-Hypervolemia-will discuss specific to electrolytes see below
-Hypovolemia- will discuss specific to electrolytes see below
-Sodium-
-Can have hypernatremia and hyponatremia with various volume states
-Hypovolemic Hyponatremia can be due to GI losses from vomiting or diarrhea or renal losses from diuretics.
-Euvolemic Hyponatremia is associated with SIADH but can also been seen with primary polydipsia and low dietary solute intake
-Hypervolemic Hyponatremia can be due to heart failure or cirrhosis. With the extracellular volumes increased the pressure sensed by the carotid sinus baroreceptors is generally reduced by the fall of cardiac output in heart failure and the arterial vasodilation in cirrhosis
-Hypernatremia is most often due to water loss, but can also be caused by the intake of salt without water or the administration of hypertonic solutions
-3 mechanisms of hypernatremia are water loss not replaced, water loss into cells, and sodium overload
-Water loss can be from skin losses, GI losses, and urinary losses
-Transient hypernatremia can occur from water loss into cells seen in severe exercise and electroshock induced seizures
-Sodium overload can be intentional or iatrogenic
-Hypokalemia-
-Many causes of hypokalemia. Causes of hypokalemia include: decreased potassium intake, increased entry into cells, increased availability of insulin, elevated beta adrenergic activity, elevation of extracellular pH, hypothermia, barium intoxication, cesium intoxication, chrloroquine intoxication, anti-psychotic drugs, GI losses, increased urinary losses, increased sweat losses, dialysis, plasmapheresis
-Many causes of hyperkalemia. Causes of hyperkalemia include: pseudohyperkalmeia (hemolyzed sample), metabolic acidosis, insulin deficiency, hyperglycemia, hyperosmolality, increased tissue catabolism, beta blockers, exercise, reduced urinary potassium excretion, reduced aldosterone secretion, reduced distal sodium and water delivery, acute and chronic kidney disease,
-Treatment of hypokalemia involves simple replacement either orally or parenterally. The cause of hypokalemia will need to be investigated
-Treatment of hyperkalemia involves determining the etiology. Life threatening levels treated with Kayexylate 30 gram PO or PR, Calcium Gluconate 1 amp PO, 1 amp D50 with 10 units of regular insulin, and administration of beta agonist.
-Hypovolemia- will discuss specific to electrolytes see below
-Sodium-
-Hypovolemic Hyponatremia can be due to GI losses from vomiting or diarrhea or renal losses from diuretics.
-Euvolemic Hyponatremia is associated with SIADH but can also been seen with primary polydipsia and low dietary solute intake
-Hypervolemic Hyponatremia can be due to heart failure or cirrhosis. With the extracellular volumes increased the pressure sensed by the carotid sinus baroreceptors is generally reduced by the fall of cardiac output in heart failure and the arterial vasodilation in cirrhosis
-Hypernatremia is most often due to water loss, but can also be caused by the intake of salt without water or the administration of hypertonic solutions
-3 mechanisms of hypernatremia are water loss not replaced, water loss into cells, and sodium overload
-Water loss can be from skin losses, GI losses, and urinary losses
-Transient hypernatremia can occur from water loss into cells seen in severe exercise and electroshock induced seizures
-Sodium overload can be intentional or iatrogenic
-Hypokalemia-
-Many causes of hyperkalemia. Causes of hyperkalemia include: pseudohyperkalmeia (hemolyzed sample), metabolic acidosis, insulin deficiency, hyperglycemia, hyperosmolality, increased tissue catabolism, beta blockers, exercise, reduced urinary potassium excretion, reduced aldosterone secretion, reduced distal sodium and water delivery, acute and chronic kidney disease,
-Treatment of hypokalemia involves simple replacement either orally or parenterally. The cause of hypokalemia will need to be investigated
-Treatment of hyperkalemia involves determining the etiology. Life threatening levels treated with Kayexylate 30 gram PO or PR, Calcium Gluconate 1 amp PO, 1 amp D50 with 10 units of regular insulin, and administration of beta agonist.
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