FLUID

AND
ELECTROLYTE
IMBALANCE

Electrolytes

play a vital role in

maintaining homeostasis within the
body. They help to regulate heart and
neurological function, fluid balance,
oxygen delivery, acid-base balance and
much more. Electrolyte imbalances can
develop by the following mechanisms:
excessive ingestion; diminished
elimination of an electrolyte;
diminished ingestion or excessive

HYPERKALEMIA

CAUSES OF HYPERKALEMIA

Ineffective elimination- Renal insufficiency

Medication that interferes with urinary excretion. amiloride

ACE inhibitors and angiotensin receptor blockers

Potassium-sparing diuretics (e.g spironolactone)

NSAIDs such as ibuprofen, naproxen, or celecoxib

Mineralocorticoid deficiency or resistance, such as: Addison's

disease

Aldosterone deficiency

CAUSES OF HYPERKALEMIA

Some forms of congenital adrenal hyperplasia

Massive blood transfusion or massive hemolysis

Shifts/transport out of cells caused by acidosis, low insulin levels, betablocker therapy, digoxin overdose, or the paralyzing agent succinylcholine

Acute Digoxin toxicity may cause hyperkalaemia

Excessive intake Excessive intake with potassium salt-substitute, potassiumcontaining dietary supplements, or potassium chloride (KCl) infusion

SIGNS AND SYMPTOMS

Malaise
palpitations
muscle weakness
mild hyperventilation may indicate a compensatory
response to metabolic acidosis which is one of the possible
causes of hyperkalemia.

TREATMENT

Insulin

(e.g. intravenous injection of 10-15 units

of regular insulin along with 50 ml of 50%
dextrose to prevent hypoglycemia) will lead to a
shift of potassium ions into cells

Salbutamol

(albuterol, Ventolin), a 2-selective

catecholamine, is administered by nebulizer (e.g.
1020 mg). This drug also lowers blood levels of
K+ by promoting its movement into cells

Calcium

(calcium chloride or calcium gluconate)

HYPOKALEMIA

DEFINITION
The

condition in which
the concentration
ofpotassium(K+) in the
blood is low

CAUSES

Gastrointestinal or skin loss

Diarrhea, vomiting or excessive perspiration.

Urinary loss

medications likeloop diuretics, thiazide diuretics,

cancer drug, cisplatin, can also cause long-term
hypokalemia.

Inadequate potassium intake

diabetic ketoacidosis

high aldosterone levels can cause hypertension and

excessive urinary losses of potassium-renal artery stenosis
and tumors

Cushing's syndrome

SIGNS AND SYMPTOMS

Flaccid

paralysis, muscle weakness,

myalgia, tremor, and muscle cramps

Respiratory

depression from severe

impairment of skeletal muscle function

Electrocardiographic

(ECG) findings
associated with hypokalemia include
flattened or inverted T waves, a U wave, ST
depression, and a wide PR interval

TREATMENT

Treat the cause for hypokalemia

improving the diet, treating diarrhea, or stopping an offending

medication

Mild hypokalemia (>3.0 meq/l) may be treated with oral potassium chloride
supplements

potassium-containing foods may be recommended, such as leafy gree

vegetables, avocados, tomatoes, coconut water, citrus fruits, oranges, or
bananas.

Severe hypokalemia (<3.0 meq/l) may require intravenous supplementation.

HYPONATREMIA

CAUSES
Hypervolemic

hyponatremia

Both sodium & water content

increase: Increase in sodium content leads to hypervolemia and water content to
hyponatremia. Total body water and sodium are regulated independently
cirrhosis of the liver
congestive heart failure
nephrotic syndrome in the kidneys
massive edema of any cause

Euvolemic hyponatremia

there is volume expansion in the

body, no edema, but hyponatremia occurS

states of severe pain or nausea
due to trauma or other damage to the brain
SIADH (and its many causes)
Hypothyroidism
Glucocorticoid (steroid) deficiency

CAUSES OF HYPONATREMIA
Hypovolemic

hyponatremia

The hypovolemia
(extracellular volume loss) is due to total body sodium loss. The hyponatremia is
caused by a relatively smaller loss in total body water
- Prolonged vomiting, decreased oral intake
- Severe diarrhea
- Diuretic use
- Addison's disease and congenital adrenal
hyperplasia in which the adrenal glands
do not produce enough steroid hormones

SIGNS AND SYMPTOMS

nausea

and vomiting
headache
short-term memory loss
confusion, lethargy, fatigue
loss of appetite, irritability,
muscle weakness, spasms or cramps
seizures
decreased consciousness or coma

TREATMENT OF HYPONATREMIA
Hypovolemia - intravenous administration of normal saline (salt)
is usual, care being taken not to raise the serum sodium level

Euvolemic

hyponatremia

- managed by fluid
restriction and treatment to abolish any stimuli for ADH secretion such as
nausea.

Hypervolemic

hyponatremia

addressing the underlying heart or liver failure

- treated by

HYPERNATREMIA

DEFINITION

Hypernatremia

or
hypernatraemia is an
elevated sodium level in
the blood.

SIGNS AND SYMPTOMS

weakness, irritability, neuromuscular

excitability
consisting of lethargy
edema
With more severe elevations of the sodium
level, seizures and coma may occur.

TREATMENT

Administration of free water to

correct the relative water deficit.
Water can be replaced orally
Administered intravenously given
with addition to dextrose or saline
infusion solutions

THANK

YOU