Diarrhea (OTC Treatment)

DIARRHEA Diarrhea = an increase in stool frequency Loose, watery stools May be acute or chronic Viruses are the cause of most acute diarrhea  (rotavirus vaccine cures this the majority of the time) Traveler’s diarrhea is usually bacterial in nature May also be caused by parasites, food intolerances (lactose), medications (like antibiotics) Lactose intolerance:  congenital … Continue reading

Fluids Overview

Body fluid compartments as a percentage of total body weight and their approximate total volumes a.    Total body water (TBW) 60% of body weight for adults 40% intracellular 15% interstitial 5 % intravascular 1 L of fluid = 2.2 lbs  (1 kg) Ex. A 154lb male:  (154/2.2) * 0.60 = 42.0 L b.    Extracellular fluid … Continue reading

Electrolytes Overview

Electrolytes that are primarily found in the ECF and ICF compartments ECF Na, K, Ca, Mg Cl, HCO3, PO4, SO4 ICF K, Mg PO4, SO4 Relationship between serum sodium concentration and TBW Plasma osmolality is determined by ratio of plasma solutes (Na) and plasma water The body regulates water to maintain plasma osmolality An increased … Continue reading

Hypertonic hyponatremia

Hypertonic hyponatremia Usually associated with hyperglycemia (present in patients with diabetic ketoacidosis) For every 60mg/dL above 200mg/dL of serum glucose, Na is expected to decrease by ~1 mEq/L When there is an osmotic shift of water from ICF to ECF, there is a decrease in serum Na

Hypervolemic Hyponatremia

Hypotonic hyponatremia with increased ECF volume  (hypervolemic hyponatremia) Excess of both total body Na & water Excess of TBW is greater than the excess of Na Results in chronic fluid overload Causes: CHF, hepatic cirrhosis, nephrotic syndrome, renal failure (both acute & chronic) Trxt: hypertonic NaCl/fluid restriction, loop diuretic + treat the underlying disorder Drug … Continue reading

Hypovolemic Hyponatremia

Hypotonic hyponatremia with decreased ECF volume  (hypovolemic hyponatremia) Deficit of both total body Na & water Deficit of total body Na is greater than the deficit of total body water Causes: diuretics, sweating, Vomit/Diarrhea, hypoadrenalism (low cortisol, low aldosterone), renal tubular acidosis, burns (third space losses) Trxt: resolve the underlying cause, NS, (DON’T USE VAPTANS–CONTRAINDICATED … Continue reading

Euvolemic Hyponatremia

Hypotonic hyponatremia with normal ECF volume  (euvolemic hyponatremia) Slight excess of total body water, normal Na Excess of “free water” Causes: inappropriate ADH, carcinomas, pulmonary disorders, CNS disorders (strokes, meningitis, etc), Drugs (antidepressants, antipsychotics, anesthetics, etc) Trxt: fluid restriction (500-1000mL), hypertonic saline, take away the drugs causing it Drugs used for trxt: demeclocycline (delayed onset … Continue reading

Hypernatremia

Hypernatremia Same sign and symptoms of TBW depletion Causes: dehydration, decreased water intake, osmotic diuresis, diabetes insipidus Replace the deficit over 48-72 hours with solution hypotonic to patient’s serum Don’t try to correct too quickly or it can lead to cerebral edema/death Replace half of the calculated deficit with hypotonic solutions over 12-24 hours

Hypokalemia

Hypokalemia Signs/symptoms: muscle weakness, cramps, N/V, polyuria, EKG changes, arrhythmias, increase in pH & bicarb Causes: HI loss (D/V), renal losses (high aldosterone, low Mg), inadequate intake, alkalosis, meds (beta-2 agonists, insulin, diuretics, corticosteroids, high dose antibiotics, amphotericin B, cisplatin, foscarnet, aminoglycosides) Trxt: potassium repletion should involve close monitoring of levels rather than using a … Continue reading

Hyperkalemia

Hyperkalemia Signs/symptoms:  muscle weakness, GI hypermotility, hypotension, acidosis, EKG changes, cardiac arrythmias, a decrease in pH causes an increase in potassium Causes: increased potassium intake due to salt subs, blood transfusions, rapid excessive IV admin, meds (K-sparing diuretics, cyclosporine, ACE-I, B-blockers, bactrim, NSAIDs, heparin, digoxin, succinylcholine, K supplements Other causes: decreased K excretion due to … Continue reading