•••quote:•••Originally posted by bbbmd:
•I used that little book of formulas too. It was helpful, but does anyone know of a source that gives an algorithmic approach to treating electrolyte abnormalities? A stepwise approach to diagnosing and working up suspected electrolyte abnormalities and the steps in management? Which fluid to give and so on? Am I the only one worried about this? From my experience during clerkship, managing fluids seemed more complicated than following the protocol of the "code". Also, I probably would not be alone during my first year actually leading a code, but I am sure I will be expected to know what to do (with confidence) if my patient is hyperkalemic, hypokalemic, hypernatremic, fluid overloaded, dehydrated and so on... If I am the only one clueless in this regard, please tell me what you guys know! I know the practice of medicine is not only following protocols and algorithims, but knowing them will certainly help this soon to be intern in the middle of a night on call!!!•••••I think that you will find that most of your patients do not have some bizarre electrolyte imbalance but something simple. For example, hypokalemia is probably most likely due to a patient wasting K+ from Lasix.
What to do? Give him some K+!! Check the level again after replacement. Give some more (don't give more than 40 mEq at at time PO, patients will barf on ya).
Hyperkalemic? Oops...you've given them too much K+ replacement, they're dehydrated or they can't get rid of it (ie, renal failure).
What to do? Depends on HOW high they are. We have a protocol here, but in general 5.0-5.3 we recheck in 6 hrs and get an EKG. Above 5.3 you start trying to get rid of K with some Calcium, D50, and Kayexelate (also getting an EKG and looking to T wave changes). Call renal if its REALLY high and isn't coming down - they may need to be dialyzed. If the patient isn't monitored, get them on tele.
Hypernatremic? Probably dehydrated.
What to do? Give some free water boluses or dilute their tube feeds with free water.
and so on...I find the Washington Manual for Interns has some good algorithms as does Surgery On-Call. Since you aren't going into Surgery I don't expect you to purchase the latter, but presumably any Medicine On-Call series will have the same information.
I find that a lot of the time you aren't asked WHY the patient has the imbalance, just whether or not you did something about it. Most electrolyte imbalances are iatrogenic and aren't great mysteries.