1. Electrolyte Disturbance Dr. Khalid Jamal Hamdi

3. Hyponatremia Causes of SIADH Infections (meningitis TB Pneumonia ) Neoplasm Drugs (Crbamazepine, cytoxan, tricyclic ) Postoperative Subarachnoid haemorrhage

4. Hyponatraemia Sever when below 120 mmol/l Symptoms depend on severity and rapidity of decline in serum sodium Chronic hyponatraemia is less symptomatic but should be corrected with great caution

5. Hyponatremia symptoms May be asymptomatic Weakness lethargy dizziness and decreased concentration Seizures confusion and even coma can be seen in sever cases particularly if developed quickly

6. Hyponatremia Deficient can be calculated by ( Desired Na – Serum Na ) *(wt*.6) ( Desired Na – Serum Na ) *(wt*.6) Correction should at a rate of 1-2 mmol/l Correction should be to mild hyponatremia Central pontine myelonysis is mainly seen in alcoholics

7. Hyponatremia investigations Plsma osmolality Urine osmolality Urine Na concentration

8. Hyponatremia treatment Normal saline is indicated in volume depletion volume depletion Diuretics induced Diuretics induced Water restriction indicated in SIADH Oedema renal failure SIADH Oedema renal failure Hypertonic saline indicated in sever symptomatic hyponatremia

9. Hyponatremia treatment of SIADH Acute Water restriction Water restriction Hypertonic saline Hypertonic saline Loop diuretics Loop diureticsChronic Water restriction Water restriction Loop diuretic Loop diuretic Demeclocycline Demeclocycline

10. Hypernatremia causes Water loss (sweating Burns ) Renal loss GI losses Hypothalamic disorders DI

11. Hypernatremia symptoms Mainly neurological Lethargy weakness and irritability are early symptoms which can progress to seizures coma and death Symptoms are more with acute oncet

12. Hypernatremia treatment Dextrose infusion

21. Hpokalemia symptoms Weakness lethargy If chronic may lead to polyuria Can lead to sever alkalosis May trigger cardiac arrhythmia in patients with ischemic heart disease or recent myocardial infarction

22. Hypokalemia Treatment K supplement either oral or intravenous K deficiency can not be calculated Usual requirement in the range of 60 mEq/24 hours Rapid KCL infusion is fatal IV KCL can be given in a maximum rate of 10 – 20 mEq/h this may require a central line

28. Hypocalcemia treatment Calcium and vitamin D supplement If symptomatic then intravenous Ca gluconate should be used ( Ca <0.7 mmol/l ) Mg should be checked since if hypomagnesaemia present hypocalcemia can not be corrected

29. Hypomagnesaemia causes DiureticsAlcoholHypercalcemia Nephrotoxins (cisplatinum Amphotiricin B) Tubular disorders