Disturbances of electrolytic balance

Description:

The hyponatremia — decrease in concentration of sodium in blood to 135 mmol/l and below, at a gipoosmolyarny and izoosmolyarny hydropenia means true deficit of Na in an organism. In case of a gipoosmolyarny overhydratation the hyponatremia can not mean the general deficit of sodium, though in this case it is quite often observed.
Hypercalcemia (content of calcium in blood is higher than 2,63 mmol/l).

The hypopotassemia — reduction of potassium concentration in blood is lower than 3,5 mmol/l.

The hyperpotassemia — increase in potassium concentration is higher than 5,5 mmol/l.

The hypomagnesiemia — decrease in level of magnesium is lower than 0,5 mmol/l.

Symptoms of Disturbances of electrolytic balance:

In a clinical picture of a hypocalcemia — increase in neuromuscular irritability, a tetany, a laryngospasm, spastic manifestations from a GIT, coronary vessels.

At acute poisoning with calcium (hypercalcemia) giperkaltsiyemichesky crisis which is shown by an acute pain in epigastriums, thirst, nausea, pernicious vomiting, the polyuria leading to dehydration and then to an oligoanuriya, a hyperthermia, acute disorders of blood circulation up to its stop can develop.

Main manifestations of a hypopotassemia: muscular weakness which can cause hypoventilation development of HPN, an alkalosis, decrease in tolerance to carbohydrates, encephalopathy, dynamic intestinal impassability, disturbance of a heart rhythm (fibrillation is possible). On an ECG ST interval decreases, RYoT is extended, the T tooth is flattened. At decrease in a kaliyemiya to 1,5 mmol/l the atrioventricular block, the increased U tooth amplitude without lengthening of QYoT develops. Sensitivity to cardiac glycosides increases.

Main clinical manifestations of a hyperpotassemia: symptoms of neuromuscular defeat (weakness, paresthesias, the ascending paralysis, a quadriplegia, nausea, vomiting), impassability of intestines.

Danger of a hyperpotassemia is defined by dysfunction of a myocardium. At a hyperpotassemia of 5-7 mmol/l carrying out impulses in a myocardium accelerates, at 8 mmol/l there are zhizneugrozhayushchy arrhythmias. On an ECG the high sharp-pointed tooth of T, then lengthening of an interval of PYoQ, disappearance of a tooth P and a stop of auricles is observed in the beginning. Broadening of the QRS complex, developing of ventricular tachycardia with development of fibrillation of ventricles is possible.

Gipermagniyemiya (over 0,75-1 mmol/l) and gipermagniygistiya are observed at allocation reduction by his kidneys, excess introduction, use of antacids, especially against the background of HPN.

Clinical manifestations: at a magniyeyomiya of 1,25-2,5 mmol/l there are nausea, vomiting, bradycardia, feeling of heat and thirst. At exceeding of concentration to 3,5 mmol/l there is a drowsiness, a hyporeflexia, carrying out impulses in a myocardium is broken. At exceeding of content of magnesium 6 mmol/l — a coma, an apnoea, a cardiac standstill are higher.

Reasons of Disturbances of electrolytic balance:

External losses of liquids and their pathological redistributions between the main liquid environments are the main reasons for disturbances of water and electrolytic balance.
Are the main reasons for a hypocalcemia:
— injury of epithelial bodies;
— therapy by a radioiodine;
— removal of epithelial bodies;
— pseudohypoparathyroidism.

The most frequent reason of a hypercalcemia — primary or secondary hyperparathyreosis.

Carry to the main reasons for a hyponatremia:
— the serious wasting diseases which are followed by decrease in a diuresis;
— posttraumatic and postoperative states;
— extrarenal losses of sodium;
— excess water inflow in an antidiuretic phase of a posttraumatic or postoperative state;
— uncontrolled use of diuretics.


Are the reasons of a hypopotassemia:
— potassium shift in cells;
— excess of losses of potassium over its receipt is followed by a gipokaliygistiya;
— a combination of the factors stated above;
— alkalosis (respiratory, metabolic);
— aldosteronism;
— periodic gipokaliyemichesky paralysis;
— use of corticosteroids.

Are the main reasons for a hyperpotassemia:
— a potassium exit from a cell owing to its damage;
— a potassium delay in an organism, most often an izyoza of excess receipt of a katiton in the patient's organism.

Can be the reasons of a hypomagnesiemia:
— alcoholism;
— damage of a liver;
— enterectomy;
— diarrhea, existence of fistulas;
— hypoparathyrosis;
— administration of insulin.

Treatment of Disturbances of electrolytic balance:

For correction of a hypopotassemia it is recommended to enter 3 g of potassium of chloride (75 ml of 4% of solution) for each liter of the glucose entered intravenously.

At a hyponatremia 20-30 ml of 10% of solution of sodium of chloride, and also intravenously kapelno are entered by 0.5-1 l of isotonic solution of sodium of chloride intravenously struyno.

At a hypocalcemia 10-20 ml of 10% of solution of calcium of a gluconate or chloride are entered intravenously.