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RareMetabolic
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> Inc K Renal failure Drugs - ACEi, K or K sparing diuretics Addisons, Metabolic acidosis - DM Artefact - haemolysis Dec K Fluid loss - diuretics, laxatives, d&v, villous adenoma / fistula, Cushings / xs steroids, Conn's Inc Na Fluid loss - D&V, burns, diabetes insipidus Conn's Dec Na Fluid loss - diuretics, laxatives, d&v, villous adenoma / fistula Addisons, CF, SIADH, Hypothyroid, Cirrhosis ''Sanjeev theory ...'' Usually problem with H2O not with Na Look for problem drugs and stop Check fluid status and if ... hypovolaemic - drop in BP (? postural drop) - give fluids (fluid loss - d/v kidney diuretic) hypervolaemic - raised JVP - give IV frusemide (nephrotic, CCF ascites) even if BP low - cardiogenic shock - poor outcome Note pseudo hypo Na - Glc, or protein or TG xs displacing Na - correct the first and Na will resolve Euvolaemia - less common - check for steroids, cortisol deficiency, thyroid status THEN think SIADH - urine Na, paired osmolality (urine > serum), causes - Carbamazpine, CNS infection or lung ca HIGH Sodium may reflect lack of access to drinking water or renal tubular problem Diabetes Insipidus - dec ADH leads to polyuria with water loss and high Na Lithium, hypokalaemia and hypercalcaemia - impair ADH - can cause nephrogenic DI with high Na LOW Sodium - common finding associated with diuretic use and heart failure, but also in chronic disease SIADH - rapidly evolving low Na that needs urgent treatment - high urine osmolality and Na so low serum osmolality and Na (hyponatraemic and hypervolaemic) As Na drops - neuro complications ? coma loop diuretics unlikely to cause rapid (over days) drop in Na - don't give Na supplements - admit ADH secreting tumours esp small cell lung cancer, neuro disorders, TB or lung abscess drugs - carbamazepine, phenothiazines, tricyclics, SSRI, Mx - fluid restrict ? with tolvaptan or domeclocycline Addisons low Na but hypovolaemic Potassium intracellular ion crucial to muscle function (cardiac smooth and skeletal) eliminated by kidneys so may accumulate in renal insufficiency controlled by Na/K pump - sensitive to adrenaline and blocked by BB (so they cause a rise in K) changes in acid-base (eg DKA) may cause problems Note Lo-salt contains lots of KCl Low K - flattened T waves and U wave on ECG Loop diuretics cause K and Mg loss leading to myalgia, muscle weakness and arrythmias low Mg effects PTH which leads to low Ca low K leads to polyuria Conn's - usually low K - needs aldosterone / renin ratio and consider adrenal mass ectopic ACTH - massive levels of steroid exert mineralocorticoid action and so low K Mx - beware K supplements if aSx esp if on ACE due to dangerous hyperK High K check genuiness of result if normal renal function (?EDTA bottle used, refrigeration of sample, old sample, blood dyscrasias or clots) Extreme values of K (>7.0 or <2.6) or rapidly changing need admission beware artefact when renal function is normal unexplained high or low values needs investigation
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