Electrolyte Disorders – Emergencies

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See also The ECG in Electrolyte Disorders

Approx. ranges for severe abnormality Mild / Moderate

Symptoms

Severe symptoms Urgent treatment (if severe) Comments
Hyperkalaemia

( > 6.5 mmol/L)

QRS widening symptomatic arrhythmia CaCl or Calcium gluconate IV bolus

 

Ca2+ temporarily stabilizes membrane action potential
Hypokalaemia

(< 2.6 mmol/L)

Muscle weakness Arrhythmia KCl IV bolus
Hyponatraemia

(< 110 mmol/L)

Confusion Seizures or coma Hypertonic saline bolus Risk of cerebral pontine myelinolysis and quadriplegia
Hypocalcaemia

(Total Ca2+ < 2 mmol/L)

Paraesthesia > Tetany Respiratory difficulties, Hypotension, Arrhythmias CaCl or Calcium gluconate IV
Hypercalcaemia

(Total Ca2+> 3.5 mmol/L)

Constipation

Fatigue

Coma Saline rehydration

 

Hypophosphataemia

( < 0.4mmol/L)

Arrhythmias

 

IV K2HPO4/K2HPO4 Risk of dangerous hypocalcaemia
Hyperphosphataemia

 

See hypocalcaemia Arrhythmias

Resp. failure

Saline rehydration

Dialyse (if severe hypocalcaemia)

Hypomagnesaemia

(< 0.5 mmol/L)

ECG – PR/QRS prolongation Arrhythmias MgSO4 IV bolus Risk of hypotension
Hypermagnesaemia

(> 5 mmol/L)

Hyporeflexia

Confusion

Arrhythmia

Hypotension

Respiratory failure

CaCl or Calcium gluconate IV bolus
Hypophosphataemia

( < 0.4mmol/L)

Weakness

Paraethesia

Confusion

Arrhythmias

 

IV K2HPO4/K2HPO4 Risk of dangerous hypocalcaemia

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