Fluid and Electrolyte Disorders
Fluid and Electrolyte Disorders
Fluid and Electrolyte Disorders
Electrolyte
Disorders
Hypervolemic hyponatremia:
hypervolemia is caused by volume overload
from…
Heart failure
Liver failure (cirrhosis)
Kidney failure or
Hypoalbuminemia (nephrotic syndrome)
…leading to interstitial fluid overload
Clinical Findings:
Electrocardiographic (ECG) findings include peaked
T waves (from vigorous accelerated repolarization), PR
interval prolongation, QRS widening, and eventually
a sinusoidal tracing
Treatment:
Tx is threefold:
1. Reduce myocardial irritability to prevent
arrhythmia and death;
2. Move potassium intracellularly to temporarily
reduce potassium, and
3. Promote potassium loss through the urine and
stool
Gastrointestinal loss
GI fluids are generally K+-rich (stomach
acid and stool) so vomiting and
diarrhea can lead to K+ loss further
exacerbated by volume loss, leading to
RAA axis stimulation and ↑ K+ loss via
aldosterone action
Clinical Findings:
Electrocardiographic (ECG) findings include
presence of a U wave (a small hump after T
wave), and altered membrane potentials
can also lead to arrhythmias w hypokalemia
muscle weakness caused by a more negative
membrane resting potential
o Note: hypokalemia or hyperkalemia causes muscle
weakness
Treatment:
K+ repletion and correction of underlying cause
Avoid alkalinization and use of glucose or insulin
in patients with severe hypokalemia b/c both of
these can increase intracellular K+ uptake and
exacerbate existing hypokalemia
Overview:
The two forms of volume disorders, volume
depletion and volume excess, will be discussed
below, followed by details regarding laboratory
distinction of the two disorders
Clinical presentation
In mild volume depletion: Orthostatic
dizziness and tachycardia
In severe volume depletion: Hypotension,
mental obtundation, cool extremities, severe
oliguria
2. Serum osmolality
Increased in: Dehydration, diabetes insipidus,
increased glucose, hypernatremia, methanol
intoxication, ethylene glycol intoxication, and uremia.
Decreased in: Excess fluid intake, hyponatremia,
SIADH
Marc Imhotep Cray, MD 46
Further Study
Textbook:
Kamel KS, Halperin ML. Fluid, Electrolyte, and Acid-Base
Physiology: A Problem-Based Approach, 5th Ed. Philadelphia, PA:
Elsevier, 2017.