Electrolyte disturbances treatment

The steady decline in renal function can often be halted and sometimes reversed by correction of fluid and electrolyte disturbances, treatment of hypertension and urinary tract infection, and by the scrupulous avoidance of analgesics (143, 146, 193, 201, 202 ). It is not sufficient merely to persuade the patient to discontinue phena-cetin-containing analgesics. Paracetamol, aspirin and other anti-inflammatory drugs should also be stopped if at all possible. 

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. 

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. 

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... 

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). 

The most effective treatment is haemodialysis, which allows the removal of salicylate and the correction of acid-base, fluid, and electrolyte disturbances, and is the preferred treatment for severe or complicated salicylate poisoning. 

In the treatment of secondary adrenocortical insufficiency, lower doses of cortisol are generally effective, and fluid and electrolyte disturbances do not have to be considered, since patients with deficient corticotrophin secretion generally do not have abnormal function of the zona glomerulosa. Since cortisol replacement therapy is required for life, adequate assessment of patients is critical to avoid the serious long-term consequences of excessive or insufficient treatment. In many cases, the doses of glucocorticoid used in replacement therapy are probably too high. Patients should ideally be administered three or more doses daily. To limit the risk of osteoporosis, replacement therapy should be carefully assessed on an individual basis and overtreatment avoided. 

Bulimic patients have a low mortality rate, but they may suffer the consequences of electrolyte disturbances if they engage in frequent and/ or aggressive purges. The electrolyte disturbances can cause fatigue, seizures, and death in extreme cases. Unlike anorexia nervosa, studies have shown that specific treatments can be effective in bulimia nervosa. Cognitive-behavioral therapy (CBT) is one such intervention, with reported remission rates of 25-50% for bulimic patients (Walsh, 2001). The most effective medications are the SSRIs, which typically require antiobsessional doses to be effective. Often the therapist will want to start with CBT, and if this is not sufficiently effective alone, then consultation can be obtained to add an SSRI to the treatment regimen. 

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. Antimicrobials are indicated in the infirm, those who are immunocompromised, children in daycare centers, the elderly, malnourished children, and healthcare workers. Antimicrobials may shorten the period of fecal shedding and attennate the clinical illness. 

The primary endpoint for monitoring treatment of fluid and electrolyte disorders is the correction of the abnormal serum electrolyte. The frequency depends on the presence of symptoms and degree of abnormality. In general, monitoring is initially performed at frequent intervals and, as homeostasis is restored, subsequently performed at less frequent intervals. AH electrolytes should be monitored since individual electrolyte abnormalities typically coexist with another abnormality (e.g., hypomagnesemia with hypokalemia and hypocalcemia, or hyperphosphatemia with hypocalcemia). Patients should be monitored for resolution of clinical manifestations of electrolyte disturbances and for treatment-related complications. 

Chlorothiazide readily crosses the placenta (149), but there have been few studies of the effects of diuretic treatment on the fetus. There are case reports of abnormalities of glucose handling (150) and severe electrolyte disturbances (151) in pregnant women taking diuretics. 

Treatment for salicylate intoxication is directed toward (1) decreasing further absorption, (2) increasing elimination, and (3) correcting add-base and electrolyte disturbances. Activated charcoal binds aspirin and prevents its absorption. Elimination of salicylate may be enhanced by alkaline diuresis and in severe cases by hemodialysis." Sodium bicarbonate may be given to alleviate metabolic acidosis. Indications for hemodialysis include serum salicylate >1000 mg/L, severe CNS depression, intractable metabolic acidosis, hepatic failure with coagulopathy, and renal failure. ... 

Primary therapy of most acid-base disorders must include treatment or elimination of the underlying cause, not just correction of the pH and electrolyte disturbances. 

Treatment of drug intoxication, summarized in Table 64—7, is primarily supportive. Vital functions are maintained while waiting for the drug to be eliminated. When absolutely necessary, physical restraint may be required temporarily while a diagnostic evaluation is initiated to rule out other causes for the behavior (e.g., metabolic or fluid and electrolyte disturbances). Whenever possible, drug therapy should be avoided because psychotropic drug therapy has the potential... 

Hemodialysis and hemoperfusion have not been evaluated In the treatment of serious barium poisoning. Hemodialysis might be helpful In correcting severe electrolyte disturbances. 

A. Emergency and supportive measures. Provide aggressive supportive care, with careful monitoring and treatment of fluid and electrolyte disturbances. 

To be most effective, lithium should be taken at monthly intervals throughout the patients life and closely monitored for side effects, which usually immediately (or soon) disappear when treatment is stopped. Doses less than 0.6 mmol/liter of blood serum are usually not effective, and more than 1.5-2 mmol/liter can cause life-threatening reactions. However, the toxic effects usually wear-off fast (Uthium is 50% excreted within 24-48 hr), or in severe cases can be treated by vomiting, emesis and close monitoring of the body s fluid electrolyte disturbances. Doses of 0.9-1.4 meq of Li/liter ( 0.5 g/day lithium carbonate or citrate) are thus usually prescribed to alleviate the acute manic or other symptoms (Ezzell, 2003 Fieve and Peselow, 1985). 

The identification of co-occurring medical problems is an important element in detoxification (Naranjo and Sellers 1986). Good supportive care and treatment of concurrent illness, including fluid and electrolyte repletion, are essential (Naranjo and Sellers 1986). Administration of thiamine (50—100 mg/day po or im) and multivitamins is a low-cost, low-risk intervention for the prophylaxis and treatment of alcohol-related neurological disturbances. 

Patients with acute stroke should be monitored intensely for the development of neurologic worsening, complications, and adverse effects from treatments. The most common reasons for clinical deterioration in stroke patients are (1) extension of the original lesion in the brain (2) development of cerebral edema and raised intracranial pressure (3) hypertensive emergency (4) infection (e.g., urinary and respiratory tract) (5) venous thromboembolism (6) electrolyte abnormalities and rhythm disturbances and (7) recurrent stroke. The approach to monitoring stroke patients is summarized in Table 13-3. 

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