Pediatric electrolytes

Virtually all investigators now agree that self-induced water intoxication, symptomatic hospital-acquired hyponatremia, and hyponatremia associated with intracranial pathology are true emergencies that demand prompt and definitive intervention with hypertonic saline. A 4- to 6-mmol/L increase in serum sodium concentration is adequate in the most seriously ill patients and this is best achieved with bolus infusions of 3% saline. Virtually all investigators now agree that overcorrection of hyponatremia (which we define as 10 mmol/L in 24 hours, 18 mmol/L in 48 hours, and 20 mmol/L in 72 hours) risks iatrogenic brain damage...

Hypocalcaemia is one of the commonest disorders of mineral metabolism seen in children and can be a consequence of several different aetiologies. These include a failure of secretion or action of parathyroid hormone, disorders of vitamin D metabolism and abnormal function of the calcium-sensing receptor. A practical approach to the investigation, diagnosis and subsequent management of hypocalcaemic disorders is presented.

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Hypercalcemia is an occasional clinical problem in outpatient and in patient pediatrics. If undiagnosed and untreated, it can cause significant sequelae. While the differential diagnosis of hypercalcemia is expansive, the clinician can isolate the cause with their patients if a step-wise approach is taken clinically and biochemically. Here we present the case of an adolescent female with symptomatic hypercalcemia and a family history of hypercalcemia. Next we discuss each cause within the differential diagnosis of hypercalcemia, and provide an algorithm for evaluating patients...

BACKGROUND AND OBJECTIVES: Experimentally elevated potassium causes a clear pattern of electrocardiographic changes, but, clinically, the reliability of this pattern is unclear. Case reports suggest patients with renal insufficiency may have no electrocardiographic changes despite markedly elevated serum potassium. In a prospective series, 46% of patients with hyperkalemia were noted to have electrocardiographic changes, but no clear criteria were presented. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Charts were reviewed for patients who were admitted to a community-based hospital with a diagnosis of hyperkalemia...

Potassium disorders are the most common electrolyte abnormality identified in clinical practice. Presenting symptoms are similar for both hypo- and hyperkalemia, primarily affecting the cardiac, neuromuscular, and gastrointestinal systems. Generally, mild hypokalemia is the most common potassium disorder seen clinically;however, severe complications can occur. Hyperkalemia is less common but more serious, especially if levels are rising rapidly. The etiologies and treatments for both hypo- and hyperkalemia are discussed, with special emphasis on the role medications play in the etiologies of each...

BACKGROUND: Hyperkalaemia occurs in outpatients and in between 1% and 10% of hospitalised patients. When severe, consequences include arrhythmia and death. OBJECTIVES: To review randomised evidence informing the emergency (i.e. acute, rather than chronic) management of hyperkalaemia SEARCH STRATEGY: We searched MEDLINE (1966-2003), EMBASE (1980-2003), The Cochrane Library (issue 4, 2003), and SciSearch using the text words hyperkal* or hyperpotass* (* indicates truncation)...

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This article reviews the diagnosis and management of clinical disorders of potassium balance, with particular attention to the critically ill patient. The normal regulation of potassium balance is reviewed as a background for understanding these disorders, followed by a discussion of the causes and management of hypo- and hyperkalemia. Practical guidelines are presented for acute and chronic management.