Electrolyte management

EQUILIBRIO ACIDO BASE Y ALTERACIONES HIDROELECTROLITICAS VERONICA BOTERO OSORIO RESIDENTE DE PEDIATRIA CES - FVL

DIFERENCIAS EN LIQUIDOS 70-80 % LIQUIDOS 60% LIQUIDOS Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

AGUA CORPORAL TOTAL ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

DISTRIBUCIÓN DE LOS IONES Na+ HCO3 Cl L E C K L I C Mg HPO4 PROT

BALANCE HÍDRICO PRESION HIDROSTATICA 35 MM Hg p.oncotica 25 mmHg + 10 p. hidrostatica 15 mm Hg P. osmotica - 10 arteria vena

ACTIVIDAD OSMOLAR ,[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

ELECTROLITOS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

COMO INTERPRETAR LA QUIMICA SANGUINEA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Prim Care Clin Office Pract 35(2008)195-213

SODIO ,[object Object],[object Object]

PRIMER PASO: SODIO ,[object Object],[object Object],[object Object],Prim Care Clin Office Pract 35(2008)195-213 ,[object Object],[object Object],[object Object],Osm urinaria <100 mOsm/lt polidipsia primaria Osm Urinaria > 100 mOsm/lt < excreción renal de agua Filtración, reabsorción AVP

HIPONATREMIA ,[object Object],Na bajo Na alto Na normal Vomito ICC SIADH Diarrea Cirrosis Hipotiroidismo 3° espacio (sepsis, peritonitis) Síndrome nefrotico Deficiencia de glucocorticoides Piel Falla renal crónica Intoxicación hidrica Ventriculostomía Diureticos Hiperglicemia Insuficiencia adrenal, cerebro perdedor sal Enfermedad tubulointersticial

HIPONATREMIA MANIFESTACIONES CLÍNICAS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

MANEJO DE HIPONATREMIA ,[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

Prim Care Clin Office Pract 35(2008)195-213

VOLEMIA ,[object Object],[object Object],[object Object],Prim Care Clin Office Pract 35(2008)195-213 ,[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],Prim Care Clin Office Pract 35(2008)195-213

HIPERNATREMIA MANIFESTACIONES CLÍNICAS ,[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

MANEJO DE HIPERNATREMIA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006 Na bajo Na alto Na normal Vomito Ingesta > Perdidas insensibles Diarrea Diuresis osmótica Ingesta baja

PASO 2: CLORO ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Prim Care Clin Office Pract 35(2008)195-213 Hb H HCO3 – Cl

[object Object],[object Object],[object Object],Prim Care Clin Office Pract 35(2008)195-213 alcalosis respiratoria aguda o cronica acidosis metabolica hipercloremica con anion gap alto

ALCALOSIS RESPIRATORIA AGUDA Y CRÓNICA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Prim Care Clin Office Pract 35(2008)195-213 HCO3 bajo, Cloro alto, Anion Gap alto

PASO 3: ANION GAP ,[object Object],[object Object],[object Object],Prim Care Clin Office Pract 35(2008)195-213 Na – (Cl + HCO3)= 12 +/- 2 Acidosis metabolica con AG normal o Hiperclorémica Acidosis metabolica con AG alto albumina , P Calcio y magnesio

CLASIFICACIÓN DE ACIDOSIS METABÓLICA ,[object Object],Prim Care Clin Office Pract 35(2008)195-213 Renal ATR proximal (tipo II) ATR distal hipokalemica (tipo I) ATR distal hiperkalemica (Tipo IV) ATR + IR (TFG > 15 ml/min) Extrarenal Diarrea Fistulas gastroentericas Secreción biliar o pancreatica

ACIDOSIS METABÓLICA ,[object Object],Prim Care Clin Office Pract 35(2008)195-213 Renal Extrarenal Acidosis urémica (TFG < 12 ml/min) Acidosis láctica Cetoacidosis diabetica Cetoacidosis alcoholica Envenenamiento (ASA, metanol, E. glicol)

PASO 4: ES EL HCO3 EL PREDICHO??? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Prim Care Clin Office Pract 35(2008)195-213 Acidosis metabolica con anion Gap alto

PASO 5: INTERPRETAR GASES ARTERIALES ,[object Object],[object Object],Prim Care Clin Office Pract 35(2008)195-213 ,[object Object],[object Object],[object Object],Acidosis metabólica 1.2 mmHg PCO2 por cada 1 mEq/lt caída del HCO3 PCO2 = HCO3 + 15 PCO2 = últimos 2 dígitos del pH Alcalosis metabolica PCO2 0.7 por cada mEq HCO3

POTASIO ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

PASO 6: POTASIO ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Prim Care Clin Office Pract 35(2008)195-213

HIPOCALEMIA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

HIPOCALEMIA MANIFESTACIONES CLÍNICAS ,[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

HIPOCALEMIA TRATAMIENTO ,[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

[object Object],Prim Care Clin Office Pract 35(2008)195-213

HIPERCALEMIA MANIFESTACIONES CLÍNICAS ,[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

MANEJO DE HIPERKALEMIA ,[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

MANEJO DE HIPERKALEMIA ,[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

HOMEOSTASIS DEL CALCIO ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

CALCIO ,[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

HIPERCALCEMIA ,[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

HIPOCALCEMIA ,[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

HIPOCALCEMIA ,[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

HIPOCALCEMIA MANIFESTACIONES CLÍNICAS ,[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

HIPOCALCEMIA TRATAMIENTO ,[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

MAGNESIO ,[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

HIPERMAGNESEMIA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

HIPERMAGNESEMIA MANIFESTACIONES CLÍNICAS ,[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

TRATAMIENTO ,[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

HIPOMAGNESEMIA ,[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

HIPOMAGNESEMIA CAUSAS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

HIPOMAGNESEMIA CAUSAS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

HIPOMAGNESEMIA MANIFESTACIONES CLÍNICAS ,[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

HIPOMAGNESEMIA TRATAMIENTO ,[object Object],[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

HIPOMAGNESEMIA TRATAMIENTO ,[object Object],[object Object],[object Object],Electrolyte Management in Pediatric Critical Illnes, Fuhrman and Zimmerman, Pediatric Critical Care 3° Ed, 2006

Electrolyte management

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Electrolyte management