Category: Electrolytes

Hypercalcaemia

Serum calcium concentration is tightly regulated between 2.1-2.6mmol/L. Severe hypercalcaemia is a life-threatening electrolyte emergency requiring prompt recognition and urgent treatment.   Classification Mild (2.65 – 3.00 mmol/L): Patient is often asymptomatic Moderate (3.01-3.40 mmol/L): Can be asymptomatic or symptomatic Severe (>3.40 mmol/L): Risk of dysrhythmia and coma Serum calcium is found in 2 forms

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Hypomagnesaemia

The UK Medicines Information group have provided excellent guidance on how to replace magnesium.Useful advice on treatment: Clinical features Usually asymptomatic Irritability & lethargy Nausea/vomiting Psychiatric: confusion, depression, psychosis Neuromuscular: Tremors, cramps, tetany, weakness & seizures ECG: prolonged PR, ST depression, altered T waves, arrhythmias Causes Dietary such as refeeding syndrome GI losses (D&V, high stoma output)

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Nutrition

Nutrition is an important aspect of a patient’s health and is overlooked during medical school as you are learning exciting pathophysiology of weird and wonderful diseases. One never thinks about nutrition until you are placed on a ward where you need to manage patients in need of nutritional support. Various studies show that doctors and

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Fluid Balance

Almost every patient admitted to hospital receives IV fluids at some point in their journey. However, the body manages this, without the need for careful medical assessment and adjustment, as fluid balance is one of its core functions. Despite this, there are many situations where we need careful and controlled management. These include: Electrolyte disturbance

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Hyperkalaemia

Hyperkalaemia can cause life-threatening emergencies particularly cardiac arrhythmias. A widely used definition is extracellular [K+] ion concentration ≥ 5.5 mmol/L. Complications increase with severity and hyperkalaemia may be classified as: Mild 5.5-5.9 mmol/l Moderate 6.0-6.4 mmol/l Severe ≥ 6.5 mmol/l Causes Always consider the cause of hyperkalaemia. Emergency treatments only temporarily lower potassium levels to

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Hypernatraemia

Hypernatraemia is defined as a sodium above 145 mmol/L with severe being more than 150 mmol/L.

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Hypokalaemia

As an FY1 you will frequently see hypokalaemia and most trusts have guidelines that should be used in the first instance. The advice below is informal & based on broad day to day practice. It should never replace clinical judgement and escalation for senior support if indicated. The UK Medicines Information group have provided information

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Hyponatraemia

Hyponatraemia (serum Sodium <135 mmol/L) is one of the most common electrolyte abnormalities you will see and so a systematic approach to identifying the underlying cause and management is vital. We will use the algorithm below from ESE which is far easier to use than the antiquated system of first assessing their volume status. Recommended Investigations

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Refeeding Syndrome

Defined as a collection of electrolyte abnormalities associated with a massive intracellular shift of electrolytes. Associated with aggressive nutritional rehabilitation of malnourished patients in e.g. malignancy, chronic organ dysfunction, inflammatory conditions (e.g. pancreatitis, colitis), the perioperative period as well as anorexia nervosa. Clinical features Sequelae of hypophosphataemia, hypokalaemia, hypocalcaemia, hypomagnesaemia, e.g.Congestive heart failure, peripheral oedema,

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Hypophosphataemia

The UK Medicines Information group have provided excellent guidance on how to replace phosphate. Clinical features Generally asymptomatic if mild Can cause many systemic features CNS & MSK: weakness/myalgia, lethargy, confusion, seizures Cardiorespiratory failure Rickets/Osteomalacia if chronic Causes Malabsorption D&V Refeeding syndrome Investigations Check the calcium, U&Es, renal function Treatment Use local guidelines or consider

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