Electrolytes abnormalities

In the ED setting, the diagnosis of ketamine intoxication is a clinical one. Ketamine is not routinely detected by urine toxicology tests, although it can be detected with high-performance liquid chromatography (Koesters et al. 2002). As with MDMA, the initial assessment for ketamine intoxication includes the use of routine laboratory tests to detect electrolyte abnormalities and to evaluate renal and hepatic functioning (Koesters et al. 2002). 

Georgiadis et al. Stroke 2002 33(6) 1584-1588 Nonblinded prospective hemicraniectomy for nondominant and cooling for dominant hemisphere 19 of 36 tx with hypothermia Hypothermia to 33°C with cooling blankets or endovascular technique on clinical course in pts with >2/3 MCA infarct 12% vs. 47% mortality for surgery vs. hypothermia. Hypothermia with increased complications of hypotension and electrolyte abnormalities. Both tx with longer ICU course... 

Automaticity of cardiac fibers is controlled in part by activity of the sympathetic and parasympathetic nervous systems. Enhanced activity of the sympathetic nervous system may result in increased automaticity of the SA node or other automatic cardiac fibers. Enhanced activity of the parasympathetic nervous system tends to suppress automaticity conversely, inhibition of activity of the parasympathetic nervous system increases automaticity. Other factors may lead to abnormal increases in automaticity of extra-SA nodal tissues, including hypoxia, atrial or ventricular stretch [as might occur following long-standing hypertension or after the development of heart failure (HF)], and electrolyte abnormalities such as hypokalemia or hypomagnesemia. 

In patients with sinus bradycardia due to underlying correctable disorders (such as electrolyte abnormalities or hypothyroidism), management consists of correcting those disorders. 

Patients with complex nausea and vomiting may have mal-nourishment, dehydration, and electrolyte abnormalities. 

Patients with previously stable cirrhosis who develop acute encephalopathy often have an identifiable precipitating event that can account for the increased production and/or decreased elimination of these toxins. Infections, variceal hemorrhage, renal insufficiency, electrolyte abnormalities, and increased dietary protein have all been associated with acute development of HE. 

Monitor serum electrolytes and arterial blood gases regularly. Correct metabolic acidosis slowly to prevent the development of metabolic alkalosis or other electrolyte abnormalities. 

Initiation of dialysis is dependent on the patient s clinical status. Symptoms that may indicate the need for dialysis include persistent anorexia, nausea, vomiting, fatigue, and pruritus. Other criteria that indicate the need for dialysis include declining nutritional status, declining serum albumin levels, uncontrolled hypertension, and volume overload, which may manifest as chronic heart failure, and electrolyte abnormalities, particularly hyperkalemia. Blood urea nitrogen (BUN) and serum creatinine (SCr) levels may be used as a... 

The goals of dialysis are to remove toxic metabolites to decrease uremic symptoms, correct electrolyte abnormalities, restore acid-base status, and maintain volume status to ultimately improve quality of life and decrease the morbidity and mortality associated with ESRD. 

In summary, the settings in which fluid replacement is used are hypovolemic patients (e.g., sepsis or pneumonia) hypervolemic patients [e.g., congestive heart failure (CHF), cirrhosis, or renal failure] euvolemic patients who are unable to take oral fluids in proportion to insensible losses (e.g., the perioperative period) and patients with electrolyte abnormalities (see below). 

Continuous cardiovascular and hemodynamic monitoring should be used for significant pH disturbances, as the most serious sequelae of acid-base disorders include electrolyte abnormalities, cardiac dysrhythmias, and systemic hypotension. 

Normal saline or dopamine at renal perfusion dose of 2 mcg/kg per minute for oliguria monitor for electrolyte abnormalities and replace as indicated. 

Discontinue or avoid medications that affect renal function or contribute to electrolyte abnormalities. Obtain a complete medication history. 

Electrolytes are involved in many metabolic and homeostatic functions, including enzymatic and biochemical reactions, maintenance of cell membrane structure and function, neurotransmission, hormone function, muscle contraction, cardiovascular function, bone composition, and fluid homeostasis. The causes of electrolyte abnormalities in patients receiving PN may be multifactorial, including altered absorption and distribution excessive or inadequate intake altered hormonal, neurologic, and homeostatic mechanisms altered excretion via gastrointestinal and renal losses changes in fluid status and fluid shifts and medications. 

The goal is to transition the patient to enteral or oral nutrition and taper off PN as soon as feasible clinically. When initiating enteral or oral nutrition, monitor the patient for glucose, fluid, and electrolyte abnormalities. Perform calorie counts to determine the adequacy of nutrition via the oral or enteral route. When the patient is tolerating more than 50% of total estimated daily calorie and protein requirements via the oral or enteral route, wean PN by about 50%. PN can be stopped once the patient is tolerating more than 75% of total estimated daily calorie and protein requirements via the oral or enteral route, assuming that intestinal absorption is maintained. 

Ventricular tachycardia (VT) is defined by three or more repetitive PVCs occurring at a rate greater than 100 beats/min. It occurs most commonly in acute myocardial infarction (MI) other causes are severe electrolyte abnormalities (e.g., hypokalemia), hypoxemia, and digitalis toxicity. The chronic recurrent form is almost always associated with underlying organic heart disease (e.g., idiopathic dilated cardiomyopathy or remote MI with left ventricular [LV] aneurysm). 

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