Acid base disorders extern2

[object Object],[object Object],[object Object],Emergency Management in Electrolyte and Acid-Base Disorders

Scope ,[object Object],[object Object],[object Object],[object Object]

Case Demonstration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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

Approach Guideline of HypoNa True Hyponatremia (exclude hyperglycemia) Assess ECF volume status TBW  , TBNa +  NaCl replacement H 2 O restriction Diuretics, H 2 O / Na restriction Hypovolemia TBW  , TBNa +  Hypervolemia TBW  , TBNa +  Normovolemia U [Na] > 20 < 20 > 20 > 20 < 20 Renal loss Extrarenal loss Renal failure Edematous state SIADH Endocrinopathy Rx Rx Rx

Emergency Rx of HypoNa: Symptomatic with serum [Na] < 120 mEq/l ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Rx of symptomatic hypoNa ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Patient Groups at Increased Risk for Neurologic Complications of HypoNa Too slow Too rapid ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Osmotic Demyelination Acute cerebral edema

Case Demonstration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Case Demonstration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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

Approach Guideline of HyperNa Rx Rx Rx Istonic + Hypotonic NaCl replacement H 2 O replacement Diuretics H 2 O replacement Assess ECF volume status U [Na] > 20 < 20 U sp gr low high U [Na] > 20 Renal loss Extrarenal loss Renal loss Extrarenal loss Sodium gain TBW  , TBNa +  Hypovolemia TBW  , TBNa +  Hypervolemia TBW  , TBNa +  Normovolemia

Emergency Rx of HyperNa: Symptomatic with serum [Na] > 158-160 mEq/l ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Rx of symptomatic hyperNa ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Case Demonstration ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Hyperkalemia ,[object Object],[object Object],[object Object],tall peak T-wave widen QRS complex, sine wave prolonged PR interval

Approach Guideline of HyperK Increased serum [K]  production - Rhabdomyolysis - Intravasc hemolysis  excretion - Renal failure - dRTA type IV - Adrenal insufficiency - Drugs: ACEI K-sparing diuretics NSAID Heparin, etc. Redistribution - Acidosis - Insulin insufficiency - Drugs:  -blocker succinylcholine Digitalis intox Renal K excretion: vary low high (>10) * TTKG = Urine K / Serum K Urine osm / Serum osm

Emergency Rx of Hyperkalemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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

Approach Guideline of HypoK Decreased serum [K]  excretion Redistribution - Alkalosis - Insulin Rx - HypoK periodic paralysis - Drugs:  -agonists - Barium poisoning Renal K excretion: vary low high (>10) low (< 2) Extrarenal - Diarrhea - Cathartics Renal - Diuretics - HypoMg - Hyperaldosteronism - Inherited kidney dis - Drugs toxicity: Amphotericin B Carbenicillin, etc. Low intake

Emergency Rx of Hypokalemia: Symptomatic hypokalemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Emergency Rx of Hypokalemia: Symptomatic hypokalemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],A Stepwise Standard Approach

Metabolic acidosis ,[object Object],[object Object],* Urine anion gap = U.Na + + U.K + - U.Cl -

Major Causes of Acute Metabolic Acidosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Wide AG acidosis Normal AG acidosis

Management of Life-Threatening Acidosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Complication of Bicarbonate Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Metabolic alkalosis ,[object Object],[object Object]

Approach Guideline of Met. alkalosis ,[object Object],[object Object],[object Object],[object Object],[object Object]

Diagnostic Algorithm of Metabolic Alkalosis urine pH Metabolic alkalosis Is the GFR very low? Yes Alkali intake Iron exchange resin Milk-alkali syndrome Vomiting No Is the ECF volume contracted? Yes No Hyperaldosteronism Cushing syndrome Exogenous mineralo- corticoids Liddle syndrome Is the urine Cl low? low, <10 high, >20 Gastric fluid loss Remote diuretics Other rare causes Current diuretics Bartter’s syndrome Mg ++ depletion Recent Remote high low high UNa low UNa    

Rx of Metabolic Alkalosis ,[object Object],[object Object],[object Object],[object Object]

Acid base disorders extern2

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Acid base disorders extern2