Hypokalemia

·        Decrease in potassium levels in the blood.

·        Ka serum level: < 3.5 mEq/L(3.5 mmol/L)

·        Ka moderate serum level: 2.5-3.0 mEq/L

·        Severe: serum level <2.5 mEq/L.

Hyperkalemia

·        increase in potassium levels in the blood.

·        Ka serum level > 5.0-5.5 mEq/L in adults.

·        Serum level: > 7 mEq/L can lead to severe complications such as hemodynamic and neurologic consequences.

Hypokalemia

·        Potassium is obtained through diet.

·        Excretion increased by aldosterone, diuretics, and negatively charged ions deposited into the collecting duct.

·        Excretion minimized by low serum and urination flow.

Hyperkalemia

·        Triggered by minimal glomerular activity.

Hypokalemia

·        Eating disorders

·        AIDS

·        Alcoholism

·        Bariatric surgery

Hyperkalemia

·        ARBs or potassium-sparing diuretics.

·        Virilization

·        Adrenal gland suppression

·        Kidney problems

Hypokalemia

·        Abnormal losses: medications, gastrointestinal losses, renal losses, hypomagnesemia, dialysis

·        Transcellular shift: medications, thyrotoxicosis.

·        Pseudo hypokalemia: extreme leukocytosis, delayed sample analysis

·        Starvation, dementia.

Hyperkalemia

·        Pseudo hyperkalemia

·        Decreased renal excretion

·        Deficiency in insulin, mineral acidosis, cell injury

Hypokalemia

·        Low levels of potassium will cause rise in sodium levels therefore causing hypernatremia.

Hyperkalemia

·        high levels of potassium will cause drops in levels of sodium hence causing hyponatremia.

Hypokalemia

·        Asymptomatic when mild (3-3.5 mmol/L)

·        Nonspecific symptoms (general weakness, lassitude, constipation) with more severe hypokalemia

·        Serum level of < 2.5 mmol/L leading to muscle necrosis

·        Serum level of < 2.0 mmol/L leading to ascending paralysis and impairment of respiratory functions.

Hyperkalemia

·        Weakness which at times progresses to flaccid paralysis and hypoventilation.

·        Metabolic acidosis.

·        Altered heart electrical activity.

Hypokalemia

·        Repeated serum potassium measurements.

·        Measurements for magnesium and glucose.

·        Measurements for creatine and urine.

·        Acid-base balance.

·        If initial work-ups fail, perform thyroid and adrenal work-up.

Hyperkalemia

·        Clinical history

·        Physical examination

·        Medications review

·        Assessment of cardiac functions

·        Assessment of hydration status

·        Electrocardiogram

·        Comprehensive laboratory workup

Hypokalemia

·        Potassium tablets or infusion.

·        Increase intake of materials containing potassium.

Hyperkalemia

·        Calcium chloride.

·        Insulin

·        Furosemide

·        Sodium polystyrene

·        Patiromer

Hypokalemia

·        Increases mortality in CKD or CHF

·        Symptoms dependent on severity

·        Severe hypokalemia may result in heart block.

Hyperkalemia

·        Frequently asymptomatic

·        Can present irregular heart rhythms

Hyponatremia

·        Na+ serum level < 135 mEq/L

·        Common imbalance that is mostly seen in isolation

·        Mild; serum level 130-134 mmol/L

·        Moderate: serum level 125-129 mmol/L

Hypernatremia

·        Rise in sodium concentration.

·        Level of concentrations exceeds 145 mmol/L

·        A water and not sodium problem

Hyponatremia

·        Water intake depends on thirst mechanism.

·        Thirst is stimulated by osmolality increase.

·        Hyponatremia occurs only when some conditions impair normal free water excretion.

Hypernatremia

·        Cells become dehydrated after hypernatremia of any etiology occurs.

·        Increased sodium reacts and extracts the water.

Hyponatremia

·        Older age >65

·        Use of pain medications

·        SSRIs for antidepressant therapy

·        Diuretics

·        Diets poor in sodium

·        Hypothyroidism

Hypernatremia

·        Older age >65

·        Mental and physical disability

·        Hospitalization

·        Residence in nursing home

·        Inadequate nursing care

·        Diabetes insipidus

·        Diabetes mellitus

·        Diuretic therapy

Hyponatremia

·        Kidney failure

·        Congestive heart failure

·        Diuretics

·        Pain medication

·        Severe vomiting or diarrhea

·        Excessive thirst

Hypernatremia

·        Diabetes insipidus- Central, Nephrogenic

·        Diarrhea, emesis

·        Burns, excessive sweating

·        Premature infants, radiant warmers, phototherapy

Hyponatremia

·        Low levels of sodium will cause an increase in potassium levels, thus causing hyperkalemia

Hypernatremia

·        Subsequently, high levels of sodium will cause a drop in potassium levels causing hypokalemia.

Hyponatremia

·        Headaches, seizures, confusion, coma

·        Weakness in muscles

·        Vomiting, diarrhea, pain in abdomen

Hypernatremia

·        50 % mortality rate due to encephalopathy

·        Coma, weakness, neurologic deficits

Hyponatremia

·        Physical examination

·        History examination

·        Radiologic imaging

Hypernatremia

·        Thorough physical exam inclusive of volume status, mental status and neurologic assessment.

Hyponatremia

·        Fluid restriction (0.5- 1 liter/day). Encourage water intake

·        Demeclocycline (600- 1200 mg/d). inhibits action of adh

·        Urea (30mg/d). osmotic diuresis

·        Lithium (up to 900mg/d). inhibits action of adh

Hypernatremia

·        Reduce intakes rich in sodium.

·        Sodium chloride

·        Intravenous dextrose

Hyponatremia

·        Fatigue

·        Convulsions

·        Feeling weak

·        Coma

·        Low blood pressure

·        Confusion

·        Short temper

Hypernatremia

·        Intense thirst

·        Fever

·        Nausea or vomiting

·        Intense thirst

·        Seizures

·        Labored respiration

·        Focal neurologic deficits

Hypocalcemia

·        Ca serum level: <8.8 mg/dL

·        Hereditary.

Hypercalcemia

·        90% of hypercalcemia cases caused by hyperparathyroidism.

·        Mild: Ca 10.5-11.9 mg/dL (2.5-3 mmol/L

·        Severe: Ca 14-16 mg/dL (3.5-4 mmol/L)

Hypocalcemia

·        Cased by numerous conditions: hypoparathyroidism, hungry bone syndrome, medications, infusion of phosphate, and kidney and liver diseases.

Hypercalcemia

·        Calcium is crucial in intracellular and extracellular metabolism controlling many processes.

·        Ca metabolism regulated by hormones affecting entry into the intercellular space and controls its excretion from the kidneys.

Hypocalcemia

·        Medications

·        Rapid citrated blood transfusion

·        Infusion of phosphate

·        Hungry bone syndrome

·        Altered vitamin D metabolism

·        hypoparathyroidism

Hypercalcemia

·        Vitamin D intoxication

·        Vitamin A intoxication

·        AIDS

·        Drugs

·        Lithium

·        Thiazide diuretics

·        Mild alkali syndrome

·        Chronic renal insufficiency

Hypocalcemia

• Hypoalbuminemia
• Hypomagnesemia
• Hyperphosphatemia
• Surgical effects
• PTH deficiency or resistance
• Vitamin D deficiency or resistance

·        Medication effects

Hypercalcemia

·        Hyperthyroidism

·        Primary adenoma, hyperplasia, carcinoma

·        lithium therapy

·        tertiary hyperparathyroidism

·        familial hypocalciuric hypercalcemia

Hypocalcemia

·        low levels of calcium may be caused by low or deficiency of magnesium.

·        A drop in calcium levels causes an increase in phosphate levels causing hyperphosphatemia

Hypercalcemia

·        Too much calcium in the body will cause a decrease in potassium levels in the blood. Patients with severe hypercalcemia will always be hypokalemic.

·        An increase in calcium level in the blood will cause a drop in phosphate levels thus causing hypophosphatemia when hypercalcemia is not severe.

Hypocalcemia

·        Paranesthesia around mouth, fingers and toes.

·        Muscle cramps

·        Tetany

·        Seizures

·        Latent hypocalcemia

Hypercalcemia

·        Diabetes insipidus

·        Acute kidney injury

·        Hypertension

·        Nausea

·        Vomiting

·        Constipation

·        Fatigue

·        Coma

Hypocalcemia

·        Physical examination

·        History examination

·        Measurement of serum intact parathyroid hormone.

Hypercalcemia

·        Blood test for high calcium levels in blood.

·        Mammogram

·        Chest x-ray

·        MRI

·        CT scan

Hypocalcemia

·        Magnesium supplements

·        Intravenous IV calcium gluconate for acute hypocalcemia

·        Calcium and vitamin D supplements (oral) for chronic hypocalcemia

Hypercalcemia

·        IV hydration with isotonic saline

·        Salmon calcitonin

·        Bisphosphonate

Hypocalcemia

·        Respiratory arrest

·        Cardiac arrest

·        Tetany

·        Seizures

·        Laryngospasm

Hypercalcemia

·        Kidney stones

·        Kidney failure

·        Fractures

·        Hypertension

·        Pancreatitis

·        Osteoporosis

Hypophosphatemia

·        Phosphate serum level:< 2.5 mg/dL (0.8 mmol/L) in adults.

·        Normal ranges of Phos in neonates are 4.8 – 8.2 mg/dL, 3.8 – 6.5 mg/dL in 1week to 3 years old children, 3.7 – 5.5 mg/dL in 3 to 12 year olds, and 2.9 to 5 mg/dL for adolescents to age 19 years.

·        A serum Phos < 2.5 mg/dL considered hypophosphatemia where < 1.5 is severe.

Hyperphosphatemia

·        Abnormally high serum phosphate levels.

·        A serum Phos from > 4.5 mg/dL considered hyperphosphatemia.

Hypophosphatemia

·        Mainly caused by low intake of phosphate into the body, high excretion of phosphate.

Hyperphosphatemia

·        Most common cause are decreased kidney function, and massive extracellular fluid phosphate loads.

Hypophosphatemia

·        Severe malnutrition

·        Alcoholism

·        Severe burns

·        Fanconi syndrome

·        Chronic diarrhea

·        Vitamin D deficiency (in children)

·        Inherited conditions such as X-linked familial hypophosphatemia (XLH)

Hyperphosphatemia

·        Excessive body fat

·        Diabetes mellitus

·        Hypercalcemia

·        Kidney infections

·        High cholesterol levels

Hypophosphatemia

·        Malnutrition

·        Hyperparathyroidism

·        Starvation

Hyperphosphatemia

·        Renal failure

Hypophosphatemia

·        A drop in phosphate levels will cause a rise in calcium levels in the blood causing hypercalcemia.

Hyperphosphatemia

·        A rise in phosphate levels in the blood will always cause a drop in calcium levels leading to hypocalcemia.

Hypophosphatemia

• Weakness in muscles.
• Seizures
• Blood issues
• Getting numb
• Alteration of mental state
• Weakening of bones

Hyperphosphatemia

• Rashes
• Soft bones thus weak
• Pain in joints
• Spasms
• Numbness in the mouth

Hypophosphatemia

·        Measurement of blood phosphate.

·        Additional tests may also be done to determine underlying cause of disorder

Hyperphosphatemia

·        Measurement of blood phosphate

·        Other tests to check to reason behind rise of phosphate.

Hypophosphatemia

·        Phosphate supplements, orally.

·        Active vitamin D

·        Treatment for related disorders: cinacalcet, calcitonin, or dipyridamole, but in future.

Hyperphosphatemia

·        Reduction of phosphate in diet.

·        Removal of extra phosphate with dialysis.

·        Lower amount of phosphate intestines absorbs using medication

Hypophosphatemia

·        Acute hypocalcemia

·        Tetany

·        Renal failure

Hyperphosphatemia

·        Cardiac arrest

·        Valve calcification (heart)

·        Elevated PO4 due to lack of adequate binders.

·        Elevation of PO4 can still be caused by diets high in phosphorus.

Hypomagnesemia

·        An electrolyte disturbance caused by low levels of serum magnesium.

·        While in low levels:< 1.46 mg/dL in the blood

Hypermagnesemia

·        Serum concentration: Mg >2.6 mg/dL (> 1.05 mmol/L)

Hypomagnesemia

·        Magnesium is essential for biochemical reactions.

·        Affects sodium, calcium and potassium, mostly while is in low levels.

·        Magnesium homeostasis involves the kidney.

·        Hypomagnesemia occurs when something changes or interferes with magnesium homeostasis.

·        Deficiency in magnesium can cause other conditions such as hypocalcemia.

Hypermagnesemia

·        Occurs mostly due to chronic kidney disease

Hypomagnesemia

·        Diabetes mellitus

·        Poor nutrition

·        Heart failure

·        Potassium deficiency

·        Calcium deficiency

Hypermagnesemia

·        Decreased renal function

·        Lithium therapy

·        Low thyroid activity

·        Diseases such as Addison’s

·        Syndromes such as milk-alkali

·        Drugs containing magnesium

·        Familial hypocalciuric hypercalcemia

Hypomagnesemia

·        Mainly caused by starvation, alcoholism, and critical illness.

·        Can be secondary to medications such as proton pump inhibitors, digitalis, chemotherapeutic drugs, amphotericin, aminoglycoside antibiotics, loop and thiazide diuretics.

Hypermagnesemia

·        Renal failure.

·        Low renal excretion caused by depletion of salt.

·        Drug abuse (antacids and laxatives)

·        Rhabdomyolysis

·        Endocrinopathies

Hypomagnesemia

·        When magnesium levels in the blood are low (hypomagnesemia) the patient will suffer from hypocalcemia and hypokalemia.

Hypermagnesemia

·        Having too much magnesium in the blood is uncommon.

Hypomagnesemia

·        Hypocalcemia, prolonged QT and QU interval, tremors, weakness in muscles.

Hypermagnesemia

·        Confusion, weakness in muscles, paralysis in the bladder, lethargy

Hypomagnesemia

·        Physical exam

·        Symptoms

·        Medical history

·        Blood test

Hypermagnesemia

·        Blood test

Hypomagnesemia

·        Supplements for magnesium (oral)

·        Increased intake of foods containing magnesium

·        Magnesium intravenously for severe cases

Hypermagnesemia

·        First identify and stop the production of extra magnesium.

·        To reduce symptoms, administer intravenous (IV) calcium.

·        Diuretics

·        Water pills

·        Dialysis for patients with kidney failure or if other medications are failing.

Hypomagnesemia

·        Seizures

·        Sudden death

·        Cardiac arrhythmias

·        Coronary artery vasospasm

Hypermagnesemia

·        Hypotension

·        Cardiac arrhythmia

·        Confusion

·        Lethargy

·        Coma

·        Cardiac arrest