Summary of Desequilibrio electrolitico. Hiponatremia, Hipernatremia, Hipokalemia, Hiperkalemia

Summary of the Video: "Desequilibrio electrolítico. Hiponatremia, Hipernatremia, Hipokalemia, Hiperkalemia"

This educational video addresses Electrolyte imbalances focusing on sodium and potassium disorders commonly encountered in emergency settings: Hyponatremia, Hypernatremia, Hypokalemia, and Hyperkalemia. It emphasizes their clinical significance, diagnostic approach, symptomatology, and treatment principles.

Main Ideas and Concepts

1. General Introduction to Electrolyte imbalances

• Electrolyte imbalances are findings, not diseases themselves, often accompanying other comorbidities.
• Common in elderly, patients with chronic diseases (e.g., chronic kidney disease), drug users, or those with gastrointestinal issues.
• Electrolyte disturbances can cause neurological symptoms and other systemic effects.
• Treatment focuses on addressing the underlying cause rather than just correcting electrolyte levels.

2. Hyponatremia (Low Sodium)

• Defined as serum sodium <135 mEq/L.
• Classified by severity:
  • Mild: 130-134 mEq/L
  • Moderate: 125-129 mEq/L
  • Severe: <125 mEq/L
• Most frequent electrolyte disorder seen in emergency rooms.
• Causes:
  • Relative excess water compared to sodium.
  • Excess water intake, impaired water excretion (e.g., due to antidiuretic hormone release).
  • Associated with osmolarity changes (hypoosmolar or hyperosmolar states).
• Symptoms:
  • Often asymptomatic; symptoms arise from underlying causes.
  • Neurological dysfunction (nausea, vomiting, headache, lethargy, seizures, coma) when sodium <125 mEq/L.
  • Severity depends on sodium level and symptom duration.
• Diagnosis:
  • Assess volume status (hypovolemia, euvolemia, hypervolemia).
  • Consider osmolarity (normal 280-320 mOsm/kg).
  • Review medications (diuretics, ACE inhibitors, corticosteroids).
• Treatment:
  • Treat underlying cause.
  • Fluid management based on volume status.
  • Sodium replacement calculated carefully to avoid rapid correction.

3. Hypernatremia (High Sodium)

• Defined as serum sodium >145 mEq/L.
• Causes:
  • Water loss (dehydration, osmotic diuresis, fever, diarrhea, sweating, burns, fistulas).
  • Sodium gain (excess saline infusion, salt intake, hypothalamic lesions affecting thirst).
• Classified by volume status:
  • Hypovolemic Hypernatremia (fluid loss exceeds sodium loss).
  • Euvolemic (controversial, e.g., diabetes insipidus).
  • Hypervolemic (excess sodium with fluid overload).
• Diagnosis:
  • Clinical evaluation of volume status.
  • Calculate total body water and fluid deficit.
  • Calculate osmolarity (2 x Na + glucose/18).
• Treatment:
  • Fluid replacement tailored to volume status.
  • Monitor for complications like fluid overload.

4. Hypokalemia (Low Potassium)

• Defined as serum potassium <3.5 mEq/L.
• Causes:
  • Low intake.
  • Loss through urine (diuretics) or gastrointestinal tract (vomiting, diarrhea).
  • Excessive sweating or physical exertion.
• Symptoms:
  • Muscle weakness, cramps, paresthesias.
  • Electrocardiogram (ECG) changes (ST depression, low T wave amplitude, U waves).
  • Risk of arrhythmias, especially in patients with heart disease or on digoxin.
• Diagnosis:
  • Clinical symptoms plus ECG findings.
• Treatment:
  • Potassium replacement carefully administered to avoid complications (phlebitis, arrhythmias).
  • Typical dosing: 10-20 mEq diluted in 100 mL over several hours.
  • Severe cases may require central venous access and faster replacement.
  • Continuous ECG and electrolyte monitoring during replacement.

5. Hyperkalemia (High Potassium)

• Defined as serum potassium >5.5 mEq/L.
• Causes:
  • Chronic kidney disease.
  • Use of potassium-sparing diuretics.
  • Excessive potassium intake or cellular release.
• Symptoms:
  • Muscle weakness, paresthesias, fatigue.
  • ECG changes progressing with severity:
    • Peaked, symmetrical T waves (>5.5 mEq/L).
    • Prolonged PR interval, loss of P waves, widened QRS (>7-8 mEq/L).
    • Risk of life-threatening arrhythmias.
• Emergency treatment:
  • Membrane stabilization: Calcium gluconate (does not lower potassium but protects heart).
  • Shift potassium intracellularly:
    • Salbutamol (beta-agonist)

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Educational

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