Electrolyte

Imbalance
IV Solutions
HYPONATREMIA Hyponatremia
EVALUATION Na < 135 mEq/L

Severe symptoms Mild symptoms

Seizure, coma, respiratory distress Headache, lethargy

Severe hypoNa
Na < 120 mEq
Serum osmolality
2 x [Na] + (Glucose/18) + (Ureum/2.8)
NaCl 3%

Isotonic/pseudo hypoNa Hypotonic hypoNa Hypertonic hypoNa

280-285 mOsm/kg <280 mOsm/kg >285 mOsm/kg

Hyperproteinuria Hyperglycemia
Corrected Na = Na + {(gluc – 100)/100}
Hyperlipidemia

Hypovolemic Euvolemic Hypervolemic

NaCl 0.9% Fluid restriction Fluid & Na

restriction
HYPONATREMIA
TREATMENT

Na deficit  k  body weight  ΔNa

k  0.6 for men
k  0.5 for women

Max ΔNa/24h  10 mEq

[Na] in NaCl 3%  513 mEq/L

Na deficit
NaCl 3% required  / 24 hours
513 mEq/L
HYPONATREMIA
TREATMENT

 Too rapid correction can cause central pontine

myelinolysis

 CPM is destruction of myelin in pons. However, no

therapy of CPM has been proven effective
HYPONATREMIA
TREATMENT

Example
 60 kg woman, Na 112, seizure

Na deficit  0.6  60  (120  112)  288 mEq

288 mEq
NaCl 3% required  / 24 hours
513 mEq/L
 0.561 L/24 hours
 561 mL/24 hours
HYPERNATREMIA
EVALUATION
HYPERNATREMIA
TREATMENT

serum [Na] - 140

Free water deficit  k  body weight 
140
k  0.45 for women  65 yo
k  0.5 for women  65 yo or men  65 yo
k  0.6 for men  65 yo
If water deficit is given, serum [Na] will decrease as :
infusate Na - serum Na
Na   max10 mEq/24hours
(k  body weight)  1
Solution [Na] in mEq/L
NaCl 0.9% 154
NaCl 0.45% or D5½NS 77
RL 130
D5 0
HYPERNATREMIA
TREATMENT
Example
60 kg, 60 yo woman, Na 160
160 - 140
Free water deficit  0.5  60 
140
 4.29 L
If D5 1/2 NS is given, serum [Na] will decrease as :
77 - 160
Na   2.68 mEq/L
(0.5  60)  1
 (2.68  4.29) mEq/24 hours
  11.5 mEq/24 hours
( 10 mEq/24 hours)
Thus, 4.29 L of D5 1/2 NS cannot be given in 24 hours :
4.29 L
D5 1/2 NS to be given   2L/24hours
2 days
HYPOKALEMIA
EVALUATION
HYPOKALEMIA
TREATMENT

Adults Serum [K] [K] deficit

3.0 – 4.0 200 mEq
2.0 – 3.0 400 mEq
<2.0 600 mEq

Peripheral Line Central Line

Recommended 10 mEq/hour 10 mEq/hour
infusion rate
Max infusion rate 20 mEq/hour 40 mEq/hour
Max 100 mEq/500 mL 200 mEq/500 mL
concentration
HYPERKALEMIA
EVALUATION
HYPERKALEMIA
TREATMENT