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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