Dyselectrolytemia

about dyselectrolytemia

1. DYSELECTROLYTEMIA PRESENTER: Dr. S. Keerthi Dept. Of Paediatrics, J.S.P.S Govt Homoeopathic Medical College, Ramanthapur, Hyderabad. MODERATOR: Dr. RAJANI CHANDER, M.D (Hom) H.O.D, Prof & P.G. Guide, Dept. Of Paediatrics, J.S.P.S Govt Homoeopathic Medical College, Ramanthapur, Hyderabad. 1

2. Definition Dyselectrolytemia is an electrolyte disorder is an imbalance of certain ionized salts . An electrolyte disorder occurs when the levels of electrolytes in your body are either too high or too low. This is discussed in ICD-10 in chapter 4 Endocrine, nutrional& metabolic diseases under sub classification METABOLIC DISEASES i.e.; E70-E90, specifically E79-E90. 2

3. ELECTROLYTES – these are ionized molecules found throughout the body. These substances are present in your blood, bodily fluids, and urine. They’re also ingested with food, drinks, and supplements CATIONS - +ve ( Na, K, Ca, Mg ) etc ANIONS - -ve (Cl, phosphate , bicarbonate ) etc 3

4. Normal levels of electrolytes 4

5. Ecf icf electrolytes and exchange 5

6. General functions of electrolytes Help to balance pH and acid base balance in body Facilitate the transport of fluids Regulating the functions of endocrine , neuromuscular and excretory systems . 6

7. Causes of electrolyte disorders Electrolyte disorders are most often caused by a loss of bodily fluids through prolonged vomiting, diarrhoea, or sweating. They may also develop due to fluid loss related to burns. Certain medications can cause electrolyte disorders as well. 7

8. Types of electrolyte disorder Sodium: hypernatremia and hyponatremia Potassium: hyperkalaemia and hypokalaemia Calcium: hypercalcemia and hypocalcaemia Chloride: hyperchloremia and hypochloraemia Magnesium: hypermagnesemia and hypomagnesemia Phosphate: hyperphosphatemia or hypophosphatemia 8

9. Sodium Normal range 135 -145 mEq/l Sodium helps to balance fluid levels in body Daily sodium requirement is 2 to 3 mEq /kg body weight although intakes are generally well in excess. 9

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11. HYPONATRAEMIA: Hyponatremia, defined as plasma sodium less than 135mEq/l Commonly results from excessive loss of sodium from excessive sweating, vomiting, diarrhea, burns and the administration of diuretics Becomes symptomatic when the levels fall below 125mEq/ml or the decline is acute i.e, in < 24 hrs. Broadly classified as a)Hypovolemic hyponatremia b)Normovolemic hyponatremia c)Hypervolemic hyponatremia 11

12. HYPOVOLEMIC HYPONATRAEMIA Renal loss: - Diuretics - Osmotic diuresis - Renal salt wasting - Adrenal insufficiency - Pseudo-hypo-aldosteronism B) Extra renal loss: - Diarrhoea, Vomitings, Sweat - Fistulas, Drains - Cerebral salt wasting syndrome - Effusions, Ascites 12

13. NORMOVOLEMIC HYPONATREMIA This is caused by conditions that predispose to SIADH i.e., A) Inflammation of CNS- Meningitis, Encephalitis B) Pulmonary- severe Asthma, Pneumonia C) Drugs D) Others- tumours, postoperative 13

14. HYPERVOLEMIC HYPONATREMIA: Caused by - Congestive heart failure - Cirrhosis of liver - Nephrotic syndrome - Acute or Chronic renal failure 14

15. CLINICAL SYMPTOMS: Milder symptoms include- headache, nausea, vomitings, lethargy, confusion In advanced stages, there may be- seizures, coma, decorticate posturing, dilated pupils, anisocoria, papilledema, cardiac arrhythmias, myocardial ischaemia, central diabetes insipidus, cerebral oedema 15

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18. Hypernatremia Hypernatremia is defined as increase in serum sodium concentration to levels more than 150 mEq /l The major cause of hypernatremia Is loss of body water, inadequate intake of water, a lack antidiuretic hormone (ADH), or excessive intake of Sodium (e.g. solutions with high sodium ) 18

19. The most objective sign of hypernatremia is lethargy or mental status changes, which proceeds to coma and convulsions. With acute and severe hypernatremia, the osmotic shift of water from neurons leads to shrinkage of the brain and tearing of the meningeal vessels and intracranial hemorrhage; slowly developing hypematremia 19

20. POTASSIUM • Main ICF component • Normal range 3.5-5.0Meq/dl • Sources-meat, bones, fruits and potatoes • Main Hormones for regulation -Aldosterone and insulin • Functions: 1)excitability of nerve and muscle tissue 2)contractibility of cardiac, skeletal and smooth muscles • 20

21. Regulation Aldosterone :it causes increasing of sodium absorption and potassium excretion maintaining balance 2)it also leads to loss in saliva, sweat etc Alkalosis : in which hydrogen ions which are exchanged in place of potassium into cells INSULIN :causes potassium uptake by Na+-k+activity 21

22. HYPOKALEMIA when potassium levels falls below 3.5mE/dL. • If it is less than 2.5mE/dl causes abdominal distension and paralytic ileus Causes/etiology : Reduced intake Malnutrition High renal loss - Diuretics, osmotic diuretics Tubular defects -renal tubular acidosis 22

23. Acid base disturbances - alkalosis Endocrinopathies -Cushing syndrome, primary aldosteronism , thyrotoxicosis High extrarenal loss : GIT- Diarrhea, vomiting ,frequent enemas, Profuse sweating Decrease in muscle mass myopathies 23

24. Symptoms: Weakness of skeletal muscles Hypotonia Hyporeflexia Abdominal distension Paralytic ileus Respiratory distress Prolonged loss -polyuria, polydipsia Cardiac-arrythmia 24

25. ECG CHANGES -depressed ST ,Flat/inversed T Wave prolonged P-R interval 25

26. HYPERKALAMIA Causes Acidosis Renal insufficiency Diseases including aldosterone and insulin functions Increased k + intake Packed cell transfuion Cell injury Packed cell transfusion 26

27. Decreased excretion Renal failure Ut obstruction Addison disease Angiotensin receptor blockers 27

28. Symptoms: Nausea Vomiting’s Paresthesia Skeletal fatigue ECG CHANGES -T wave TALL, prolonged PR interval, flat Pa 28

29. CALCIUM : 98% 0f calcium is in Skeleton Functions: Blood coagulation Cellular communication Exocytosis Muscle contraction Neuromuscular transmission 29

30. HYPO CALCEMIA: LESS THAN 8mg/dl or ionized ca +2 4mg/dl Causes: Aplasia of thyroid gland Pseudo hypo parathyroidism Mutations in calcium sensing receptors Vit D deficiency, resistance to Vit D actions 30

31. Hypo magnesemia Hyper phosphatemia Mal absorption Renal tubular acidosis Acute pancreatitis Drugs: corticosteroids or ptenytoin 31

32. Symptoms: CNS irritability Poor muscular contractility Poor feeding Vomiting’s Abdominal distension Muscle twitching ,cramps Tetany and signs of nerve irritability Carpopedal spasm and stridor Chavokestick sigh (twitching of orbiculo occcular ) 32

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34. RICKETS most common presentation in children 34

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36. HYPER CALCEMIA :   12mg/dl causes symptoms Causes : Neonatal hypoparathyroidism familiar hypocaloric hyper calcemia excess ca +2 supplementation Ewing sarcoma neuroblastoma Rhabdo sarcoma vit D Or A excess ,phosphate deficiency prolonged immobilization 36

37. symptoms : coma lethargy confusion hyporeflexia muscle weakness constipation nephrolithiasis polyuria Ectopic -conjunctivitis, pancreatitis 37

38. MAGNESIUM It is 3 rd moat abundant intracellular cation It is mostly bound to proteins Function s It helps in protein carbohydrate and fat metabolism Regulation of parathyroid hormone function Functioning of normal cell membrane Source Green leafy vegetables, cereals, nuts and meat. 38

39. ABSORBTION Parathyroid hormone and glucocorticoids increases its absorption Vitamin D and PTH also enhances its absorption In kidneys it is absorbed mainly in thick ascending loop of henle 39

40. 40 Increased intestinal motility and calcium also decrease magnesium absorption. Vitamin D and parathyroid hormone (PTH) may enhance absorption, although this effect is limited. Intestinal absorption does increase when intake is decreased

41. Hypermagnesemia When magnesium is greater than 2.5mg/dl Causes Mg containing antacids In neonates whose mother was given magnesium sulphate to prevent eclamsia 41

42. Symptoms Vomiting feeding difficulty Lethargy Weakness and dizziness 42

43. 43 HYPOMAGNESEMIA Hypomagnesemia with secondary hypocalcaemia, a rare autosomal recessive disorder, is caused by decreased intestinal absorption of magnesium and renal magnesium wasting. Poor intake Insulin administration Pancreatitis Intrauterine growth retardation Infants of diabetic mothers

44. 44 GASTROINTESTINAL DISORDERS Diarrhea Nasogastric suction or emesis Inflammatory bowel disease Small bowel resection or bypass Pancreatitis Protein-calorie malnutrition Hypomagnesemia with secondary hypocalcaemia

45. BICARBONATE (HCO3-): It is alkaline & a vital component of pH buffering system of human body. Normal range: 24-30 meq/lt FUNCTIONS: The blood electrolytes Sodium, Potassium, Chloride and bicarbonate helps to regulate nerve & muscle function and maintain Acid-Base balance and water balance in the body. Thus having electrolytes in right concentrations is important in maintaining fluid balance. . 45

46. SOURCE: It is released from the pancreas in response to harmone secretin to neutralize the acidic chime entering the duodenum from the stomach. DEFICIENCY: A low level of bicarbonate in blood may cause a condition called Metabolic acidosis 46

47. PHOSPHATES A phosphate is a chemical derivative of phosphoric acid. The phosphate ion (PO3−4) is an inorganic chemical, the conjugate base that can form many different salts. Phosphate, or phosphorous, is similar to calcium, and is found in your teeth and bones. You need vitamin D in order to absorb phosphate. NORMAL RANGE The normal range is 2.5-4.5 mg/dL. 47

48. SOURSE Finding foods with high phosphorus levels isn’t hard. Pork, cod, salmon, and tuna are all high in phosphorus. Good dairy sources include: • milk • chocolate • yogurt • ricotta and American cheese Bran cereal, blueberry muffins, and nachos are also high in phosphorus. 28% of frozen blueberries, 20% of celery, 27% of green beans, 17% of peaches, 8% of broccoli, and 25% of strawberries 48

49. Functions Phosphorus works with calcium to help build bones. You need the right amount of both calcium and phosphorus for bone health. Phosphorus also plays an important structural role in nucleic acids and cell membranes. And it’s involved in the body’s energy production. Your body absorbs less phosphorus when calcium levels are too high, and vice versa. You also need vitamin D to absorb phosphorus properly. 49

50. • Poor absorption of phosphate • If you had stomach surgery • If you are lacking in Vitamin-D • The absorption of phosphate is being blocked by aluminum hydroxide found in laxatives low blood magnesium (needed to absorb phosphorous), or high blood calcium (which binds to the phosphorous, making it lower than normal CAUSES 50

51. diuretics • Endocrine problems - such as a hyper parathyroid or thyroid gland • Alcoholism - drinking too much alcohol on a regular basis • Rickets • uncontrolled diabetes (or elevated blood glucose)- phosphate likes to follow or accompany glucose into the cells, so you may have severely low blood phosphorous 51

52. Symptoms of Hypophosphatemia: • Signs of hypophosphatemia include a lower than normal blood phosphate level. Other electrolyte values are likely to be affected , There are no symptoms of hypophosphatemia, unless the values are critically low. Then you may notice trouble breathing or respiratory problems, confusion, irritability, or coma. These all may occur with phosphorous levels of 0.1-0.2 mg/ dL. phosphorous levels are below 1.0 mg/dL, your tissues may have more trouble connecting hemoglobin with oxygen - which is critical for breathing. You may become mild to moderately short of breath. 52

53. HIGH PHOSPHATES The kidneys excrete phosphate. Therefore, the most common cause of hyperphosphatemia is the kidney's inability to get rid of phosphate. Hyperphosphatemia is also seen in people who have: •Excessive dietary intake of phosphate (also from laxatives or enemas) •Your body may have a deficiency in calcium or magnesium, or it may have too much Vitamin D, resulting in hyperphosphatemia. 53

54. • Severe infections can cause increased phosphate levels, resulting in hyperphosphatemia. • Cell destruction - from chemotherapy, when the tumor cells die at a fast rate. This can cause tumor lysis syndrome. • You may have high phosphate levels from prolonged exercise, which causes muscle damage. Certain athletes and distance runners may get this, called rhabdomyolysis. • You may have problems with your thyroid, parathyroid gland, or other hormones, causing increased levels of phosphate in your blood and resulting in hyperphosphatemia 54

55. • Normal Range - 95-105 m Eq/l • essential for maintaining acid/base balance transmitting nerve impulses , regulating in out of cells. • 90% Excreted in urine and also excreted in stool and sweet. • Sources - Table Salt ,Sea weed, rye, Tomatoes. • Hypochloraemia - Less than 95 meg/l caused by excessive use of loop diuretics ,Nasogastric suction, Vomiting, Metabolic alkalosis is usually present with hypochloraemia . H/O of diuretic therapy, vomiting , assessment of values in the metabolic alkaloses. 55

56. • Hypochloraemia - greater then 108 meg/L result of dehydration , administration of NACL metabolic acidosis is seen often seen in pts with severe diarrhoea (or) ureteral diversion. 56

57. Bibliography GHAI essential paediatrics Suraj Gupte short text book of paediatrics Nelson text book of paediatrics 20 edition 57

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