Kuliah Water&Electr Imbalance 2010

7/28/2019 Kuliah Water&Electr Imbalance 2010

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FLUID & ELECTROLYTEIMBALANCET.Haryanto S. dr SpPK


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FLUID & ELECTROLYTE IMBALANCE

Fluid and electrolyte disorders refer to an imbalance inthe mixture of water and electrolytes ---needed for

normal body function.

Necessary salts contain sodium, potassium, calcium,

bicarbonate, and phosphate.

All body parts--even hard bone -- are bathed in a

precise blend of water and natural salts.


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APPROPRIATE HEALTH CARE INCLUDES:1. Physician's monitoring of general condition and

medications.

2. Self-care after diagnosis of a minor imbalance/ as soon as

possible

3. Hospitalization for intravenous fluids and treatment of a

serious imbalance, including the underlying cause.

4. Especially important in infants. Dehydration with fluidand electrolyte imbalance can be life-threatening in the very

young.


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CONDITION CAUSE FLUID IMBALANCE:

*SEVERAL DAYS AFTER SURGERY ---- CAUSING SWELLING OF THE

BODY

*IN HEART FAILURE, FLUID COLLECTS IN THE LUNGS, LIVER,BLOOD

VESSELS, AND BODY TISSUES BECAUSE THE HEART DOES A POOR JOB

OF PUMPING IT TO THE KIDNEYS WHERE IT CAN BE ELIMINATED

*WHEN THE KIDNEYS DO NOT WORK WELL BECAUSE OF CHRONIC

KIDNEY DISEASE, THE BODY CANNOT GET RID OF UNNEEDED FLUIDS*DIARRHEA, VOMITING, EXCESSIVE BLOOD LOSS, OR HIGH FEVER

*OFTEN ASSOCIATED WITH IMBALANCES OF ELECTROLYTE


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SIGNS & SYMPTOMS

Depends on whether water or salts are out of proportion.

The following may indicate either imbalance problem:

Dry mouth.Wrinkled skin.

Increased, decreased, or absent urination.

Fatigue.

Puffy legs, hands, face, or abdomen.

Lung congestion.Weakness and confusion.

Heartbeat irregularities.

Volume depletion : water and salt are lost : weight loss, excessive thirst, dry

mucous membrane

Dehydration : lost especially water : resting tachycardia, orthostatic

hypotension and shock


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CAUSESFluid and salts may be lost by:

Vomiting.

Diarrhea.

Heavy perspiration.Some medications, such as diuretics.

Fluid and salts may accumulate from:

Congestive heart failure.

Excess intravenous fluids.Acute or chronic kidney failure.

Adrenal disease.

Chronic lung disease.

Use of cortisone drugs, female hormones, or sodium bicarbonate.

RISK FACTORSFever; kidney disease; diabetes mellitus; heart disease; anorexia nervosa

or bulimia; use of diuretics; infancy and early childhood -- infants and

young children lose fluid very quickly when sick; alcoholism.


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DIABETES INSIPIDUS

ETIOLOGI :

1.Abnormality of ADH production from hypothalamus

2.ADH action in kidneyADH insufficiency : produce large amount of urine

Type of Diabetes Insipidus :

1.Central DI : insufficiency ADH released in response to physiologic stimuli.

Cause : Acquired ( head trauma, neoplastic or inflammatory condition

affecting

posterior pituitary ) , Congenital, Idiopathic

2.Gestational DI : increase metab of plasma ADH by an amino peptidase

produced by the placenta leads to deficiency of ADH during pregnancy

3. Primary polydipsia results in secondary insufficiencies of ADH due to

inhibition of ADH secretion by excessive fluid intake4. Nephrogenic DI : genetic or acquired from drug exposure ( lithium,

demeclocycline etc), metabolic condition (hypercalcemia) or renal damage


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SYMPTOMS:

Polyuria, polydipsia ( urine out put > 50 ml/Kg BW/Day , urine osmolality 20 mmol/L

Treatment :

Fluid intake restricted ( less 500 ml than urinary out put)

If Severe symptoms : Infused hypertonic saline ( 3 %) at 24-48 hours and if corrected rapidly

Another drug : Demeclocycline and fludrocortisone in case chronic SIADH


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EDEMA


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ELECTROLYTE DISTURBANCE / IMBALANCE

T.HARYANTO S. dr SpPK


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ELECTROLYTE DISTURBANCE / IMBALANCE

Electrolytes are chemicals in the body that regulate important physiologicalfunctions-----help to regulate myocardial and neurological function, fluid balance,

oxygen delivery, acid-base balance .

ELECTROLYTE include sodium, chloride, magnesium, potassium and calcium.

When dissolved in water, electrolytes separate into positively and negativelycharged ions.

Nerve and muscle function are dependent upon the proper exchange of these

ions in and out of the cells.

Electrolytes must exist in the body within a narrow concentration range in order to

effectively serve a variety of critical functions .


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The most serious electrolyte disturbances involve abnormalities in

the levels ofsodium, potassium, and/or calcium.

Other electrolyte imbalances are less common, and often occur in

conjunction with major electrolyte changes.

Chronic laxative abuse or severe diarrhea or vomiting can lead to

electrolyte disturbances alone or with dehydration.

People suffering from bulimia or anorexia are at especially high

risk for an electrolyte imbalance.
http://en.wikipedia.org/wiki/Laxativehttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Laxativehttp://en.wikipedia.org/wiki/Dehydrationhttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Laxative


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Causes electrolyte imbalance

Electrolyte imbalance is commonly caused by1. loss of body fluids through prolonged vomiting, diarrhea,

sweating, or high fever.

2.side effects of chemotherapy treatment.

3. renal failure.The kidneys play a critical role in regulating electrolytes.

They control the levels of chloride in the blood and flush out

potassium, magnesium and sodium.

Therefore, a disturbance in blood levels of these electrolytes

may be related to kidney function.


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Symptoms of electrolyte imbalanceSymptoms depend on

WHICH ELECTROLYTE IS OUT OF BALANCETHE LEVEL ELECTROLYTE IS TOO HIGH OR TOO LOW.

Altered potassium, magnesium, sodium or calcium levels, can lead one or more of the

following symptoms:

Muscle spasm

Bone disorders

Weakness

Blood pressure changes

Twitching

Irregular heartbeat

Numbness

Nervous system disorders

Confusion

Convulsions

Lethargy

Seizures etc


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Electrolyte

Calcium

Chlorida

Potassium

Magnesium

Sodium

Functions in the body Necessary for muscle

contraction, nervefunction, blood clotting,cell division, healthybones and teeth

Maintains fluid balancein the body

Regulates heart

contraction, helpsmaintain fluid balance

Necessary for musclecontraction, nervefunction, heart rhythm,bone strength,generating energy andbuilding protein

Maintains fluid balanceand necessary formuscle contraction andnerve function

Normal adult range*

4.5-5.5 mEq/L

97-107 mEq/L

3.5-5.3 mEq/L

1.5-2.5 mEq/L

136-145 mEq/L


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HYPERNATREMIASymptoms :

thirst , orthostatic hypotension , dry mouth and mucous

membranes

concentrated urineloss of elasticity in the skin

irregular heartbeat (tachycardia)

irritability

fatigue

lethargymuscle twitching and/or seizures


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Hypernatremia is high sodium in the blood that occurs with

excessive fluid loss.

- Inadequate water intake

- Excessive fluid loss ( diabetes insipidus, kidney disease, severe

burns, and prolonged vomiting or diarrhea)

- Sodium retention (caused by excessive sodium intake or

aldosteronism).- Certain drugs, including loop diuretics, corticosteroids, and

antihypertensive medications may cause elevated sodium levels.


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Diagnose

By measuring the sodium levels in a blood sample.

Normal blood sodium levels are 136 to 145 milliequivalents per liter

(mEq/L) Hypernatremia : blood sodium level higher than 145 mEq/L.

Important: to look for any underlying causes of hypernatremia, such as

diabetes insipidus or other disorders.

Treatment

Principle : replacing the lost fluids.

Mild cases---drinking electrolyte replacement fluids.

Severe cases--- fluids are given intravenously . The fluid is given slowly,

and the blood sodium levels are constantly monitored so thesodium/water levels are brought to the proper balance.

Unless brain function has been affected, most people make a full recovery

from hypernatremia.


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Who gets it?

1. Eldery : who may not recognize that they are thirsty

or are unable to get themselves something to drink.

2.Diuretic user : which cause the kidneys to excrete

more water

3.Patientdiabetes insipidus or diseases of the

hypothalamus or pituitary gland, which can alsointerfere with normal kidney function


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SymptomsMost patients with chronic water intoxication are asymptomatic, but may have

symptoms related to the underlying cause.

Severe hyponatremia may cause osmotic shift of water from the plasma into the

braincells. Typical symptoms include nausea, vomiting, abdominal cramping,

edema (swelling) headache and malaise.

Since nausea is, itself, a stimulus for the release ofADH, which promotes the

retention of water, a positive feedback loop may be created and the potential for

a vicious circle of hyponatremia and its symptoms exists.

As the hyponatremia worsens, confusion, diminished reflexes, convulsions,stuporor comamay occur.
http://en.wikipedia.org/wiki/Symptomhttp://en.wikipedia.org/wiki/Osmosishttp://en.wikipedia.org/wiki/Brainhttp://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Malaisehttp://en.wikipedia.org/wiki/Vasopressinhttp://en.wikipedia.org/wiki/Positive_feedback_loophttp://en.wikipedia.org/wiki/Reflexhttp://en.wikipedia.org/wiki/Convulsionhttp://en.wikipedia.org/wiki/Stuporhttp://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Stuporhttp://en.wikipedia.org/wiki/Convulsionhttp://en.wikipedia.org/wiki/Reflexhttp://en.wikipedia.org/wiki/Positive_feedback_loophttp://en.wikipedia.org/wiki/Vasopressinhttp://en.wikipedia.org/wiki/Malaisehttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Brainhttp://en.wikipedia.org/wiki/Osmosishttp://en.wikipedia.org/wiki/Symptomhttp://en.wikipedia.org/wiki/Comahttp://en.wikipedia.org/wiki/Stuporhttp://en.wikipedia.org/wiki/Convulsionhttp://en.wikipedia.org/wiki/Reflexhttp://en.wikipedia.org/wiki/Positive_feedback_loophttp://en.wikipedia.org/wiki/Vasopressinhttp://en.wikipedia.org/wiki/Malaisehttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Cell_(biology)http://en.wikipedia.org/wiki/Brainhttp://en.wikipedia.org/wiki/Osmosishttp://en.wikipedia.org/wiki/Symptom


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Causes

Hyponatremia is caused by conditions such as water retention and renal failure that result

in a low sodium level in the blood.

Pseudohyponatremia occurs when too much water is drawn into the blood; it is

commonly seen in people with hypoglycemia (low blood sugar).

Psychogenic polydipsia occurs in people who compulsively drink more than four gallons

of water a day.

Hypovolemic hyponatremia (with low blood volume due to fluid loss) occurs in

dehydrated people who rehydrate (drink a lot of water) too quickly, in patients taking

thiazide diuretics, and after severe vomiting or diarrhea.

Hypervolemic hyponatremia (high blood volume due to fluid retention) occurs in people

with liver cirrhosis, heart disease, or nephrotic syndrome. Edema (swelling) often

develops with fluid retention.

Euvolemic hyponatremia (decrease in total body water) occurs in people with

hypothyroidism, adrenal gland disorder, and disorders that increase the release of theantidiuretic hormone (ADH), such as tuberculosis, pneumonia, and brain trauma.


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HYPERKALEMIA

Hyperkalemia may be caused by ketoacidosis (diabetic coma), myocardial

infarction (heart attack), severe burns, kidney failure, fasting, bulimia nervosa,gastrointestinal bleeding, adrenal insufficiency, or Addison's disease. Diuretic

drugs, cyclosporin, lithium, heparin, ACE inhibitors, beta blockers, and

trimethoprim can increase serum potassium levels, as can heavy exercise. The

condition may also be secondary to hypernatremia (low serum concentrations

of sodium).


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SYMPTOMS

Nonspecific and generally include malaise, palpitations and muscle weakness;

Mild hyperventilation may indicate a compensatory response to metabolic

acidosis, which is one of the possible causes of hyperkalemia.

Detected hyperkalemia

*during screening blood tests for a medical disorder,

* detected after complications have developed, such as cardiac arrhythmia

or sudden death.

*during the medical history taking, a physician will dwell on kidney disease

and medication use ( as these are the main causes) .
http://en.wikipedia.org/wiki/Malaisehttp://en.wikipedia.org/wiki/Palpitationshttp://en.wikipedia.org/wiki/Muscle_weaknesshttp://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Blood_testhttp://en.wikipedia.org/wiki/Cardiac_arrhythmiahttp://en.wikipedia.org/wiki/Cardiac_arresthttp://en.wikipedia.org/wiki/Nephrologyhttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Nephrologyhttp://en.wikipedia.org/wiki/Cardiac_arresthttp://en.wikipedia.org/wiki/Cardiac_arrhythmiahttp://en.wikipedia.org/wiki/Blood_testhttp://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Muscle_weaknesshttp://en.wikipedia.org/wiki/Palpitationshttp://en.wikipedia.org/wiki/Malaisehttp://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Nephrologyhttp://en.wikipedia.org/wiki/Cardiac_arresthttp://en.wikipedia.org/wiki/Cardiac_arrhythmiahttp://en.wikipedia.org/wiki/Blood_testhttp://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Metabolic_acidosishttp://en.wikipedia.org/wiki/Muscle_weaknesshttp://en.wikipedia.org/wiki/Palpitationshttp://en.wikipedia.org/wiki/Malaise


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Diagnosis

Attention : Result increase K in serum can be due to hemolysis in the

sample.

The normal serum level of potassium is 3.5 to 5,3 mEq/L.

Generally, blood tests for renal function (creatinine, blood urea nitrogen),glucose and occasionally creatine kinase and cortisol will be performed.

In many cases, renal ultrasound will be performed, since hyperkalemia is highly

suggestive of renal failure.

Also, electrocardiography (EKG/ECG) may be performed to determine if there is asignificant risk of cardiac arrhythmias (see ECG/EKG Findings, below).
http://en.wikipedia.org/wiki/Hemolysishttp://en.wikipedia.org/wiki/Renal_functionhttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Blood_urea_nitrogenhttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Creatine_kinasehttp://en.wikipedia.org/wiki/Cortisolhttp://en.wikipedia.org/wiki/Medical_ultrasonographyhttp://en.wikipedia.org/wiki/Electrocardiographyhttp://en.wikipedia.org/wiki/Arrhythmiashttp://en.wikipedia.org/wiki/Hyperkalemiahttp://en.wikipedia.org/wiki/Hyperkalemiahttp://en.wikipedia.org/wiki/Arrhythmiashttp://en.wikipedia.org/wiki/Electrocardiographyhttp://en.wikipedia.org/wiki/Medical_ultrasonographyhttp://en.wikipedia.org/wiki/Cortisolhttp://en.wikipedia.org/wiki/Creatine_kinasehttp://en.wikipedia.org/wiki/Creatine_kinasehttp://en.wikipedia.org/wiki/Creatine_kinasehttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Blood_urea_nitrogenhttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Renal_functionhttp://en.wikipedia.org/wiki/Hemolysishttp://en.wikipedia.org/wiki/Hyperkalemiahttp://en.wikipedia.org/wiki/Arrhythmiashttp://en.wikipedia.org/wiki/Electrocardiographyhttp://en.wikipedia.org/wiki/Medical_ultrasonographyhttp://en.wikipedia.org/wiki/Cortisolhttp://en.wikipedia.org/wiki/Creatine_kinasehttp://en.wikipedia.org/wiki/Creatine_kinasehttp://en.wikipedia.org/wiki/Creatine_kinasehttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Blood_urea_nitrogenhttp://en.wikipedia.org/wiki/Creatininehttp://en.wikipedia.org/wiki/Renal_functionhttp://en.wikipedia.org/wiki/Hemolysis


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2.Excessive release from cells

Rhabdomyolysis, burns or any cause of rapid tissue necrosis, including tumor lysissyndrome

Massive blood transfusion or massive hemolysis

Shifts/transport out of cells caused by acidosis, low insulin levels, beta-blocker

therapy, digoxin overdose, or the paralyzing anesthetic succinylcholine

3. Excessive intakeIntoxication with salt-substitute, potassium-containing dietary supplements, or

potassium chloride (KCl) infusion. Note that for a person with normal kidney

function and nothing interfering with normal elimination (see above),

hyperkalemia by potassium intoxication would be seen only with large infusions of

KCl or massive doses of oral KCl supplements.

4.Lethal injection

Hyperkalemia is intentionally brought about in an execution by lethal injection,

with potassium chloride being the third and last of the three drugs administered to

cause death..
http://en.wikipedia.org/wiki/Rhabdomyolysishttp://en.wikipedia.org/wiki/Burn_(injury)http://en.wikipedia.org/wiki/Necrosishttp://en.wikipedia.org/wiki/Tumor_lysis_syndromehttp://en.wikipedia.org/wiki/Tumor_lysis_syndromehttp://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/Hemolysishttp://en.wikipedia.org/wiki/Acidosishttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Beta-blockerhttp://en.wikipedia.org/wiki/Digoxinhttp://en.wikipedia.org/wiki/Succinylcholinehttp://en.wikipedia.org/wiki/Intoxicationhttp://en.wikipedia.org/wiki/Potassium_chloridehttp://en.wikipedia.org/wiki/Capital_punishmenthttp://en.wikipedia.org/wiki/Lethal_injectionhttp://en.wikipedia.org/wiki/Potassium_chloridehttp://en.wikipedia.org/wiki/Potassium_chloridehttp://en.wikipedia.org/wiki/Lethal_injectionhttp://en.wikipedia.org/wiki/Capital_punishmenthttp://en.wikipedia.org/wiki/Potassium_chloridehttp://en.wikipedia.org/wiki/Intoxicationhttp://en.wikipedia.org/wiki/Succinylcholinehttp://en.wikipedia.org/wiki/Digoxinhttp://en.wikipedia.org/wiki/Beta-blockerhttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Acidosishttp://en.wikipedia.org/wiki/Hemolysishttp://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/Tumor_lysis_syndromehttp://en.wikipedia.org/wiki/Tumor_lysis_syndromehttp://en.wikipedia.org/wiki/Tumor_lysis_syndromehttp://en.wikipedia.org/wiki/Tumor_lysis_syndromehttp://en.wikipedia.org/wiki/Necrosishttp://en.wikipedia.org/wiki/Burn_(injury)http://en.wikipedia.org/wiki/Rhabdomyolysishttp://en.wikipedia.org/wiki/Potassium_chloridehttp://en.wikipedia.org/wiki/Lethal_injectionhttp://en.wikipedia.org/wiki/Capital_punishmenthttp://en.wikipedia.org/wiki/Potassium_chloridehttp://en.wikipedia.org/wiki/Intoxicationhttp://en.wikipedia.org/wiki/Succinylcholinehttp://en.wikipedia.org/wiki/Digoxinhttp://en.wikipedia.org/wiki/Beta-blockerhttp://en.wikipedia.org/wiki/Beta-blockerhttp://en.wikipedia.org/wiki/Beta-blockerhttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Acidosishttp://en.wikipedia.org/wiki/Hemolysishttp://en.wikipedia.org/wiki/Blood_transfusionhttp://en.wikipedia.org/wiki/Tumor_lysis_syndromehttp://en.wikipedia.org/wiki/Tumor_lysis_syndromehttp://en.wikipedia.org/wiki/Tumor_lysis_syndromehttp://en.wikipedia.org/wiki/Tumor_lysis_syndromehttp://en.wikipedia.org/wiki/Necrosishttp://en.wikipedia.org/wiki/Burn_(injury)http://en.wikipedia.org/wiki/Rhabdomyolysis


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Pseudohyperkalemia

Pseudohyperkalemia is a rise in the amount of potassium that occurs

due to excessive leakage of potassium from cells, during or after

blood is drawn.

Pseudohyperkalemia is typically caused by hemolysis during

venipuncture(by either excessive vacuum of the blood draw or by a

collection needle that is of too fine a gauge); excessive tournequet

time or fist clenching during phlebotomy (which presumably leads toefflux of potassium from the muscle cells into the bloodstream); or

by a delay in the processing of the blood specimen.

It can also occur in specimens from patients with abnormally high

numbers ofplatelets (>1,000,000/mm), leukocytes (> 10 000/mm),or erythrocytes (hematocrit > 55%). People with "leakier" cell

membranes have been found, whose blood must be separated

immediately to avoid pseudohyperkalemia.
http://en.wikipedia.org/wiki/Hemolysishttp://en.wikipedia.org/wiki/Venipuncturehttp://en.wikipedia.org/wiki/Platelethttp://en.wikipedia.org/wiki/Leukocytehttp://en.wikipedia.org/wiki/Erythrocytehttp://en.wikipedia.org/wiki/Cell_membranehttp://en.wikipedia.org/wiki/Cell_membranehttp://en.wikipedia.org/wiki/Cell_membranehttp://en.wikipedia.org/wiki/Cell_membranehttp://en.wikipedia.org/wiki/Erythrocytehttp://en.wikipedia.org/wiki/Leukocytehttp://en.wikipedia.org/wiki/Platelethttp://en.wikipedia.org/wiki/Venipuncturehttp://en.wikipedia.org/wiki/Hemolysishttp://en.wikipedia.org/wiki/Cell_membranehttp://en.wikipedia.org/wiki/Cell_membranehttp://en.wikipedia.org/wiki/Erythrocytehttp://en.wikipedia.org/wiki/Leukocytehttp://en.wikipedia.org/wiki/Platelethttp://en.wikipedia.org/wiki/Venipuncturehttp://en.wikipedia.org/wiki/Hemolysis


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PATHO PHYSIOLOGY

Potassium is the most abundant intracellular cation. I

Important for many physiologic processes, including maintenanceof cellular membrane potential, homeostasis of cell volume, and

transmission ofaction potentials in nerve cells.

Main dietary sources are vegetables (tomato and potato), fruits

(orange and banana) and meat.

Elimination is through the gastrointestinal tract and the kidney.

The renal elimination of potassium is passive (through the

glomeruli), and resorption is active in the proximal tubule and the

ascending limb of the loop of Henle.There is active excretion of potassium in the distal tubule and the

collecting duct; both are controlled by aldosterone.
http://en.wikipedia.org/wiki/Membrane_potentialhttp://en.wikipedia.org/wiki/Homeostasishttp://en.wikipedia.org/wiki/Action_potentialhttp://en.wikipedia.org/wiki/Nerve_cellhttp://en.wikipedia.org/wiki/Vegetablehttp://en.wikipedia.org/wiki/Tomatohttp://en.wikipedia.org/wiki/Potatohttp://en.wikipedia.org/wiki/Orange_(fruit)http://en.wikipedia.org/wiki/Bananahttp://en.wikipedia.org/wiki/Meathttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Glomerulihttp://en.wikipedia.org/wiki/Proximal_tubulehttp://en.wikipedia.org/wiki/Loop_of_Henlehttp://en.wikipedia.org/wiki/Distal_tubulehttp://en.wikipedia.org/wiki/Collecting_ducthttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Collecting_ducthttp://en.wikipedia.org/wiki/Distal_tubulehttp://en.wikipedia.org/wiki/Loop_of_Henlehttp://en.wikipedia.org/wiki/Loop_of_Henlehttp://en.wikipedia.org/wiki/Proximal_tubulehttp://en.wikipedia.org/wiki/Glomerulihttp://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Meathttp://en.wikipedia.org/wiki/Bananahttp://en.wikipedia.org/wiki/Orange_(fruit)http://en.wikipedia.org/wiki/Potatohttp://en.wikipedia.org/wiki/Tomatohttp://en.wikipedia.org/wiki/Vegetablehttp://en.wikipedia.org/wiki/Nerve_cellhttp://en.wikipedia.org/wiki/Action_potentialhttp://en.wikipedia.org/wiki/Homeostasishttp://en.wikipedia.org/wiki/Membrane_potentialhttp://en.wikipedia.org/wiki/Aldosteronehttp://en.wikipedia.org/wiki/Collecting_ducthttp://en.wikipedia.org/wiki/Distal_tubulehttp://en.wikipedia.org/wiki/Loop_of_Henlehttp://en.wikipedia.org/wiki/Loop_of_Henlehttp://en.wikipedia.org/wiki/Proximal_tubulehttp://en.wikipedia.org/wiki/Glomerulihttp://en.wikipedia.org/wiki/Kidneyhttp://en.wikipedia.org/wiki/Gastrointestinal_tracthttp://en.wikipedia.org/wiki/Meathttp://en.wikipedia.org/wiki/Bananahttp://en.wikipedia.org/wiki/Orange_(fruit)http://en.wikipedia.org/wiki/Potatohttp://en.wikipedia.org/wiki/Tomatohttp://en.wikipedia.org/wiki/Vegetablehttp://en.wikipedia.org/wiki/Nerve_cellhttp://en.wikipedia.org/wiki/Action_potentialhttp://en.wikipedia.org/wiki/Homeostasishttp://en.wikipedia.org/wiki/Membrane_potential


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Treatment

Acute:When arrhythmias occur, or when potassium levels exceed 6.5 mmol/l--- EMERGENCY

Several agents are used to lower K levels.

Calcium supplementation (calcium gluconate 10% (10ml), preferably through a central

venous catheter , does not lowering potassium but decreases myocardial excitability,

protecting against life threatening arrhythmias.

Insulin(e.g. intravenous injection of 10-15u of regular insulin will lead to a shift ofpotassium ions into cells, secondary to increased activity of the sodium-potassium

ATPase.

Bicarbonate therapy is effective in cases of metabolic acidosis. The bicarbonate ion will

stimulate an exchange of cellular H+ for Na+, thus leading to stimulation of the sodium-

potassium ATPase.

Salbutamol (albuterol, Ventolin) is a 2-selective catecholamine that is administered bynebulizer (e.g. 10-20 mg). This drug promotes movement of K into cells, lowering the

plasmalevels.

Dialysis in refractory or severe cases may need to remove the potassium from the

circulation.
http://en.wikipedia.org/wiki/Central_venous_catheterhttp://en.wikipedia.org/wiki/Central_venous_catheterhttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Arrhythmiashttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Arrhythmiashttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Central_venous_catheterhttp://en.wikipedia.org/wiki/Central_venous_catheterhttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Sodium-potassium_ATPasehttp://en.wikipedia.org/wiki/Arrhythmiashttp://en.wikipedia.org/wiki/Myocardiumhttp://en.wikipedia.org/wiki/Central_venous_catheterhttp://en.wikipedia.org/wiki/Central_venous_catheter


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Principal causes of potassium depletion.

1. Deficient dietary intake2.Excessive losses

A.Gastrointestinal

a.Protracted vomiting

b.Diarrheac.Fistula

d.Laxative abuse

B..Renal

a. metabolic alkalosis

b.Diuretics

c.Aldosteronism

d.Tubular dysfunction


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A major cause ofpotassium depletion is diuretic use.Diuretics that block sodium reabsorption in the renal tubule at site proximal

to where sodium potassium exchange occurs.

There fore more sodium is delivered to these sites for exchange.

Furthermore, because of ECV depletion from the saline diuresis ,aldostreron is stimulated enhancing potassium secretion

The symptoms and signs of potassium depletion usually do

not appear until deficiency is marked.


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Determination of plasma potassium is the most valuable aid in

the diagnosis of potassium depletion .

When hypokalemia is present and before any therapy is given,

the urinary potassium concentration is helpful in defining the

etiology of depletion.

If the urine potassium is less than 10 mEq/L , non renal losses

should be defining the etiology of depletion .When urine potassium concentrations exceeds 10 mEq/L,

depletion is probably secondary to renal losses.

In summary , potassium depletion may be suggested by :

1.Recognition of causative events.2.Symptoms and signs of neuromuscular dysfunction

3.electrocardiographic changes.


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SYMPTOMS

Irregular heartbeat, which can range from mild to severe.Severe cases can result in cardiac arrest and paralysis of thelungs.

Other symptoms muscle weakness, cramping, or flaccid

paralysis (limpness); leg discomfort; extreme thirst; frequent

urination; and confusion.

Infants and young children with gastrointestinal

illnesses that cause prolonged vomiting and diarrhea

can die from cardiac arrest when potassium levels

become dangerously low.


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DIAGNOSE

Hypokalemia is diagnosed by measuring the

potassium levels in a blood sample.

Normal blood potassium :3.5 to 5.3 (mEq/L)To determine the cause of hypokalemia, --- also

check potassium levels in a urine sample----also

order test electrocardiogram (ECG or EKG).

EKG : prominent u waves with flat T


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TREATMENT

In most cases /mild and moderate case treated by increasing the amounts of

potassium-rich foods in the diet, drinking electrolyte replacement fluids during

intense exercise or for severe vomiting or diarrhea, or by taking a potassium

supplement .

Severe hypokalemia is treated in a hospital with intravenous (IV) potassium.

It is important to have the potassium levels in the blood checked regularly if

taking diuretics or conditions.

It is difficult to predict if hypokalemia will occur with vomiting and diarrhea or

with diuretic use.


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HYPERCALCEMIA

Blood calcium levels may be elevated

*IN CASES OF HYPO THYROID calcitonin decreaserenal excretionand bone formation decrease .

*HYPER PARATHYROID (adenoma, carcinoma) stimulating

osteoclast and increasing absorption in GIT & renal retention

* TUMOR PROMOTE BONE BREAK DONE OR CA RELEASE FROM

BONE :Multiple myeloma, metastatic cancer in bone , multiplebone fractures, and Paget's disease.

*EXCESSIVE USE OF CALCIUM-CONTAINING SUPPLEMENTS AND

MEDICATIONS (i.e., antacids) may also cause hypercalcemia.

*IN INFANTS, lesser known causes may include blue diaper

syndrome, Williams syndrome, secondary hyperparathyroidism

from maternal hypocalcemia, and dietary phosphate deficiency.

*GFR DECREASE /renal disease : ca retention

*MILK ALKALI SYNDROME : massive Ca ingestion in GIT


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Symptoms :fatigue

constipation

depression

confusionmuscle pain

nausea and vomiting

dehydration

increased urination

irregular heartbeat (arrhythmia)/severe case


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TREATMENT:

IF THE CALCIUM LEVEL IS VERY HIGH, RAPID TREATMENT IS NEEDED. GIVING

FLUIDS INTRAVENOUSLY, Often, drugs such as calcitonin and bisphosphonatesmust be given intravenously--- These drugs decrease the amount of bone being

broken down and thus the amount of calcium released into the bloodstream.

When the cause is cancer or Paget's disease, bisphosphonates are often taken

by mouth indefinitely.

When the cause is a tumor in the parathyroid gland, surgery to remove the

tumor or part of the parathyroid gland may be done.


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SYMPTOMS :

WEAKNUMBNESS IN THE HANDS OR FEET.

MUSCLE CRAMPS AND SPASMS

TETANY AND/OR CONVULSIONS

MOOD CHANGES (DEPRESSION, IRRITABILITY)DRY SKIN

BRITTLE NAILS

FACIAL TWITCHING

TREATMENT :

INVOLVES TAKING CALCIUM SUPPLEMENTS BY MOUTH.

IF A DISORDER IS THE CAUSE, IT SHOULD BE TREATED.


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HYPERMAGNESEMIAExcessive magnesium levels may occur with

end-stage renal disease, Addison's disease, or

an overdose of magnesium salts.Hypermagnesemia is characterized by:

lethargy

hypotension

decreased heart and respiratory rate

muscle weakness

diminished tendon reflexes


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HYPOMAGNESEMIA

CAUSES

Common cause : Inadequate dietary intake , often caused by

chronic alcoholism or malnutrition.

Other causes include malabsorption syndromes, pancreatitis,

aldosteronism, burns, hyperparathyroidism, digestive system

disorders, and diuretic use.Symptoms :

leg and foot cramps

weight loss

vomitingmuscle spasms, twitching, and tremors

seizures

muscle weakness

arrthymia


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HYPERCHLOREMIA

Severe dehydration, kidney failure, hemodialysis, traumatic

brain injury, and aldosteronism can also cause hyperchloremia.

Drugs such as boric acid and ammonium chloride and the

intravenous (IV) infusion of sodium chloride can also boost

chloride levels, resulting in hyperchloremic metabolic acidosis.Symptoms include:

weakness

headache

nauseacardiac arrest


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HYPOCHLOREMIA

Hypochloremia usually occurs as a result of sodium and potassium

depletion (i.e., hyponatremia, hypokalemia). Severe depletion of

serum chloride levels causes metabolic alkalosis.

Symptoms include:

mental confusion

slowed breathing

paralysis

muscle tension or spasm


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HYPERPHOSPHATEMIA

Skeletal fractures or disease, kidney failure,hypoparathyroidism, hemodialysis, diabetic ketoacidosis,

acromegaly, systemic infection, and intestinal obstruction can

all cause phosphate retention and build-up in the blood. The

disorder occurs concurrently with hypocalcemia.mild hyperphosphatemia : asymptomatic

severe hyperphosphatemia include :

tingling in hands and fingers

muscle spasms and crampsconvulsions

cardiac arrest


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HYPOPHOSPHATEMIA

Serum phosphate levels of 2 mg/dL or below may be

caused by hypomagnesemia and hypokalemia. Severe

burns, alcoholism, diabetic ketoacidosis, kidney disease,

hyperparathyroidism, hypothyroidism, Cushing'ssyndrome, malnutrition, hemodialysis, vitamin D

deficiency, and prolonged diuretic therapy can also

diminish blood phosphate levels.

Symptoms of severe hypophosphatemia include:muscle weakness

weight loss

bone deformities (osteomalacia)


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THE END


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Bicarbonate

The bicarbonate ion acts as a buffer to maintain the normal levels of acidity (pH) in

blood and other fluids in the body.

Bicarbonate levels are measured to monitor the acidity of the blood and body

fluids.

The acidity is affected by foods or medications that we ingest and the function ofthe kidneys and lungs.

The chemical notation for bicarbonate on most lab reports is HCO3- or

represented as the concentration of carbon dioxide (CO2). The normal serum

range for bicarbonate is 22-30 mmol/L.

The bicarbonate test is usually performed along with tests for other blood

electrolytes.

Disruptions in the normal bicarbonate level may be due to diseases that interfere

with respiratory function, kidney diseases, metabolic conditions, or other causes.


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ADDISON DISEASE :

caused by destruction or dy;sfunction of adreno coritices . Chronic

deff cortisol, aldosteron, adrenal androgens

Acute Adrenal Insufficiency primary

--- insuff cortisol

Adrenal crisis may occur :

1Following stress : trauma, surgery, infection

2.following sudden with drawal of adrenocortic hormon

Kuliah Water&Electr Imbalance 2010

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