Treatment of electrolyte disorders in adult patients in the intensive care unit

Abstract

Purpose. The treatment of electrolyte disorders in adult patients in the intensive care unit (ICU), including guidelines for correcting specific electrolyte disorders, is reviewed. Summary. Electrolytes are involved in many metabolic and homeostatic functions. Electrolyte disorders are common in adult patients in the ICU and have been associated with increased morbidity and mortality, as has the improper treatment of electrolyte disorders. A limited number of prospective, randomized, controlled studies have been conducted evaluating the optimal treatment of electrolyte disorders. Recommendations for treatment of electrolyte disorders in adult patients in the ICU are provided based on these studies, as well as case reports, expert opinion, and clinical experience. The etiologies of and treatments for hyponatremia hypotonic and hypernatremia (hypovolemic, isovolemic, and hypervolemic), hypokalemia and hyperkalemia, hypophosphatemia and hyperphosphatemia, hypocalcemia and hypercalcemia, and hypomagnesemia and hypermagnesemia are discussed, and equations for determining the proper dosages for adult patients in the ICU are provided. Treatment is often empirical, based on published literature, expert recommendations, and the patient's response to the initial treatment. Actual electrolyte correction requires individual adjustment based on the patient's clinical condition and response to therapy. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders in order to provide the optimal therapy to patients. Conclusion. Treatment of electrolyte disorders is often empirical, based on published literature, expert opinion and recommendations, and patient's response to the initial treatment. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders to provide optimal therapy for patients.

Delayed Recovery from Anaesthesia: Missing Information

“…(Treatment for hyperkalaemia is furosemide 20-40 mg IV, time of onset being 5-15 minutes and duration of action 4-6 hours) [11].…”

“…Continuous cardiac monitoring and infusion via a central venous catheter are recommended for infusion rates > 10 mEq/h. Maximum K = 80 mEq/L via a peripheral vein, upto 120 mEq/ L via a central vein (admixed in 0.9% or 0.45% sodium chloride injection) [11].…”

“…There has been numerous reports of neuromuscular weakness postneostigmine administration following spontaneous recovery of muscle function [10,11]. It has been suggested to use lower dose of reversal agent if the TOF is between 0.4 to 0.9 [12].…”

Preventing Hypokalemia in Critically Ill Patients

“…2,10 Hypokalemia is often associated with hypomagnesemia, which is also common in critically ill patients. [11][12][13] Normally serum potassium levels fluctuate between 3.5 and 5 mmol/L.…”

“…These indications include nausea, vomiting, weakness, constipation, respiratory compromise, and arrhythmia. 2 In instances of marked potassium loss, paralysis, rhabdomyolysis, myocardial infarction, and sudden death can occur. 1,4,14 Hypokalemia has also been associated with difficulty in weaning from mechanical ventilation 2,3 and subsequently can cause an increase in length of stay in the intensive care unit (ICU) and the hospital.…”