stable
    0.45% or 0.225% NaCl
  8. hypovolemic hypernatremia hemodynamically unstable
    0.9% NaCl or LR
  9. isovolemic hypernatremia
    • calculate water deficit
    • sodium restriction
    • correct diabetes insipidus
  10. hypervolemic hypernatremia
    • removal of sodium products and limit intake
    • diuretics - loop or thiazide
  11. hypokalemia mild-moderate
    20-40 mEq K, oral or IV
  12. hypokalemia severe
    40-80 mEq K, IV or oral
  13. hyperkalemia symptomatic
    • intracellular driven
    •   insulin & dextrose
    •   sodium bicarbonate
    •   albuterol
    • increase K elimination
    •   potassium wasting diuretic
    •   sodium polystyrene sulfonate
    •   renal replacement therapy
  14. hypophosphatemia asymptomatic
    oral phosphate - if GI tract is functional
  15. hypophosphatemia symptomatic - 2.3-2.7 mg/dL
    0.08-0.16 mmol/kg/dose
  16. hypophosphatemia symptomatic - 1.5-2.2 mg/dL
    0.16-0.32 mmol/kg/dose
  17. hypophosphatemia symptomatic <1.5 mg/dL
    0.32-0.64 mmol/kg/dose
  18. hyperphosphatemia
    • oral phosphate binders
    •   calcium - preferred in chronic renal insufficienc
    •   aluminum - causes constipation
    •   magnesium - causes diarrhea
  19. hypophosphatemia + hypercalcemia
    sevelamer - renagel, renvela
  20. hypocalcemia asymptomatic
    no therapy needed
  21. hypocalcemia severe
    • IV - 1000mg calcium chloride
    •        3 g calcium gluconate over 10 minutes
  22. hypercalcemia mild
    hydration and ambulation
  23. hypercalcemia severe
    • IV hydration - 0.9% NaCl (200-300 mL/hr)
    • IV furosemide - 40-100 mg q 1-4 h
    • hemodialysis if life threatening
  24. hyperkalemia not in acute setting
    bisphosphonates
  25. hypomagnesemia mild - moderate
    8-32 mEq Mg IV (1-4 g magnesium sulfate)
  26. hypomagnesemia severe
    32-64 mEq IV (4-8 g magnesium sulfate)
  27. hypermagnesemia asymptomatic
    • magnesium restriction
    • loop diuretics
    • hemodialysis
  28. hypermagnesemia severe
    IV calsium

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