ELECTROLYTE
MANAGEMENT
Serum Electrolyte
Commonly measures the level of
Water Balance
Sodium
Potassium
Chloride
Calcium
Why Serum Electrolyte is Done
Preventive health checkup
Evaluate the cause of:
Kidney diseases
Heart diseases
Muscle weakness
Monitor the hospitalized and seriously ill patients
Monitor the condition of patients on diuretic therapy, IV fluids, or
dialysis
WATER BALANCE
Water Balance
The amount of water taken in and lost by the body depends on
intake, diet, activity and the environment. Over time the intake of
water is normally equal to that lost.
The minimum daily intake necessary to maintain this balance is
approximately 1500 – 2500 mL.
Water
Water Excess
Depletion
Diabetes insipidus Antidiuretic hormone
DM Vasopressin intake
Fever
Diarrhea
Dehydration
Types of Solutions
high Low
solute, solute,
Low high
solvent solvent
Hypotonic Isotonic Hypertonic
Low solute concentration Equal concentration High solute concentration
Used in case of: Used in: Mostly is ICU (can cause
Dehydration Blood loss edema)
DKA Surgery
Hyperosmolar Dehydration
hyperglycemia
Examples: Examples: Examples:
D5W 0.9% NS 3% hypertonic saline
0.25% NS D5W D10W
0.45% NS Ringer lactate DS
DS1/2
RL+D5W
SODIUM
Sodium
Major cation of ECF
Normal range: 135-145 mmol/L
Its major partner is chloride
Primary source is salt, food
Hypernatremia Hyponatremia
Excessive water loss Sodium deficiency
Drug induced (phenytoin, Salt-restricted diet
amphotericin-B)
Diuretic overuse
Burn
Vomiting
Dehydration
Diarrhea
IV saline administration
Neurological disorders
POTASSIUM
Potassium
Potassium is the major intracellular cation.
Normal range: 3.5-5.0 mmol/L
The serum potassium concentration is not an adequate measure of
the total body potassium because most of the body’s potassium is
intracellular.
Hyperkalemia Hypokalemia
Renal Failure Decrease K-intake
K-sparring diuretics Starvation
ACEI, ARB, NSAID, Clay ingestion
heparin Metabolic alkalosis
Metabolic acidosis Diarrhea, vomiting
Aldosterone deficiency Diuretic use, insulin
GI bleeding
Hemolysis
Treatment Strategies
Hyperkalemia Hypokalemia
Cocktail: KCL IV
Calcium gluconate 10% 10ml K-lyte syrup
over 10 min (20mg/100ml)
Insulin (10 units) + 25-50%
dextrose or glucose 50ml
Bicarbonate
Kayexalate PO (30g) /enema
CHLORIDE
Chloride
Major extracellular anion
Normal range: 96 to 106 mEq/L or mmol/L
Involve in osmolarity, blood volume, electrical neutrality.
It is almost completely absorbed by GIT then filtered out by the
glomerulus and passively reabsorbed in conjunction with sodium,
by the proximal tubule.
Excess is normally excreted in urine and sweats.
If excessively excreted, aldosterone activates and start it
reabsorption.
Hyperchloremia Hypochloremia
Dehydration Vomiting
Metabolic acidosis DKA
CHF Pyelonephritis
Cystic fibrosis Metabolic alkalosis
Hypercalcemia due to
parathyroid hyperfunction
GI losses
Overuse of NS
Treatment Strategies
Hyperchloremia Hypochloremia
Iv hypotonic fluid without Oral/IV chloride administration
chloride (0.45%Ns or D5W) IV dose:500-1000mL NS IV over 1-
Ringer lactate in case of NS 2 hrs for moderate case
overuse
Bicarbonates to deal with Discontinue the diuretic use that
acidosis (1-2mEq/kg over 4-6 is causing imbalance
hrs period)
ORS to treat dehydration
Dialysis
CALCIUM
Calcium
Calcium (Ca²⁺) is a vital electrolyte that plays a key role in many
physiological processes, including bone formation, muscle
contraction, nerve function, and blood clotting.
Calcium levels are tightly regulated by parathyroid hormone
(PTH), calcitonin, and vitamin D.
Normal ranges:
Total Serum Calcium: 8.5–10.5 mg/dL (2.1–2.6 mmol/L)
Hypercalcemia Hypocalcemia
Hyperparathyroidism Hypoparathyroidism
Malignancy Vitamin-D deficiency
Excessive vit-D CKD
Granulomatous disease Mg deficiency
Thiazide diuretic Acute pancreatitis
Loop diuretics
Treatment Strategies
Hypercalcemia Hypocalcemia
Stop calcium supplements, vitamin
D analogs, and thiazide diuretics Ca-gluconate (1-2g) in50-100mL
Encourage Oral Hydration D5W or NS over 10-20 min
Start with 200-300 mL/hour to Ca-chloride (0.5-1g) IV
maintain adequate urine output (100- Calcitriol (0.25-1 mcg/day)
150 mL/hour)
Mg-gluconate
20-40 mg IV every 12 hours to
promote calcium excretion.
Calcitonin: 4–8 IU/kg
subcutaneously or intramuscularly
every 6–12 hours.
CASE STUDY
A 72 year old male was brought to the ER by his family after experiencing
confusion, lethargy, and headaches over the last 24 hours. His family also reported
that he had experienced a fall at home due to dizziness. His past medical history is
HTN, CHF, T2DM, CKD, gout. His past medication history is HCT:25mg OD,
Lisinopril:20mg OD, Furosemide:40mg OD, Metformin: 500mg BID, Allopurinol:
100mg OD.
◦His vital organ values are BP: 110/70mmHg, PR: 80bpm, Temp: A/F, RR: 16
breaths/min, Mild peripheral edema. His lab values are Na: 122mEq/L, K:
3.8mEq/L, Cl: 96mEq/L, BUN: 24mg/dL, SrCr: 1.4mg/dL.
a) What is the primary diagnosis based on the patient's symptoms and lab values?
b) What are the possible causes of the patient’s lab values imbalance
c) What pharmacological factors could be contributing to this patient's condition?
d) What would be an appropriate pharmacological intervention for this patient?
e) How would you counsel patient and his family
A 68 year old male presents to the ER with complaints of palpitations, muscle
weakness, and occasional shortness of breath over the last two days. He has also
experienced nausea and mild fatigue. He has been skipping his meals but only eats
mashed bananas. His past medical history is HTN, CAD, T2DM, CKD, recent HF.
His past medication history is Spironolactone: 25mg OD, Lisinopril:10mg OD,
Metformin:500mg BID, Aspirin 75mg OD, Atorvastatin: 40mg OD. His ECG
shows Peaked T-waves and widened QRS complex.
His lab data is Na:138 mEq/L, K: 6.2 mEq/L , Chloride: 98 mEq/L, BUN: 30 mg/dL,
SrCr: 1.8mg/dL, GFR: 45mL/min
a) What is the most likely diagnosis based on the patient's symptoms and lab
values?
b) What are the likely causes of the patient’s disease
