03 Electrolytes

Cause

• decreased absorption

  • Alcoholics

• renal loss

  • DKA, alcoholics

• transcellular shift

  • DKA, burn pts

Result

• respiratory failure

• CHF

• rhabdomyolysis

• decreased chemotaxis/phagocytosis

  • infection

• platelet dysfunction

• hypercalcemia

Severe hypophosphate

• less than 1 mg/dl

• weakness, myalgia first sign

Replacement

• less than 1.5: IV

• 31 mg phos = 1mmol phos

• PO

  • milk is good choice

  • Kphos, NaPhos

• IV

  • NS, 1/2 NS, D5W, No LR (salt precipitates K)

  • 2.5-5mg/kg over 6-8 hours

  • 10-20 mmol kphos in 250 D5W over 6-8 hours

IV Phos SE

• ARF (precipitation)

• calcification of bundle of his (arrythmia)

• hypocalcemia, tetany

• hypomag

• calcification of soft tissues

Ca x PO4 product

• Ca meq/ml X phosphate mmol/ml

• if >200 then calciphylaxis

• if > 60 then at risk