{"id":799,"date":"2016-08-25T03:06:24","date_gmt":"2016-08-25T03:06:24","guid":{"rendered":"http:\/\/emedsa.org.au\/CoreMed\/?p=799"},"modified":"2016-09-26T04:14:43","modified_gmt":"2016-09-26T04:14:43","slug":"electrolyte-disorders","status":"publish","type":"post","link":"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/25\/electrolyte-disorders\/","title":{"rendered":"Electrolyte Disorders"},"content":{"rendered":"<p><a href=\"http:\/\/twitter.com\/share?url=http%3A%2F%2Femedsa.org.au%2FCoreMed%2F2016%2F08%2F25%2Felectrolyte-disorders%2F&amp;count=none&amp;text=Electrolyte Disorders - CoreMed\" class=\"twitter-share-button\">Tweet<\/a><\/p><p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-804\" src=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/ElectrolyteDisorders.png\" alt=\"ElectrolyteDisorders\" width=\"1996\" height=\"624\" srcset=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/ElectrolyteDisorders.png 1996w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/ElectrolyteDisorders-300x94.png 300w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/ElectrolyteDisorders-768x240.png 768w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/ElectrolyteDisorders-1024x320.png 1024w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/ElectrolyteDisorders-624x195.png 624w\" sizes=\"auto, (max-width: 1996px) 100vw, 1996px\" \/><\/p>\n<p><strong>Patho-physiology<\/strong><\/p>\n<ul>\n<li>A change in serum electrolyte concentrations can be either due to a change in input, output or trans-compartmental shift<\/li>\n<li>Changes in input are affected by enteral or parenteral intake\u00a0(including TPN)<\/li>\n<li>Changes in output is controlled\u00a0by the kidneys but significant losses can occur via the GIT or skin.<\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-800\" src=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide1-1.jpg\" alt=\"Slide1\" width=\"960\" height=\"720\" srcset=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide1-1.jpg 960w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide1-1-300x225.jpg 300w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide1-1-768x576.jpg 768w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide1-1-624x468.jpg 624w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide1-1-240x180.jpg 240w\" sizes=\"auto, (max-width: 960px) 100vw, 960px\" \/><\/p>\n<p>Renal excretion or transcompartmental shifts are\u00a0the main homeostatic controls in response to changes in serum electrolyte concentration. \u00a0This is assisted by the signalling effect of different hormones.<\/p>\n<p>Sodium concentration is also controlled by the regulation of thirst via osmoreceptors in the hypothalamus.<\/p>\n<table style=\"width: 622px;\">\n<tbody>\n<tr>\n<td style=\"width: 209px;\"><strong>Electrolyte<\/strong><\/td>\n<td style=\"width: 223px;\"><strong>Major compartmental body store<\/strong><\/td>\n<td style=\"width: 159px;\"><strong>Hormone<\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 209px;\"><strong>Sodium<\/strong><\/td>\n<td style=\"width: 223px;\">Extra-cellular space<\/td>\n<td style=\"width: 159px;\">ADH (but thirst mechanism is important in normal homeostasis)<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 209px;\"><strong>Potassium<\/strong><\/td>\n<td style=\"width: 223px;\">Intra-cellular space<\/td>\n<td style=\"width: 159px;\">Aldosterone<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 209px;\"><strong>Calcium, Magnesium, Phosphate<\/strong><\/td>\n<td style=\"width: 223px;\">Bone<\/td>\n<td style=\"width: 159px;\">PTH<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Since sodium is predominantly an extra-cellular electrolyte, its <em>concentration<\/em> is very sensitive to body water content. \u00a0 Therefore in the above schematic, the intake, loss and movement of <em>water<\/em> (in addition to sodium)<em>\u00a0<\/em>has a significant impact on sodium concentration.<\/p>\n<p>Therefore, the patho-physiology of electrolyte disturbances can be due to:<\/p>\n<p>The overwhelming effects of<\/p>\n<ol>\n<li>Changes in input<\/li>\n<li>Changes in output<\/li>\n<\/ol>\n<p><em>and\/or<\/em>\u00a0Disorders in homeostatic controls<\/p>\n<ol>\n<li>Alterations in renal function<\/li>\n<li>Disorders of endocrine function<\/li>\n<\/ol>\n<p><strong>Clinico-pathological Correlation<\/strong><\/p>\n<p>Disorders of electrolytes have differing effects on excitable tissue. \u00a0Depending on magnitude and rate of change, symptoms can be mild and non-specific to severe and life-threatening. \u00a0Find below the serious manifestations. \u00a0Muscular weakness can be significant enough to impair <em>respiration. \u00a0<\/em><a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/09\/22\/ecg-and-electrolyte-abnormalities\/\">Effects on cardiac tissue<\/a> can range from changes in ECG to clinically significant arrhythmias.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-801\" src=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide2-1.jpg\" alt=\"Slide2\" width=\"960\" height=\"720\" srcset=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide2-1.jpg 960w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide2-1-300x225.jpg 300w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide2-1-768x576.jpg 768w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide2-1-624x468.jpg 624w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide2-1-240x180.jpg 240w\" sizes=\"auto, (max-width: 960px) 100vw, 960px\" \/><\/p>\n<p>As a major contributor to extracellular osmolality, serum sodium\u00a0has a significant effect on cellular volume.\u00a0 This has implications in closed compartments such as the brain.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-802\" src=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide3.jpg\" alt=\"Slide3\" width=\"960\" height=\"720\" srcset=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide3.jpg 960w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide3-300x225.jpg 300w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide3-768x576.jpg 768w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide3-624x468.jpg 624w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Slide3-240x180.jpg 240w\" sizes=\"auto, (max-width: 960px) 100vw, 960px\" \/><\/p>\n<p><strong>The General clinical approach\u00a0<\/strong><\/p>\n<ul>\n<li>Is it a <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/25\/electrolyte-disorders-emergencies\/\">clinical emergency<\/a>? CNS, CVS, Resp or Neuro-musc effects (or mild, moderate abnormality)<\/li>\n<li>Review volume status (dehydrated, hypovolaemic, oedematous)<\/li>\n<li>Review GIT intake and output (oral intake, drug composition, vomiting, diarrhea)<\/li>\n<li>Review Parenteral fluids (IVT, TPN)<\/li>\n<li>Review Skin losses (sweating\/burns +++)<\/li>\n<li>Review Medication list<\/li>\n<li>Check Renal function and urine output<\/li>\n<li>Compare with recent results for rate of change<\/li>\n<li>Consider renal tubular or endocrine dysfunction \u2013 perform urine electrolytes (see below)<\/li>\n<li>Consider specific endocrine tests if cause not obvious<\/li>\n<li>If asymptomatic\/mild symptoms &#8211; address cause and monitor in an outpatient setting<\/li>\n<li>If moderate symptoms &#8211; as above in an inpatient setting<\/li>\n<li>if severe symptoms &#8211; seek specialist opinion and rapidly correct life-threatening abnormalities, address cause, admit to ICU<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><em>With multiple abnormalities \u2013 evaluate each abnormality individually and attempt to find a unifying explanation<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tweet Patho-physiology A change in serum electrolyte concentrations can be either due to a change in input, output or trans-compartmental shift Changes in input are affected by enteral or parenteral&#8230; <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/25\/electrolyte-disorders\/\">Read more &raquo;<\/a><\/p>\n","protected":false},"author":1,"featured_media":804,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"episode_type":"","audio_file":"","cover_image":"","cover_image_id":"","duration":"","filesize":"","date_recorded":"","explicit":"","block":"","filesize_raw":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-799","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/799","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/comments?post=799"}],"version-history":[{"count":5,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/799\/revisions"}],"predecessor-version":[{"id":995,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/799\/revisions\/995"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/media\/804"}],"wp:attachment":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/media?parent=799"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/categories?post=799"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/tags?post=799"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}