電解
質不
平衡
的急
診處
理
羅東
博愛
醫院
急診
部主
任
張啟
宏
Cas
e 1
�7
0 y
/o f
emal
e p
’t i
s su
ffer
ed f
rom
gen
eral
wea
kn
ess
in r
ecen
t d
ays.
�P
E:
WN
L ,
Vit
al s
ign
: st
able
.
�W
hat
sh
ou
ld w
e d
o?
�H
ow
to
man
agem
ent?
Cas
e 1
�R
ou
tin
e ch
eck
up
fo
r C
BC
, E
lect
roly
tes,
sug
ar,
etc.
�H
yp
on
atre
mia
11
0 m
mo
l/L
�T
x.
N/S
IV
F o
r 3
% s
alin
e IV
F ?
�R
apid
or
slo
wly
res
po
nse
?
�W
hy
hy
po
nat
rem
ia?
�Is
hy
po
nat
rem
ia t
he
real
ch
ief
pro
ble
m?
Cas
e 2
�6
5 y
/o m
ale
p’t
w
ith
pre
sen
tati
on
of
con
s.
Dis
turb
ance
, b
rad
yca
rdia
, co
ld s
wea
tin
g.
�V
ital
sig
n:B
P 9
0/3
6,
HR
28
�P
ast
Hx
. C
hro
nic
ren
al f
ailu
re,
DM
�W
hat
sh
ou
ld w
e d
o?
�It
is
tru
e em
erg
ency
.
Cas
e 2
�A
BC
D
�A
BG
, su
gar
on
e to
uch
, E
lect
roly
tes,
EK
G
�M
on
ito
r
�H
yp
erk
alem
ia:
7.7
mm
ol/
L
�T
X.
Cas
e 3
�6
4y
/o m
ale
p’t
, su
dd
en c
oll
apse
.
�S
ent
by
11
9
DO
A
�C
PR
an
d A
ED
wer
e in
stru
cted
�A
t E
R a
syst
ole
was
fir
st n
ote
d
�C
PR
an
d V
T w
ith
car
dio
ver
tio
n b
y E
R d
oct
or
and
p
’t r
egai
ned
pu
lse
Cas
e 3
�W
hat
sh
ou
ld w
e d
o?
�C
om
ple
te E
KG
, A
BG
�R
ou
tin
e ch
eck
up
fo
r C
BC
, E
lect
roly
tes,
su
gar
, et
c.
�A
BG
:p
H 7
.03
1
PC
O2
59
.9
PO
28
5.9
N
a 1
36
K
9.2
7
�B
UN
:46
, C
r:2
.7,
Na:
13
6,
K:1
1.1
9
�P
ast
Hx
. :
DM
, C
hro
nic
ren
al i
nsu
ffic
ien
cy
Cas
e 4
�A
80
Y/O
mal
e p
’t s
uff
ered
fo
rm p
rog
ress
ive
BW
lo
ss a
nd
po
or
app
etit
e, g
ener
al w
eak
nes
s,
som
no
len
ce ,
gen
eral
ized
ach
e.
�P
ast
Hx
. H
ealt
hy
�N
o d
rug
Hx
.
�P
E:E
3V
3M
5,
Dry
sk
in ,
pal
e co
nju
nct
iva
�W
hat
kin
d o
f ex
amin
atio
ns
sho
uld
we
app
ly?
Cas
e 4
�R
ou
tin
e ch
eck
up
�L
ab.:
Hb
: 9
.2,
BU
N:8
0,C
r:3
.5,
Na:
15
5,
K:4
.5
�C
XR
, S
ku
ll,
pu
nch
ed o
ut
lesi
on
�H
yp
erca
lcem
ia:
13
mg
/dl
�H
ow
to
man
agem
ent?
Gen
eral
Ap
pro
ach
�O
ne
sho
uld
nev
er c
om
ple
tely
tru
st t
he
lab
ora
tory
.
�E
rro
rs m
ay o
ccu
r�
In o
bta
inin
g t
he
sam
ple
�L
abel
ing t
he
sam
ple
�P
erfo
rmin
g t
he
test
�R
eport
ing t
he
resu
lt
Gen
eral
Ap
pro
ach
�A
bn
orm
alit
ies
sho
uld
be
trea
ted
at
app
rox
imat
ely
th
e ra
te a
t w
hic
h t
hey
dev
elo
ped
sin
ce b
iolo
gic
sy
stem
s re
act
pri
mar
ily
to
rat
e o
f ch
ang
e an
d n
ot
to a
bso
lute
con
cen
trat
ion
s.
Gen
eral
Ap
pro
ach
�O
ne
sho
uld
no
t co
rrec
t th
e p
H w
ith
ou
t al
so
eval
uat
ing
po
tass
ium
, ca
lciu
m,
and
mag
nes
ium
lev
els.
Gen
eral
Ap
pro
ach
�T
he
pri
ori
ties
fo
r co
rrec
tin
g m
ult
iple
flu
id,
elec
tro
lyte
s, a
nd
aci
d-b
ase
abn
orm
alit
ies
are
as f
oll
ow
s:
1.
Flu
id v
olu
me
and
per
fusi
on
def
icit
2.
pH
3.
Po
tass
ium
, ca
lciu
m, an
d m
agn
esiu
m
abn
orm
alit
ies
4.
So
diu
m a
nd
ch
lori
de
abn
orm
alit
ies
Ele
ctro
lyte
s
�何時檢查
�例行檢查
�為何懷疑電質不平衡
�緊急處理否
�危及生命否
�處置錯誤之嚴重性
�報告之判斷
急診
常見
的電
解質
不平
衡
�S
od
ium
(N
a) (
13
3-1
45
mm
ol/
L)
�P
ota
ssiu
m (
K)
(3.3
0-5
.10
mm
ol/
L)
�C
alci
um
(C
a) (
8.5
– 1
0.7
mg
/dl)
�M
agn
esiu
m (
Mg
) (1
.60
- 2
.30
mm
ol/
L)
�P
ho
sph
oru
s (P
) (2
.5 –
4.8
mg
/dl)
�C
hlo
rid
e (C
l) (
96
-1
10
mm
ol/
L)
Th
e E
lect
roly
te C
on
entr
atio
n o
f B
od
y
Flu
ids
(mE
q/L
)
E
xtr
acel
lula
r
Inte
rsti
tial
Intr
acel
lula
r
Solu
tion
Sea
wat
er
Flu
id
F
luid
F
luid
Cat
ions
S
odiu
m
425
142
1
44
10
P
ota
ssiu
m
1
5
4.5
4.5
1
50
M
agnes
ium
105
2
1
.0
4
0
C
alci
um
35
4
.5
2.5
T
ota
l
580
153
152
200
Anio
ns
C
hlo
ride
500
102
113
----
P
hosp
hat
es
10
2
2
120
S
ulf
ates
45
1
1
30
B
icar
bonat
e
25
2
7
30
10
P
rote
in
---
16
1
40
O
rgan
ic a
cids
-
--
5
5
T
ota
l
580
153
152
200
Av
erag
e E
lect
roly
te C
on
ten
t o
f
Var
iou
s B
od
y F
luid
s
S
od
ium
P
ota
ssiu
m
Ch
lori
de
B
icar
bo
nat
e
Vo
lum
e/D
ay
Sal
iva
10
-60
10
-20
15
-40
30
-15
10
00
-20
00
Sto
mac
h
4
0-1
00
5-1
5
1
5-2
0
---
-
1
50
0-2
50
0
Bil
e
13
0-1
40
4-6
9
5-1
05
3
0-4
0
5
0-1
00
0
Pan
crea
s
1
30
-14
0
4
-6
40
-60
80
-10
0
10
00
-20
00
Sm
all in
tesi
ne
13
0-1
40
4-6
4
0-6
0
8
0-1
00
10
00
-20
00
Co
lon
8
0-1
40
2
5-4
5
8
0-1
00
3
0-5
0
1
00
-60
0
Sw
eat
40
-50
5
-10
45
-60
--
--
2
00
-15
00
Hy
per
nat
rem
ia
�C
lin
ical
fea
ture
s
�A
lter
ed m
enta
l st
atu
s
�W
eak
nes
s
�N
euro
mu
scu
lar
irri
tab
ilit
y
�F
oca
l n
euro
log
ical
def
icit
s
�S
eizu
re
�C
om
a
ⅠC
ause
s o
f H
yp
ern
atre
mia
()
Ⅰ.L
oss
of
wat
er
A.
Red
uce
d w
ater
in
tak
e
1
. D
efec
tiv
e th
irst
2
. U
nco
nsc
iousn
ess
3
. In
abil
ity t
o d
rin
k w
ater
4
. L
ack
of
acce
ss t
o w
ater
ⅡC
ause
s o
f H
yp
ern
atre
mia
()
B.
Incr
ease
d w
ater
lo
ss
1
. V
om
itin
g,
dia
rrh
ea
2
. S
wea
tin
g,
fev
er
3
. H
yp
erv
enti
lati
on
4
. D
iab
etes
in
sip
idu
s, o
smo
tic
diu
resi
s
5
. T
hy
roto
xic
osi
s
6
. S
ever
e b
urn
s
Cau
ses
of
Hy
per
nat
rem
ia(Ⅲ
)
Ⅱ.G
ain
of
sod
ium
A.
Incr
ease
d i
nta
ke
1
. H
yp
erto
nic
sal
ine
ing
esti
on
or
infu
sio
n
2
. S
od
ium
bic
arb
on
ate
adm
inis
trat
ion
B.
Ren
al s
alt
rete
nti
on
(u
sual
ly b
ecau
se o
f p
oo
r p
erfu
sio
n)
Cau
ses
of
Hyper
nat
rem
ia R
elat
ed
to B
lood V
olu
me
Ⅰ.H
ypo
vo
lem
ia
A
. N
on
ren
al H
2O
lo
sses
(U
Na
< 1
0 m
Eq
/L, U
Osm
> 4
00
mO
sm/L
)
fr
om
sk
in o
r G
I o
r re
spir
ato
ry t
ract
s
B
. R
enal
H2O
lo
sses
(U
Na
> 2
0 m
Eq
/L, U
Osm
< 3
00
mO
sm/L
)
fr
om
diu
reti
cs, re
nal
dis
ease
, re
lief
of
uri
nar
y
o
bst
ruct
ion
, ad
ren
al f
ailu
re, o
smo
rece
pto
r fa
ilu
re
Cau
ses
of
Hyper
nat
rem
ia R
elat
ed
to B
lood V
olu
me
Ⅱ.E
uv
ole
mia
A.
Imp
aire
d t
hir
st (
com
a)
B.
No
nre
nal
H2O
lo
sses
(G
I, s
kin
, re
spir
ato
ry)
C.
Ren
al H
2O
lo
sses
du
e to
DI,
res
et
osm
ost
at,
reli
ef o
f u
rin
ary
ob
stru
ctio
n,
ren
al d
isea
se,
osm
oti
c d
iure
tics
Cau
ses
of
Hyper
nat
rem
ia R
elat
ed
to B
lood V
olu
me
Ⅲ.H
yp
erv
ole
mia
A.
Iatr
og
enic
(h
yp
erto
nic
sal
ine
ther
apy
)
B.
Min
eral
oco
rtic
oid
ex
cess
(U
Na
> 2
0 m
E/L
,
UO
sm >
30
0 m
Osm
/L)
du
e to
hy
per
ald
ost
ero
nis
m, C
ush
ing
’s d
isea
se,
con
gen
ital
adre
nal
hyp
erpla
sia,
ex
og
eno
us
cort
ico
ster
oid
s
Hy
per
nat
rem
ia
�T
reat
men
t
�W
ater
def
icit
(in
lit
ers)
=T
BW
(1-
)
�N
orm
al s
alin
e o
r R
ing
er’s
so
luti
on
�H
alf
sali
ne
or
D5
W
Na
2
Na
1
Hy
po
nat
rem
ia�
Cli
nic
al f
eatu
res
�F
atig
ue
�W
eaknes
s
�M
usc
le c
ram
ps
�T
hir
st
�D
izzi
nes
s
�O
ligouri
a
�C
yan
osi
s
�C
hes
t pai
n
�A
bd. P
ain
�C
onfu
sion
�S
eizu
re
�C
om
a
Cau
ses
of
Hy
po
nat
rem
iaⅠ
.Hyponat
rem
ia w
ith d
ecre
ased
EC
F
A
. E
xtr
aren
al l
oss
es;
uri
nar
y N
a <
20 m
Eq/L
1.
Sw
eati
ng, vom
itin
g,
dia
rrhea
2.
Thir
d-s
pac
e se
ques
trat
ion
(
burn
s, p
erit
onit
is, pan
crea
titi
s)
B
. R
enal
loss
es;
uri
nar
y N
a >
20 m
Eq/L
1.
Loo
p o
r o
smoti
c diu
reti
cs
2.
Ald
ost
erone
def
icie
ncy
(A
ddis
on’s
dis
ease
)
3.
Ket
on
uri
a
4.
Sal
t-lo
sing n
ephro
pat
hie
s; r
enal
tu
bula
r ac
ido
sis
Cau
ses
of
Hy
po
nat
rem
ia
Ⅱ.H
yp
on
atre
mia
wit
h n
orm
al E
CF
; u
rin
ary
Na
> 2
0
mE
q/L
A
. In
app
rop
riat
e A
DH
sec
reti
on
B
. S
ick
-cel
l o
r “r
eset
osm
ost
at”
syn
dro
mes
C
. P
hy
sica
l an
d e
mo
tio
nal
str
ess
or
pai
n
D
. M
yx
edem
a, A
dd
iso
n’s
dis
ease
,
S
hee
han
’s s
yn
dro
me
Cau
ses
of
Hy
po
nat
rem
ia
Ⅲ.H
yp
on
atre
mia
wit
h i
ncr
ease
d E
CF
A
. U
rinar
y N
a >
20
mE
q/L
1
. R
enal
fai
lure
B
. U
rinar
y N
a <
20
mE
q/L
1
. C
irrh
osi
s
2
. C
ardia
c fa
ilu
re
3
. R
enal
fai
lure
Ⅳ.P
seu
do
hy
po
nat
rem
ia (
hy
per
pro
tein
emia
, h
yp
erli
pid
emia
, h
yp
erg
lyce
mia
)
Cau
ses
of
SIA
DH
Cen
tral
ner
vo
us
syst
em d
iso
rder
s
H
ead
tra
um
a
B
rain
tu
mo
rs,
bra
in a
bsc
esse
s
M
enin
git
is,
ence
ph
alit
is
S
ub
arac
hn
oid
hem
orr
hag
e
D
elir
ium
tre
men
s
Tu
mo
rs
L
un
g c
ance
r (e
spec
iall
y s
mal
l ce
ll),
ca
nce
r o
f th
e p
ancr
eas,
ov
aria
n
can
cer
L
ym
ph
om
a
T
hym
om
a
Pu
lmo
nar
y d
iso
rder
s
T
ub
ercu
losi
s
P
neu
mo
nia
, em
pyem
a
L
un
g a
bsc
ess
C
yst
ic f
ibro
sis,
CO
PD
Dru
gs
N
arco
tics
C
hlo
rpro
pam
ide
N
SA
IDs
V
incr
isti
ne,
vin
bla
stin
e
C
ycl
op
ho
sph
amid
e, p
hen
oth
iazi
ne
M
on
oam
ine
ox
idas
e in
hib
ito
rs
T
ricy
clic
an
tid
epre
ssan
ts
T
hia
zid
e d
iure
tics
End
ocr
ine
dis
ord
ers
H
yp
oth
yro
idis
m
G
luco
cort
ico
id i
nsu
ffic
ien
cy
Mis
cell
aneo
us
P
orp
hyri
a
P
ain
, n
ause
a
Id
iop
ath
ic
Hy
po
nat
rem
ia
�T
reat
men
t
�W
ater
res
tric
tio
n
�H
yp
erto
nic
sal
ine
�C
alcu
lati
ng
so
diu
m d
efic
its:
TB
W(
x 6
0%
)(N
a 1-N
a 2)
�T
reat
men
t o
f p
seu
do
hy
po
nat
rem
ia
�O
smo
tic
dem
yel
inat
ion
sy
nd
rom
e
(cen
tral
po
nti
ne
my
elin
osi
s)
Hy
per
kal
emia
�C
lin
ical
fea
ture
s
�In
trac
ard
iac
blo
ck
�A
tria
l
�A
V n
od
e
�V
entr
icle
s
Co
mm
on
Cau
ses
of
Hy
per
kal
emia
Fac
titi
ous
L
abora
tory
err
or
P
seudohyper
kal
emia
: hem
oly
sis,
thro
mbocy
tosi
s,
leukocy
tosi
s
Met
aboli
c ac
idem
ia (
acute
)
Incr
ease
d i
nta
ke
into
the
pla
sma
E
xogen
ous:
die
t, s
alt
subst
itute
s, l
ow
-sodiu
m d
iet,
m
edic
atio
ns
E
ndogen
ous:
hem
oly
sis,
GI
ble
edin
g, ca
taboli
c st
ates
, cr
ush
in
jury
Inad
equat
e dis
tal
del
iver
y o
f so
diu
m a
nd d
ecre
ase
dis
tal
tublu
ar f
low
Co
mm
on
Cau
ses
of
Hy
per
kal
emia
Oli
gouri
c re
nal
fai
lure
Impai
red r
enin
-ald
ost
erone
axis
A
ddis
on’s
dis
ease
P
rim
ary h
ypoal
dost
eronis
m
O
ther
(hep
arin
, β
blo
cker
s, p
rost
agla
ndin
inhib
itors
, ca
pto
pri
l)
Pri
mar
y r
enal
tubula
r pota
ssiu
m s
ecre
tory
def
ect
s
ickle
cel
l dis
ease
s
yst
emic
lupus
eryth
emat
osu
s
P
ost
renal
tra
nsp
lanta
tion
O
bst
ruct
ive
uro
pat
hy
Co
mm
on
Cau
ses
of
Hy
per
kal
emia
Inh
ibit
ion
of
ren
al t
ub
ula
r se
cret
ion
of
po
tass
ium
S
pir
on
ola
cto
ne
D
igit
alis
Ab
no
rmal
po
tass
ium
dis
trib
uti
on
I
nsu
lin
def
icie
ncy
H
yp
erto
nic
ity
(h
yp
erg
lyce
mia
)
β
-Ad
ren
erg
ic b
lock
ers
E
xer
cise
S
ucc
iny
lch
oli
ne
D
igit
alis
Hy
per
kal
emia
�D
iag
no
sis
�W
hy
do
yo
u s
usp
ect?
�W
hat
to
do
?
�A
BG
�E
KG
�Q
uic
kly
ass
essm
ent.
EK
G c
han
ge
of
Hy
per
kal
emia
Hy
per
kal
emia
Em
erg
ency
Th
erap
y o
f H
yp
erk
alem
ia
D
ura
tio
n o
f H
yp
ok
ale
mic
Th
era
py
M
ech
an
ism
D
ose
O
nse
t o
f A
cti
on
E
ffec
t
Ca
chlo
rid
e (1
0%
) A
nta
go
nis
m 5
- 1
0m
L I
V 1
-3 m
in 3
0-5
0 m
in
Na
bic
arb
on
ate
A
nta
go
nis
m a
nd
5
0 m
Eq
IV
5
-10
min
1
-2 h
re
dis
trib
uti
on
Insu
lin
plu
s g
luco
se R
edis
trib
uti
on
1
0 U
reg
ula
r in
suli
n 3
0 m
in 4
-6 h
w
ith
25
g g
luco
se I
V
Diu
reti
cs E
xcr
etio
n 4
0 t
o 8
0 m
g I
V W
ith
diu
resi
s W
ith
diu
resi
s
F
uro
sem
ide
5
0 m
g I
V
E
thac
ryn
ic a
cid
Cat
ion
-ex
chan
ge
resi
n E
xcr
etio
n 1
5-5
0 g
PO
or
rect
ally
1
-2 h
4
-6 h
(K
ayex
alat
e)
w
ith
so
rbit
ol
Per
ito
nea
l d
ialy
sis
or
E
xcr
etio
n W
ith
in m
inu
tes
D
uri
ng
dia
lysi
s
hem
od
ialy
sis
Hy
po
kal
emia
�C
lin
ical
fea
ture
s
�M
usc
le w
eak
nes
s
�In
test
inal
ile
us
�R
esp
irat
ory
par
aly
sis
�R
elat
ed t
o d
igit
alis
Cau
ses
of
Hy
po
kal
emia
Ⅰ.
Sh
ift
into
th
e ce
ll
A.
Rai
sin
g t
he
pH
of
blo
od
B.
Ad
min
istr
atio
n o
f in
suli
n a
nd
glu
cose
Ⅱ.
Red
uce
d i
nta
ke
Cau
ses
of
Hy
po
kal
emia
Ⅲ. In
crea
sed l
oss
A. R
enal
loss
1
. P
rim
ary h
yper
aldost
ero
nis
m
2
. S
econdar
y h
yper
aldost
eron
ism
aso
ciat
ed w
ith d
iure
tics
, m
alig
nan
t hyper
tensi
on, B
artt
er’s
syndro
me,
ren
al a
rter
y
sten
osi
s
3
. M
isce
llan
eous
a
. H
yper
calc
emia
b
. L
iddle
’s s
yndro
me(
pse
udohyper
aldost
eronis
m)
c
. M
agnes
ium
def
icie
ncy
d
. R
enal
tubula
r ac
idosi
s
e
. A
cute
myel
ocy
tic
and m
onocy
tic
leukem
ias
B.
Gas
troin
test
inal
loss
(vo
mit
ing, d
iarr
hea
, fi
stu
las)
Hy
po
kal
emia
�T
reat
men
t
�1
0-1
5 m
Eq
KC
l IV
in
fusi
on
per
hr
�N
ever
ex
ceed
20 m
Eq K
Cl/
500
ml
�4
0-5
0 m
Eq
KC
l to
rai
se 1
.0m
Eq
/L
�O
ral
po
tass
ium
Sy
mp
tom
s an
d s
ign
s o
f H
yp
erca
lcem
iaG
ener
al
M
ala
ise,
weak
nes
s
P
oly
dip
sia,
deh
ydra
tio
n
Neu
rolo
gic
C
onfu
sion
A
pat
hy
, d
epre
ssio
n,
stu
po
r
D
ecr
eas
ed m
em
ory
I
rrit
abil
ity
H
all
ucin
ati
ons
H
ead
ach
e
A
taxia
H
yp
ore
flexia
, h
ypo
ton
ia
M
enta
l re
tard
ati
on (
infa
nts
)
Met
asta
tic
calc
ific
atio
n
B
and k
erat
opath
y
C
onju
ncti
vit
is
P
ruri
tus
Skel
etal
F
ract
ure
s
B
one
pai
n
D
efo
rmit
ies
Car
dio
vas
cula
r
H
yper
tensi
on
A
rrhy
thm
ias
V
ascu
lar
calc
ific
atio
ns
E
CG
abnorm
alit
ies
Q
T s
hort
enin
g
C
ovin
g o
f S
T-T
wav
e
W
iden
ing o
f T
wav
e
D
igit
alis
sen
siti
vit
y
Gas
troin
test
inal
A
nore
xia
, w
eight
loss
N
ause
a, v
om
itin
g
C
onst
ipat
ion
A
bdom
inal
pai
n
P
epti
c ulc
er d
isea
se
P
ancr
eati
tis
Uro
logic
P
oly
uri
a, n
oct
uri
a
R
enal
insu
ffic
iency
N
ephro
lith
iasi
s
Cau
ses
of
Hy
per
calc
emia
Ma
lig
na
ncy
L
un
g (
squ
am
ou
s ce
ll c
an
cer)
B
rea
st
K
idn
ey
M
yel
om
a
L
euk
emia
En
do
crin
op
ath
ies
P
rim
ary
hy
per
pa
rath
yro
idis
m
H
yp
erth
yro
idis
m
P
heo
chro
mo
cyto
ma
A
dre
na
l In
suff
icie
ncy
A
cro
meg
aly
Dru
gs
H
yp
erv
ita
min
osi
s D
an
d A
T
hia
zid
es
L
ith
ium
H
orm
on
al
ther
ap
y f
or
bre
ast
Gra
nu
lom
ato
us
dis
ease
S
arc
oid
T
ub
ercu
losi
s
H
isto
pla
smo
sis
C
occ
idio
my
cosi
s
Imm
ob
iliz
ati
on
Mis
cell
an
eou
s
P
ag
et’s
dis
ease
of
bo
ne
P
ost
ren
al
tra
nsp
lan
tati
on
R
eco
ver
y f
rom
acu
te r
ena
l fa
ilu
re
P
ho
sph
ate
dep
leti
on
sy
nd
rom
e
Tre
atm
ent
of
Hy
per
calc
emia
Dru
g
Do
se
Cau
tio
ns
Sal
ine
U
nti
l E
CF
is
rest
ore
d
W
atch
fo
r
h
yp
ok
alem
ia
Fu
rose
mid
e
40
-10
0 m
g I
V q
2-4
h
D
igit
alis
, re
nal
fai
lure
Dec
reas
e b
on
e ab
sorp
tio
n
C
alci
ton
in
0.5
-4 M
RC
un
its/
kg
IV
o
ver
24
h (
or
IM q
6 h
in
div
ided
do
ses)
M
ith
ram
yci
n
2
5 µ
g/k
g I
V
B
on
e m
arro
w a
nd
ren
al t
ox
icit
y
H
yd
roco
rtis
on
e
3 m
g/k
g p
er d
ay I
V i
n
M
ay t
ake
3 w
eek
s to
d
ivid
ed d
ose
s q
6 h
lo
wer
Ca2
+
I
nd
om
eth
acin
2
5 m
g P
O q
6 h
P
epti
c u
lcer
dis
ease
,
GI
ble
edin
g
Tre
atm
ent
of
Hy
per
calc
emia
�C
alci
um
>1
2 m
g/d
l
�S
ym
pto
ms
�In
abil
ity
to
mai
n a
go
od
flu
id i
nta
ke
�A
bn
orm
al r
enal
fu
nct
ion
Sy
mp
tom
s an
d s
ign
s o
f H
yp
oca
lcem
ia�
Gen
eral
Wea
kn
ess,
fat
igu
e�
Neu
rolo
gic
Tet
any
Ch
ov
stek
’s s
ign
, T
rou
ssea
u’s
si
gn
Cir
cum
ora
l an
d d
igit
al
par
esth
esis
Imp
aire
d m
emo
ry,
con
fusi
on
Hal
luci
nat
ion
s ,d
emen
tia,
se
izu
res
Ex
trap
yra
mid
al d
iso
rder
s�
Der
mat
olo
gic
Hyp
erp
igm
enta
tio
n
Co
urs
e, b
ritt
le h
air
Dry
, sc
aly s
kin
�C
ard
iov
ascu
lar
Hea
rt f
ailu
re
vas
oco
nst
rict
ion
�M
usc
ula
r
Sp
asm
s, c
ram
ps
Wea
kn
ess
�S
kel
etal
Ost
eod
yst
rop
hy
Ric
ket
s
Ost
eom
alac
ia�
Mis
cell
aneo
us
d
enta
l h
yp
op
lasi
a
Cat
arac
ts
Dec
reas
ed i
nsu
lin
sec
reti
on
Cau
ses
of
Hy
po
calc
emia
Sh
ock
or
sep
sis
Imp
aire
d p
rod
uct
ion
of
1α
, 2
5-
dih
yd
rox
yv
itam
in D
3
M
alab
sorp
tio
n
S
ever
e h
epat
ic f
ailu
re
R
enal
fai
lure
A
nti
con
vu
lsan
t th
erap
y
Pan
crea
titi
s
Cau
ses
of
Hy
po
calc
emia
Hy
po
mag
nes
emia
Alk
alo
sis
Dec
reas
ed s
eru
m a
lbu
min
lev
els
Hy
po
par
ath
yro
idis
m
I
dio
pat
hic
P
ost
surg
ical
P
seud
ohy
po
par
ath
yro
idis
m
Ost
eob
last
ic m
etas
tase
s
Fat
em
bo
lism
sy
nd
rom
e
Dru
gs
Th
at C
an C
ause
Hy
po
calc
emia
Cim
etid
ine
Ph
osp
hat
es (
e.g
., e
nem
as,
lax
ativ
es)
Dil
anti
n,
ph
eno
bar
bit
al
Gen
tam
icin
, to
bra
my
cin
Cis
pla
tin
Hep
arin
Th
eop
hy
llin
e
Dru
gs
Th
at C
an C
ause
Hy
po
calc
emia
Pro
tam
ine
Glu
cago
n
Nore
pin
eph
rine
Cit
rate
(blo
od)
Loo
p d
iure
tics
Glu
coco
rtic
oid
s
Mag
nes
ium
su
lfat
e
So
diu
m n
itro
pru
ssid
e
Tre
atm
ent
of
Hy
po
calc
emia
Par
ente
ral
Ca2
+ g
luco
nat
e
(10
%)
Ca2
+ c
hlo
rid
e
(10
%)
Ora
l
Ca2
+ g
lub
ion
ate
Tab
lets
Ca2
+ g
lub
ion
ate
(Neo
-cal
glu
con
)
Ca2
+ l
acta
te
Tab
lets
Ca2
+ c
arb
on
ate
Tit
rala
c
Os-
Cal
10
-mL
am
pu
les
10
-mL
am
pu
les
10
00
mg
(al
so 3
25
-,
5
00
-, a
nd
60
0-m
g
tab
lets
)
5 m
L s
yru
p
65
0 m
g
5-m
L s
olu
tio
n, o
r 6
50
-mg
ta
ble
t
Tab
let
93
mg
Ca2
+
(4.6
mE
q)
27
2 m
g C
a2+
(13
.6 m
Eq
)
92
mg
Ca2
+
(4.5
mE
q)
23
mg
Ca2
+ /
mL
79
mg
Ca2
+
17
0,
400
mg C
a2+
25
0 m
g C
a2+
(12
5 U
vit
amin
D)
10
-30
mL
in
10
0m
L
D
5W
ov
er
1
0-1
5 m
in
2.5
-10
mL
in 1
00
mL
D
5W
ov
er 1
0-1
5
m
in
1-4
g/d
ay i
n d
ivid
ed d
ose
s q
6 h
1-4
g/d
ay i
n d
ivid
ed d
ose
s q
6 h
1-4
g/d
ay i
n d
ivid
ed d
ose
s q
6 h
1-4
g/d
ay i
n d
ivid
ed d
ose
s q
6 h
Cau
ses
of
Hy
po
mag
nes
emia
Gas
troin
test
inal
P
rote
in-c
alori
e m
alnutr
itio
n
H
yper
alim
enta
tion a
fter
mal
nutr
itio
n
M
alab
sorp
tion (
dia
rrhea
), f
istu
las
A
lcoholi
c ci
rrhosi
s
P
ancr
eati
tis
Ren
al
G
lom
erulo
nep
hri
tis,
py
elonep
hri
tis
D
iure
tic
phas
e of
acute
tubula
r nec
rosi
s
H
yper
calc
emia
Endocr
ine
A
ldost
eronis
m
H
yper
par
athy
roid
ism
, hy
per
thy
roid
ism
Dru
g-i
ndu
ced
D
iure
tics
A
min
ogly
cosi
des
C
ispla
tin
V
itam
in D
into
xic
atio
n
D
igoxin
A
lcohol
I
nsu
lin
C
itra
te (
blo
od)
Mis
cell
aneo
us
L
act
atio
n
S
wea
tin
g
H
ungry
bone
syndro
me
B
urn
s
S
epsi
s
Sym
pto
ms
and S
igns
of
Hypom
agnes
emia
Neu
rom
usc
ula
r
T
etan
y
M
usc
le w
eaknes
s
C
ereb
ella
r (a
taxia
, nyst
agm
us,
ver
tigo)
C
onfu
sion, obtu
ndat
ion, co
ma
S
eizu
res
A
pah
ty, dep
ress
ion
I
rrit
abil
ity
P
ares
thes
ias
Gas
troin
test
inal
D
ysp
hag
ia
A
nore
xia
, nau
sea
Car
dio
vas
cula
r
H
eart
fai
lure
A
rrhyth
mia
s
H
ypote
nsi
on
Mis
cell
aneo
us
H
ypokal
emia
H
ypoca
lcem
ia
A
nem
ia
Tre
atm
ent
of
Hy
po
mag
nes
emia
Dru
g
Par
ente
ral
MgS
O4(1
g =
98 m
g o
f ele
men
tal
Mg
2+)
MgC
l 2(1
g =
118 m
g
ele
men
tal
Mg
2+)
Ora
l
MgO
Mg(O
H) 2
(m
ilk o
f m
agnes
ia)
Siz
e an
d C
on
ten
ts
10%
(20-m
L a
mpule
s, 0
.81
mE
q/m
L)o
r
50%
(2-m
l am
pule
s,
4 m
Eq/m
L)
20%
(30-m
L b
ott
le,
1.9
7
mE
q/m
L)
400-m
g t
able
ts
(20 m
Eq)
7.5
% (
2.9
mE
q/5
mL
)
Dose
1-2
g M
gS
O4 o
r
MgC
l 2 b
y c
onti
nuous
IV
ever
y 4
-6 p
rn
1-4
per
day
5-1
5 m
L t
id
Co
mm
on
Cau
ses
of
Hy
per
kal
emia
�E
nd
og
eno
us
Cau
ses
�C
hro
nic
ren
al f
ailu
re
�M
etab
oli
c ac
idosi
s
�P
seudohypoal
dost
eronis
m t
ype
II
�C
hem
oth
erap
y c
ausi
ng t
um
or
lysi
s
�R
hab
dom
yoly
sis
�R
enal
tubula
r ac
idosi
s
�H
emoly
sis
�H
ypoal
dost
eronis
m
�H
yper
kal
emic
per
iodic
par
alysi
s
Co
mm
on
Cau
ses
of
Hy
per
kal
emia
�E
xo
gen
ou
s ca
use
s
�M
edic
atio
ns:
K+
-sp
arin
g d
iure
tics
, A
CE
inh
ibit
ors
, N
SA
IDS
, p
ota
ssiu
m s
up
ple
men
ts,
pen
icil
lin
der
ivat
ives
, su
ccin
ylc
ho
lin
e, h
epar
in
ther
apy
, β
- b
lock
ers
�B
loo
d a
dm
inis
trat
ion
�D
iet,
sal
t su
bst
itu
tes
�P
seu
do
hy
per
kal
emia
Tre
atm
ent
of
Hy
per
kal
emia
�F
or
mil
d e
lev
atio
n (
5 t
o
6 m
Eq
/L)
�1
. D
iure
tics
: fu
rose
mid
e 4
0 t
o 8
0 m
g I
V
�2
. R
esin
s: K
ayex
alat
e 1
5 t
o 3
0 g
in
50
to
10
0 m
l
of
20
% s
orb
ito
l ei
ther
ora
lly
or
by
ret
enti
on
enem
a
Tre
atm
ent
of
Hy
per
kal
emia
�F
or
mo
der
ate
elev
atio
n (
6 t
o 7
mE
q/L
)
�1
. G
luco
se p
lus
insu
lin
: m
ix 2
5g
(5
0m
l o
f
D5
0)g
luco
se a
nd
10
U r
egu
lar
insu
lin
an
d g
ive
IV
ov
er 1
5 t
o 3
0 m
ins.
�2
. S
od
ium
bic
arb
on
ate:
50
mE
q I
V o
ver
5 m
ins
�3
. N
ebu
lize
d a
lbu
tero
l: 1
0 t
o 2
0 m
g n
ebu
lize
d
ov
er 1
5m
ins.
Tre
atm
ent
of
Hy
per
kal
emia
�F
or
sev
er e
lev
atio
n (
>7
mE
q/L
)�
1. C
alci
um
chlo
ride
(10%
): 5
00 t
o1000 m
g I
V o
ver
2 t
o 5
m
ins.
�2. S
odiu
m b
icar
bonat
e: 5
0 m
Eq I
V o
ver
5 m
ins
�3. G
luco
se p
lus
insu
lin:
mix
25g (
50m
l of
D50)g
luco
se
and 1
0 U
reg
ula
r in
suli
n a
nd g
ive
IV o
ver
15 t
o 3
0 m
ins.
�4. N
ebuli
zed a
lbute
rol:
10 t
o 2
0 m
g n
ebuli
zed o
ver
15m
ins
�5. D
iure
tics
: fu
rose
mid
e 40 t
o 8
0 m
g I
V�
6. R
esin
s: K
ayex
alat
e 15 t
o 3
0 g
in 5
0 t
o 1
00 m
l of
20%
so
rbit
ol
eith
er o
rall
y o
r by r
eten
tion e
nem
a�
7. D
ialy
sis