ELECTROLYTES
Are particles that carry electrical charge and are present in blood, plasma and urine.
Substances whose molecules dissociate into
ions when placed into water cations- positively charged e.g Na+, K+, Mg++, Ca++
anions – negatively charged e.g Cl - ,
What is an electrolyte?
Essential minerals necessary for nerve and muscle function
Maintain body fluid balance Regulate acid base balance
Electrolytes
Positive cations : potassium K+, sodium Na +, magnesium Mg2+, calcium 2+
Negative cations :
phosphate PO4 3-, chloride Cl_
Buffer : bicarbonate HCO3-
Types of electrolytes
Intracellular fluid (ICF) :- prevalent cation – K+, Mg++ prevalent anion - PO4
- - -
Extracellular fluid ( ECF) :- prevalent cation – Na+
prevalent anion - Cl-
Distribution
Transmission and conduction of nerve and muscle impulse
Required for repolarization of cell membrane to a resting state after an action potential
Maintenance of cardiac rhythms Acid base balance Normal : 3.5 -4.5 mmol/l
POTASSIUM or K+
High serum K caused by :- massive intake impaired renal secretion shift from ICF to ECF : massive cell
destruction e.g brain injury, crush injury
Hyperkalaemia
Manifestation :Weak or paralysed skeletal musclesVF or cardiac standstillSmall P waves and high peaked T waves REMEMBER ALS GUIDELINES
Hyperkalaemia
CORRECTION increase elimination ( diuretics, dialysis)Force K+ from ECF to ICF by IV insulin with
dextrose or sodium bicarbonatereverse membrane effects of elevated ECF
K+ by administrating Calcium Gluconate IV
Hyperkalaemia
CAUSES : Kidney malfunction Diabetic ketoacidosis Gastrointestinal tract losses : vomiting,
diarrhoeaMg deficiency : alcohol abuse Metabolic alkalosis
HYPOKALAEMIA
Clinical signs / CorrectionCardiac arrthymias : gradual sagging ST
segment, flattening of T waves , appearance of U wave
Severe muscle weakness shallow respiration : threatening respiratory
functionCorrection : oral or IV
HYPOKALAEMIA
Most prevalent cation in ECF Plays a major role :-
ECF volume and concentration : retain body water Generation and transmission of nerve impulsepH balance Normal concentration : 135- 145 mmol/l
SODIUM or Na+
Elevated serum sodium: mostly water deficit causes hyper osmolality lead to cellular
dehydration Primary protection: thirst mechanism from
hypothalamus
Hypernatraemia
Clinical signs Seizures, coma leading to irreversible brain damage
Correction : not with WATER !!
Giving NaCl solution or with addition to dextrose: gradually reduced to avoid cerebral oedema
Hypernatraemia
Causes: Low Na in plasma caused by liver failure, kidney failure and
overhydration . Proportional to excess water :SIADH (syndrome of
inappropriate anti-diuretic hormone secretion)Manifestation : nausea, vomiting, headache, confusion, lethargy ,
restlessness, muscle weakness, spasms, cramps, seizures, coma .
Non cardiogenic pulmonary oedema .
Hyponatremia
Correction :- Find the cause Hypervolemia : both water and sodium level high liver cirrhosis, CHF, correction :- address liver and cardiac function Euvolaemic hyponatremia: excess water but body Na+ level is
same Hypothoridism , steroid (glucosteroid deficiency )
Correction : water restriction Hypovolaemic hyponatraemia : both water and sodium low prolonged vomiting, severe diarrhoea, decreased oral intake ,
diuretic use Correction : administration of NaCl.
Hyponatremia
2nd most abundant cation in ICF Energy metabolism : glucose utilisation ,
fatty acid synthesis, muscle contraction Na+ – K + pump Affects Ca ++ homeostasis Release and action of PTH
Magnesium
Malabsorption : inflammatory bowel diseaseAlcoholism Following parathyrodiectomyHypercalaemia
Correction : IV MgSO4
Hypomagnesaemia
Block synaptic transmission : deep tendon reflexes
Effect on smooth muscles : ileus and urinary retention
Bradycardia and hypotension : effects on Ca+
+ & K +
Correction:IV Ca++ Renal patient : dialysis
Hypermagnesaemia
Transmission of nerve impulse Muscle contraction :Myocardial Blood clotting Formation of bones and teethBalance controlled by : parathyroid hormone Calcitonin Vitamin D
CALCIUM
Eating disorderLack of parathyroid hormone
Hypocalcaemia
Hyper parathyroid hormoneVitamin D overdoseProlonged immobilisation
Hypercalcaemia
Decreased memory Confusion , fatigue Constipation
Correction :- excretion of excess Ca++ with loop diuretics
Hydration with isotonic saline
Clinical symptoms
Maintains acid-base status Kidney regulation Good indictors of acid-base balance
Bicarbonates HCO3
_
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