Electrolyte Derrangements

“Let food be thy medicine and medicine be thy food.”― Hippocrates

By Christopher Mazis
 List of Things I Will Talk About in Order of
How Much I Hate Studying Them
• Sodium
• Potassium
• Calcium
• Magnesium
• Phosphate
Disorders of
Sodium
Imbalance
 Key Hormones
Disorders due to serum sodium are typically a result of changes in total body water…not sodium

• ADH - regulates sodium • Aldosterone - regulates total body

concentration sodium
• Secreted as a result of • Secreted as a result of hypovolemia
hyperosmolarity, reduced effective (renin & ATII mediated) and/or
arterial volume, or in response to hyperkalemia
AT-II • Reabsorption of sodium in exchange
• Inserts aquaporin-2 channels in for potassium and/or hydrogen
collecting ducts resulting in passive
water reabsorption
 Hyponatremia
<135 mEql/L

• Excess H2O relative to sodium, most

often due to increased ADH
• Appropriate ADH (hypovol or hypervol w/
low EAV)
• Inappropriate ADH (SIADH)
• Rarely due to low ADH w/ kidney
unable to maintain [Na] levels
• Excessive H2O Ingestion (Polydipsia)
• Reduced solute intake (“tea and toast”)
 Work Up
1. Detailed History…shocker I know
2. Plasma Osmolality – assess tonicity
1. Hypo – most common – true excess H2O
2. Iso – lab error 2/2 hyperlipidemia or
hyperproteinemia
3. Hyper – excess effective osmol such as
glucose (for every 100 over 100, add 2.4 to
Na to correct  )
3. If Hypotonic Hyponatremia:
1. Volume Status – vitals, orthostatics, BUN,
Cr, etc.
4. Urine Osmolality has limited use except in
euvolemic hypotonic hyponatremia
 Hypovolemic Hypotonic
Hyponatremia
• Renal Losses (U Na >20 mEq/L, FENa >1%) • Extrarenal Losses (U Na <10 mEq/L, FENa <1%)

• Diuretics (thiazides, loop diuretics) • Hemorrhage

• Salt-wasting Nephropathy • Gi Loss (diarrhea, vomiting)
• Cerebral Salt Wasting • Third Spacing (Pancreatitis)
• Mineralocorticoid Deficiency • Insensible Losses
(Addison’s Disease)