Electrolite Imbalance in Children

7/26/2019 Electrolite Imbalance in Children

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Faculty Medicine University of YARSI

Dr. Wan Nedra Sp. [email protected]

2011

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mailto:[email protected]:[email protected]


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ObectivesUpon completion of this lesson, the student will be

able to:

describe the outcomes associated with hypo andhypervolemia in pediatrics.distinguish between the different etiologies of maor

electrolyte imbalances in pediatrics.list the manifestations of electrolyte imbalances in

pediatrics.identify normal distribution of !"# and $"# in

pediatrics.state the normal serum values for %a, &, "l, 'g,

()* ,"a.

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!apillary "#c$an%e

&$e '( of blood in t$e syste)iccapillaries * t$e bul+ of blood t$ate#c$an%es )aterials ,it$ syste)ic tissue

cellsSubstances t$at pass t$rou%$ t$incapillary ,alls into interstitial fluid and

t$en into cells are- nutrients o#y%enSubstances t$at are secreted by tissuecells and re)oved fro) t$e) are- ,astes

!O/ 3


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FluidsDistribution of total body ,ater0&1W23'456( of pediatric body ,ei%$t is fluid

Intracellular 0I!F7 ,it$in cells * 86( ofbody ,ei%$t2

"#tracellular 0"!F7 plas)a7 interstitial ly)p$ */6( of body ,ei%$t2

9 :itre ,ater * /./lb or 9 +%

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Fluid S$ifts

;&$ird Spacin%


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Fluid S$ifts

;&$ird Spacin%


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ypovole)ia

A decrease in t$e "!F volu)eIntravascular and interstitial volu)e

Isotonic volu)e deficit )ay be due to

Decreased inta+e of isotonic fluidsOr e#cessivevomiting or diarrhea$e)orr$a%eurine output

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ypovole)iae)atocrit 0ct2 is sensitive to fluid s$iftsvolume (%) of erythrocytes in hole !lood"#$" mLdL males

'$" mLdL females*+$,* mLdL children

Decreased tissue perfusion!$ec+ capillary refill ti)e

Decreased blood volu)eypotension7 tac$ycardia7 oli%uria

&issue de$ydration:oss of s+in tur%or@ossible te)perature elevation

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ypovole)iaNursin% Responsibilities-calculate I O freBuently

)ini)al urinary output * C6cc?$r c$ec+ urine specific %ravityc$ec+ O/ saturationsdra, analye blood %asesauscultate lun%s 0side to side2

c$ec+ te)perature distal fro) $eart%ive isotonic solutions 0oral or IE2 Nor)al saline de#trose7 Rin%erGs lactate

%ive a fluid bolus as ordered

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ypervole)ia

"#cess of isotonic fluid in t$e intravascular andinterstitial spaces

Isotonic fluid retentionOl%uric state r?t renal failure

Secondary yperaldosteronis) Inappropriate renal reabsorption of ,ater and

sodiu)7and increased renal secretion of potassiu)Iatro%enic $ypervole)ia

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ypervole)ia@at$oAn e#cess in blood volu)e results in

elevated !@ and t$ird spacin%!linical )anifestations "de)aypertension

1oundin% pulse Increased urinary output

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Maor "lectrolytes

"lectrolytes

NaH7 H7 !aHH7 M%H * cations

!O4C7 !l47 @O48 * anionsI!F * H

"!F * NaHos)osis

os)olarity

capillary dyna)ics

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yponatre)ia0NaH J 9C' )"B?:2

Lo sodium determined !y !loodchemistry

-he most common electrolyte im!alance. +*% of hospitali/ed patients

0odium supports neuron transmission

Mec$anis) and e#a)ples

1ree ater gain2eficient sodium inta3e

4enal sodium loss in excess of ater

5ater in excess of sodium gain

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yponatre)ia0NaH J 9C' )"B?:2

ManifestationsWater e#cess rapid ,ei%$t %ain

NaH loss

neurolo%ical sy)pto)s irritability7 seiures7 J :O!Muscle cra)psAnore#ia? Nausea?Eo)itin% 0subtle si%ns2

&reat ,ater e#cessFluid restriction 0IO2&reat sodiu) loss

Oral or IE sodiu)

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ypernatre)ia0NaH K98' )"B?:2

"tiolo%yWater loss or sodiu) %ainsElderly or comatose patients

6a7 inta3e 8 ater inta3e2ia!etes insipidus (excessive fluid loss) 9

production of A2:2amage to hypothalamic thirst center; -umor or


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ypernatre)ia0NaH K98' )"B?:2

&reat)ent 0R#2

Dilute NaH and pro)ote secretionFluids 0'( D?W2 and diureticsAl,ays c$ec+ :O!loose alertness orientation

sepsis7 $ead inury7 intracranialbleed

Sodiu) pulls fluid to cause bloodvessels to burst

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@otassiu) 0H2

C.'4'.6 )"B?:@ri)arily an intracellular ion s)all a)ount

in plas)a is essential for nor)alneuro)uscular an cardiac function

Maintained by t$e cellular sodiu)4potassiu)pu)pH c$an%es altered e#citability of )uscles"li)inated by +idneysrenal proble)s causes $yper+ale)ia>nsulin- causes H to )ove fro) "!F I!FAcidosis? trauma to cells? and exercise cause H to )ove fro) I!F "!F-

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yper+ale)iaH K '.' )"B?:

Maor !ausesIncreased potassiu) inta+e e#cess or rapid delivery of H penicillin containin% H

Massive blood transfusion ,it$ irradiated pac+ed red cells1untain and @abari 09LLL2

S$ift of H fro) t$e I!F to "!F Acidosis7 uncontrolled DM increased cell lysis 0e.%. cytoto#ic dru%s2

Decreased renal e#cretion Di%italis to#icity7 renal failure7 overuse of potassiu) sparin%

diuretics 0spiroaldactone2

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Mainfestations-,ea+ s+eletal )uscles? paralysis K 5 )"B?:

parest$esiasirritabilityabdo)inal cra)pin% ,it$ diarr$eairre%ular pulse " c$an%es cardiac

standstill" c$an%es pea+ed &4,aves and a s$ortened & interval occur Depressed S& se%)ent and ,idened RS interval

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Mana%e)ent

"li)inate HDiuretics 0:asi#2

Dialysis

aye#alate

Increased fluidsIE insulin

!ardiac )onitor

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ypo+ale)ia

H J C.' )"BMaor causesJ inta+e of potassiu) or K cellular upta+e of

potassiu) Insulin- pro)otes H upta+e by )uscle liver cellsW$en insulin is %iven- H %oes into I!F J seru) H

levelUncontrolled diabetes )ellitus-

K lucose- os)otic diuretic K potassiu) via

urinary e#cretionDiabetic etoacidosis- H ions in "!F e#c$an%e across cell )e)branes H is firstelevated and t$en H stores are e#creted viaurine

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ypo+ale)ia

H J C.' )"B

"pinep$rine- pro)otes upta+e into cells

stress7 acute illness7 $ypo%lyce)ia"#cessive I loss- diarr$ea n% suction

)etabolic al+alosisDiuretics- :asi# 0,atc$ H levels2"#cessive renal e#cretion elevated

aldosterone diuresis

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ypo+ale)ia

H J C.' )"BSi%ns Sy)pto)sMuscle ea3ness. hypotonia


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Mana%e)ent ypo+ale)iaAd)inister !: slo,ly and accuratelydilute properly ,it$ ot$er IE fluids

96 )"Bs?9 $ourcan cause pain and necrosis of veins use central IE line for lar%e rapid a)ounts

!onsider discontinuin% diuretic t$erapy!onsider c$loride for )etabolic al+alosis

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!alciu)5.5 4 96 )%?d:

Maor functions-&rans)ission of nerve i)pulses!ardiac )uscle contractions1lood clottin% factorFor)ation of teet$ boneMuscle contraction

ReBuires-Eita)in D@arat$yroid $or)one 0@&2!alcitonin fro) t$yroid %land

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26http://lpi.oregonstate.edu/infocenter/minerals/calcium/capth.html


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ypocalce)ia

!aH J 5.' )%?d:

Nutritional deficiency of calciu) or Eita)inD

@arat$yroid deficiency!$ildren elderly dietary deficiency1one cancer- e#cess bone for)ation;un%ry &u)or< syndro)e

&reat)ent of prostrate cancer ,it$ estro%endepletes "!F calciu) levels

1lood transfusionspreserve blood ,it$ citrate t$is binds ,it$

calciu)

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ypocalce)ia!aH J 5.' )%?d:

Manifestations-!$voste+Gs si%n&rousseauGs si%nDysryt$)ias-J t$res$old for depolariation in

cardiac cells@arest$esias- ;pins needles


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ypercalce)ia!aH K 96.' )%?d:

Mali%nancies or $yperparat$yroidis)@& secretin% tu)or 0adeno)a2

S+eletal calciu) secreted into bloodstrea)Metastatic breast cancer )ultiple )yelo)a

@rolon%ed i))obility- loose !aH fro) bone intoblood

Osteoporosis- !aH is liberated into bloodstrea)Manifestations-let$ar%y? ,ea+ness?fati%ue?constipationpat$o%enic fractures calciu) loss fro) bone

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@$osp$ate 0@O8 42

'*# $ "*mgdL or * $ +*, mEBL0tored ith


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Ma%nesiu) 0M%H2* $ +* mEBL

0econd most a!undant >


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References+rameyer, -. . / &eyes, . . 134. 5he

pathophysiology of potassium balance. Critical

Care Nurse, 1664, 6781.9ansen, '. 14. Pathophysiology:

Foundations of disease and clinical intervention.(hiladelphia: ;aunders.

9uether, ;. $., / 'c"ance, &. . 20024.Pathophysiology.;t. ouis: 'osby.

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Electrolite Imbalance in Children