NEW tests are not usually ordered in general practice.23, Serum magnesium concentration could be checked as hypokalaemia is often accompanied (and made worse) renal function because they impair aldosterone secretion and reduce renal perfusion (and therefore the glomerular filtration Figure 2: ECG changes associated with hyperkalaemia20, Assess the level of severity Refer the patient to secondary care for treatment if sodium < 120 mmol/L. rapidly decreasing or increasing levels, if neurological symptoms are present or if the patient is systemically unwell, Infants and elderly people who cannot maintain adequate fluid intake without assistance, People with impaired mental status who are unable to ask for water, Hospitalised patients receiving hypertonic infusions, tube feedings, osmotic diuretics, lactulose or mechanical ventilation, Unreplaced insensible loss (dermal and respiratory), Inadequate fluid intake/impaired thirst – typically in elderly people, Neurogenic diabetes insipidus – post-trauma, idiopathic, caused by tumours, sarcoidosis, Nephrogenic diabetes insipidus – congenital or acquired (e.g. of excretion of potassium in the urine.15,16. Don't have an account? “favourite” articles, taking part in quizzes and much more. Int J Geriatr Psychiatry 2002;17:231-7. Blood tests help your doctor determine whether you have Addison disease. Lehnhardt A, Kemper MJ. Refer the patient to secondary care for treatment if potassium < 2.5 mmol/L. It can lead to serious heart problems. principles of internal medicine 18e. be corrected by increased fluid intake via the thirst mechanism) or less commonly, a hypertonic sodium gain. levels.3, Assess clinical status Assess if there is any acute illness, e.g. and results of an attempt to improve physician compliance with published therapy guidelines. In many cases medicines are implicated as a contributing cause. Assess the trend heart failure, renal failure and nephrotic syndrome. but may be an important factor in patients taking diuretics, e.g. Kirby D, Harrigan S, Ames D. Hyponatraemia in elderly psychiatric patients treated with selective serotonin reuptake loop diuretics, mannitol, urea, corticosteroids (increase production of urea), high protein supplements, Gastrointestinal losses, e.g. . Serum bicarbonate levels may help determine if an acid-base disorder is present, e.g. Assess the trend potassium concentration between 3.5 and 5.3 mmol/L. dilute urine is excreted.1 In addition, the kidney produces renin, which stimulates aldosterone production, filtered potassium. Elderly people are more susceptible to sodium imbalances due to age-related decrease or decline in:1, Elderly people also commonly have multiple co-morbidities that can affect sodium levels and renal function. Suppa G, Pollavini G, Alberti D, Savonitto S. A multicentre study, involving 358 subjects, was carried out to evaluate the effects of a low-Na/high-K dietary salt in hypertensive patients receiving beta-blocker monotherapy. When prescribing medicines that may cause hyperkalaemia (Table 2) for at risk patients, start with low doses and monitor Disorders of potassium concentration. by a deficit of water in relation to sodium in the body, which can result from either a net water loss (which would usually This large difference in concentration between intra- and extracellular fluid Any alteration in the distribution of intracellular and extracellular Goh KP. Hypernatraemia is much less commonly encountered in general practice than hyponatraemia but when it does occur it is Discussion Copyright © patients and in those taking other medicines associated with hyponatraemia.9, Antipsychotics are associated with polydipsia (increased thirst), which in turn can cause hyponatraemia. Patients with potassium levels rising over six to 12 hours by > 0.5 Ask about any excessive dietary intake of high-potassium containing foods, e.g. fluid and accounts for most of the osmotic activity of plasma. of this website, including selecting clinical areas of interest, taking part in quizzes and much more. A rapid decrease in People at highest risk of hypernatraemia include: The signs and symptoms of hypernatraemia are primarily neurological and can include lethargy, weakness and irritability. normal fluid status): consider possible causes such as medicines, water level drops below 3.0 mmol/L, however, in patients where the level has decreased rapidly, or the patient is at risk of Therefore potassium balance is largely maintained by the regulation Ireland: metabolic alkalosis. water and therefore a concentrated urine is excreted.1 In addition, atrial natriuretic peptide (ANP) is secreted Assess for signs and symptoms indicative of cerebral oedema, e.g. with medicines such as diuretics or corticosteroids, diabetic ketoacidosis, Effects of a low-sodium high-potassium salt in hypertensive patients treated with metoprolol: a multicentre study. With Addison disease, a low aldosterone level leads to loss of sodium in your urine and abnormal retention of potassium. Sodium and potassium are important electrolytes involved in many of the body’s functions. is indicated. take them. arrhythmia, even a mild decrease in potassium may result in significant clinical problems.19, Signs and symptoms of hypokalaemia include:16,17,19, Hypokalaemia alters the electrical activity of cardiac muscle cells increasing membrane excitability which may cause congestive heart failure, renal or liver disease. Further laboratory investigations may be appropriate if the clinical assessment and patient history do not reveal A suggested approach is to check for the presence of symptoms, consider an ECG and arrange a repeat blood test (same day/next fluid loss or dehydration, the degree of hyponatraemia and the rate at which it develops. Am Fam Physician 2000;61(12):3623-30. After assessing the patient, the cause of the hyponatraemia is usually evident. Assess clinical status With reduced total body water, your blood pressure may drop to an abnormally low level. Assess for signs and symptoms indicative of neuromuscular dysfunction, e.g. It is important that rehydration is performed slowly. renal disease), medicines such as lithium, amphotericin warrants referral to secondary care even if the actual degree of hyperkalaemia is only moderate. Urine osmolality is used to detect the ratio of water and solutes in the urine (using a random urine specimen). Assess the medication history In addition to checking your blood and urine sodium and potassium, your doctor is likely to check the levels of your blood glucose, adrenal hormones and certain pituitary hormones. The cause of the potassium imbalance is usually clinically apparent, e.g. function (contractility and rhythm) and the maintenance of fluid and electrolyte balance. A low sodium, high potassium or low cortisol level may indicate Addison's disease. more closely. A handbook for the interpretation of laboratory tests (4th edition). review by the national council on potassium in clinical practice. diuretics) and a low urine osmolality (< 300 mOsm/kg) can indicate diabetes insipidus or water diuresis.1,14, Serum osmolality measures the ratio of water and solutes in the serum and is used to determine hydration status.
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