Electrolytes disturbances

Observations for fluid and electrolyte disturbances are particularly important in the aged or chronically ill patient in whom severe dehydration may develop in a short time. The nurse must immediately report symptoms of dehydration, such as dry mucous membranes decreased urinary output, concentrated urine, restlessness or confusion in the older adult. 

All antiarrhythmic dra are used cautiously in patients with renal or hepatic disease. When renal or hepatic dysfunction is present, a dosage reduction may be necessary. All patients should be observed for renal and hepatic dysfunction. Quinidine and procainamide are used cautiously in patients with CHF. Disopyramide is used cautiously in patients with CHF, myasthenia gravis, or glaucoma, and in men with prostate enlargement. Bretylium is used cautiously in patients with digitalis toxicity because the initial release of norepinephrine with digitalis toxicity may exacerbate arrhythmias and symptoms of toxicity. Verapamil is used cautiously in patients with a history of serious ventricular arrhythmias or CHF. Electrolyte disturbances such as hypokalemia, hyperkalemia, or hypomagnesemia may alter the effects of the antiarrhythmic dru . Electrolytes are monitored frequently and imbalances corrected as soon as possible... 

Sodium and water retention may also occur with androgen or anabolic steroid administration, causing die patient to become edematous, hi addition, otiier electrolyte imbalances, such as hypercalcemia, may occur. The nurse monitors the patient for fluid and electrolyte disturbances (see Chap. 58 for signs and symptoms of electrolyte disturbance). 

Side effects from crystalloids primarily involve fluid overload and electrolyte disturbances of sodium, potassium, and chloride.23 Dilution of coagulation factors can also occur resulting in a dilutional coagulopathy.24 Two clinically significant reasons LR is different from NS is that LR contains potassium and has a lower sodium content (130 versus 154 mEq/L or mmol/L). Thus, LR has a greater potential than NS to cause... 

Is there any evidence of adverse events from the resuscitation therapies employed such as fluid overload, electrolyte disturbances, transfusion reactions, and/or alterations in coagulation If yes, manage the particular adverse event accordingly. 

When acute overuse or chronic misuse of saline or stimulant laxatives is suspected, it may be necessary to check for electrolyte disturbances (e.g., hypokalemia, hypernatremia, hyperphosphatemia, or hypocalcemia). 

Most healthy adults with diarrhea do not develop dehydration or other complications and can be treated symptomatically by self medication. When diarrhea is severe and oral intake is limited, dehydration can occur, particularly in the elderly and infants. Other complications of diarrhea resulting from fluid loss include electrolyte disturbances, metabolic acidosis, and cardiovascular collapse. 

Many of the electrolyte disturbances discussed in the remainder of this chapter represent medical emergencies that call for... 

Myxedema coma is seen in advanced hypothyroidism. These patients develop CNS depression, respiratory depression, cardiovascular instability, and fluid and electrolyte disturbances. Myxedema coma often is triggered by an underlying acute medical condition such as infection, stroke, trauma, or administration of CNS depressant drugs. 

Response to antifungal therapy in invasive candidiasis is often more rapid than for endemic fungal infections. Resolution of fever and sterilization of blood cultures are indications of response to antifungal therapy. Toxicity associated with antifungal therapy is similar in these patients as described earlier with the caveat that some toxicities maybe more pronounced in crit-ically-ill patients with invasive candidiasis. Nephrotoxicity and electrolyte disturbances, with amphotericin B in particular, are problematic and may not be avoidable even with lipid amphotericin B formulations. Fluconazole and echinocandins are generally safer options, and are generally well tolerated. Decisions to use one class of agents over the other is principally driven by concerns of non-albicans species, patient tolerability, or history of prior fluconazole exposure (risk factor for non-albicans species.). 

Prevention of tumor lysis syndrome generally is achieved by increasing the urine output and preventing accumulation of uric acid. Prophylactic strategies should begin immediately on presentation, preferably 48 hours prior to cytotoxic therapy. Treatment modalities primarily increase uric acid solubility, address electrolyte disturbances, and support renal output. 

Electrolyte disturbances that develop in patients with tumor lysis syndrome should be managed aggressively to avoid renal failure from hyperphosphatemia and hypocalcemia and cardiac signs from hyperkalemia. One exception pertains to the use of intravenous calcium for hypocalcemia. Adding calcium may cause further calcium phosphate precipitation in the presence of hyperphosphatemia and should be used cautiously. 

PN therapy is associated with significant complications, both with short- and long-term therapy. Many complications are related to overfeeding (Table 97—7). Metabolic complications include hyperglycemia, hypoglycemia, hyperlipidemia, hypercapnia, electrolyte disturbances, refeeding syndrome, and acid-base... 

Dextrose Hyperglycemia, hypertriglyceridemia, hepatic steatosis, hypercapnia hyperglycemia may cause fluid and electrolyte disturbances and increased infection risk... 

Underlying precipitating factors should be corrected by ensuring proper oxygenation and ventilation and by correcting acid-base or electrolyte disturbances. 

Hypokalemia and hypomagnesemia may cause muscle fatigue or cramps. Serious cardiac arrhythmias may occur, especially in patients receiving digitalis therapy, patients with LV hypertrophy, and those with ischemic heart disease. Low-dose therapy (e.g., 25 mg hydrochlorothiazide or 12.5 mg chlorthalidone daily) rarely causes significant electrolyte disturbances. 

The well-appreciated adverse effects of glucocorticoids include hyperglycemia, hypertension, osteoporosis, fluid retention and electrolyte disturbances, myopathies, psychosis, and reduced resistance to infection. In addition, glucocorticoid use may cause adrenocortical suppression. Specific regimens for withdrawal of glucocorticoid therapy have been suggested. 

Shigellosis is usually a self-limiting disease. Most patients recover in 4 to 7 days. Treatment of bacillary dysentery generally includes correction of fluid and electrolyte disturbances and, occasionally, antimicrobials. 

General measures such as evaluating for electrolyte disturbance (especially hypercalcemia or hyponatremia), hypoxemia, or infection (especially encephalitis, sepsis, or urinary tract infection). 

Many electrolyte disturbances occur with hypomagnesemia including hypokalemia and hypocalcemia. 

Patients should be monitored for resolution of clinical manifestations of electrolyte disturbances and for treatment-related complications. 

The activity of the renin-angiotensin system is reduced with age (Muhlberg and Platt 1999). The ability of the kidney to concentrate urine maximally after water deprivation decreases with age, as does the ability to excrete a water and salt load, particularly during the night. Nocturnal polyuria is common in the elderly (Lubran 1995). Diuretics are commonly used in the elderly. There is an increased risk for hypokalemia and hyponatremia from diuretics in the elderly (Passare et al. 2004). Electrolyte disturbances may also be caused by several types of drugs in the elderly and it is important to monitor serum electrolyte levels in the elderly. Treatment with... 

Despite limited success with amitriptyline in some anorexia patients, using this class of antidepressants can be problematic in AN patients and therefore cannot be routinely recommended. TCAs slow gastrointestinal function and can therefore worsen the constipation and bloating that commonly plague AN patients during refeeding. In addition, TCAs can increase the likelihood of seizure or cardiac arrhythmia in patients already at risk due to electrolyte disturbances. Moreover, they are often lethal after overdose. 

While the dose-limiting toxicity for vinblastine usually is leukopenia, that for vincristine is most commonly neurotoxicity (58). Prominent manifestations of neurotoxicity are loss of the Achilles tendon reflex, paresthesias, loss of muscle strength (e.g., in the foot and wrist), and ataxia. Constipation and abdominal pain may occur and are thought to result, at least in part, from actions on the autonomic nervous system. Leukopenia and stomatitis are possible effects of vincristine treatment, but they occur relatively infrequently. Alopecia occurs with vincristine at a frequency comparable to that observed with vinblastine, and vincristine also is a potent tissue irritant. Vincristine may produce a syndrome of inappropriate secretion of antidiuretic hormone, and some manifestations of neurotoxicity, such as seizures, have been considered to be due to electrolyte disturbances associated with the relative excess of the antidiuretic hormone (58). 

Electrolyte disturbance Hypokalemia or hyperkalemia may alter the effects of Class I antiarrhythmic drugs. Correct preexisting hypokalemia or hyperkalemia before administration. 

Electrolyte disturbances Correct potassium or magnesium deficiency before therapy begins as these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsades de pointes. 

Electrolyte disturbances Do not use sotalol in patients with hypokalemia or hypomagnesemia prior to correction of imbalance. 

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