Electrolytes metabolism, disorders

Samples are often only analysed once in a particular patient, unlike the serial or repeated analyses undertaken when monitoring urea and electrolytes in some patients. On the basis of that single result, the possibility of a metabolic disorder in a particular patient is often excluded and the test may not be repeated. 

Mononucleosis Sexually transmitted diseases Tuberculosis Collagen disorder Systemic lupus erythematosus Metabolic disorders Electrolyte imbalance Hypokalemia Hyponatremia Hepatic encephalopathy... 

Hepatic coma can be subdivided according to its aetiology as follows (7.) hepatocyte disintegration coma (= endogenous coma as a result of the loss of parenchyma), (2.) liver cell failure coma (= exogenous coma as a result of metabolic disorders, almost always in the presence of cirrhosis), (3.) electrolyte coma (= so-called false coma due to dyselectrolytaemia, almost always iatrogenic), and (4.) mixed forms of coma. (s. pp 214, 276, 381) (s. tab. 15.5)... 

Ascites and oedema are also found in severe hepatic diseases, pointing to serious disorders in the water and electrolyte metabolism. These complications are signs of decompensation in fiver cirrhosis or chronic liver insufficiency. At the same time, pleural effusion may also be evident. Cirrhosis-related pleural effusion without concomitant ascites has been described as a rarity. (see chapter 16)... 

Metabolic disorders such as hypoglycemia, adrenal disease, vitamin deficiencies, electrolyte imbalances Organ diseases such as hepatic encephalopathy Pernicious anemia... 

Narins RG. Acid-base disorders Definitions and introductory concepts. In Narins RG, ed. Maxwell Kleeman s Clinical Disorders of Fluid and Electrolyte Metabolism, 5th ed. New York, McGraw-Hill, 1994 765—768. 

Jennee FA, Lee CR, Paschalis C, Hill SE, Bue-kinshaw L and Jennings G (1983) Electrolyte metabolism in patients with periodic affective disorders during treatment with rubidium. Psychopharmacology 81 301-309. 

As in the case with abnormalities of glucose and electrolyte metabolism, all of the above disorders of mineral metabolism can be avoided if the physician is fully aware of the specific mineral composition of the infusate and if a careful monitoring schedule for plasma total calcium, inorganic phosphate and magnesium is adhered to. 

Cause Drugs / Drink / Dehydration Electrolyte disturbance Lots of pain Infection / Inflammation Respiratory failure (hypoxia/hypercapnia) Impaction (Faecal / constipation) Urine retention Metabolic disorder (liver/renal failure, h5q)oglycaemia) / Malnutrition Sensory impairment / Sleep problems... 

As the underlying condition improves, there should be daily assessment of the potential for discontinuing invasive ventilation. Criteria include adequate mentation, absence of fever or anemia, cessation of neuromuscular-blocking agents and sedatives, hemodynamic stability, correction of electrolyte and metabolic disorders, and adequate oxygenation (5,14-17, 27,28) (Fig. 1). After these criteria are met an SET should be considered. 

Stable metabolic status (electrolytes and metabolic disorders)... 

Max, a six-year-old dog, has an appointment in a few days for a dental cleaning with anesthesia. Before that, he is brought to his veterinarian for a blood chemistry profile and a urinalysis. Sean, a veterinary assistant, measures Max s weight and obtains the blood and urine samples needed for the pre-surgery diagnostics. The blood chemistry profile determines the overall health and condition of Max s liver and kidneys, detects any metabolic disorders, and measures the concentration of electrolytes. 

Metabolic complications of EN most commonly include disorders of fluid and electrolyte homeostasis and hyperglycemia. More severely ill patients require more frequent monitoring than those who are more stable (see Table 98-9). Both dehydration and fluid overload can occur with tube feeding. Careful monitoring of fluid inputs and outputs as well as body weight is important. Dehydration may be due either to excessive fluid... 

Individuals with chronic liver disease may have disorders of fluid and electrolyte balance, including ascites, edema, and effusions. Alterations of whole body potassium induced by vomiting and diarrhea, as well as severe secondary aldosteronism, may contribute to muscle weakness and can be worsened by diuretic therapy. The metabolic derangements caused by metabolism of large amounts of ethanol can result in hypoglycemia, as a result of impaired hepatic gluconeogenesis, and in ketosis, caused by excessive lipolytic factors, especially increased cortisol and growth hormone. 

Knowledge of phosphorus and citrate metabolism in vitamin D poisoning and in idiopathic hypercalcemia of infancy is very incomplete and somewhat contradictory, but in certain respects the changes in these electrolytes in these two disorders may differ. 

Several relatively common disorders result in aldosterone secretion abnormalities and aberrations of electrolyte status. In Addison s disease, the adrenal cortex is often destroyed through autoimmune processes. One of the effects is a lack of aldosterone secretion and decreased Na+ retention by the patient. In a typical Addison s disease patient, serum [Na+] and [CL] are 128 and 96 meq/L, respectively (see Table 16.2 for normal values). Potassium levels are elevated, 6 meq/L or higher, because the Na+ reabsorption system of the kidney, which is under aldosterone control, moves K+ into the urine just as it moves Na+ back into plasma. Thus, if more Na+ is excreted, more K+ is reabsorbed. Bicarbonate remains relatively normal. The opposite situation prevails in Cushing s disease, however, in which an overproduction of adrenocorticosteroids, especially cortisol, is present. Glucocorticoids have mild mineralocorticoid activities, but ACTH also increases aldosterone secretion. This may be caused by an oversecretion of ACTH by a tumor or by adrenal hyperplasia or tumors. Serum sodium in Cushing s disease is slightly elevated, [K+] is below normal (hypokalemia), and metabolic alkalosis is present. The patient is usually hypertensive. A more severe electrolyte abnormality is seen in Conn s syndrome or primary aldosteronism, usually caused by an adrenal tumor. Increased blood aldosterone levels result in the urinary loss of K+ and H+, retention of Na+ (hypernatremia), alkalosis, and profound hypertension. 

Metabolic Osteoporosis, fluid, electrolyte, and acid-base disorders... 

Cautions Anticoagulant therapy, history of liver disease, substantial alcohol consumption, major surgery, severe acute infection, trauma, hypotension, severe metabolic, endocrine, or electrolyte disorders, uncontrolled seizures... 

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