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العنوان
Electrolyte disturbances in adult patients in ICU \
المؤلف
Mahmoud, Shawky Sayed.
هيئة الاعداد
باحث / Shawky Sayed Mahmoud
مشرف / Alaa ELdeen Abd EL Wahab Koraa
مشرف / Hazem Mohammed Abd EL Rahman Fawzy
مناقش / Hala Salah EL- Din EL-Ozairy
تاريخ النشر
.2014
عدد الصفحات
173p.;
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
العناية المركزة والطب العناية المركزة
تاريخ الإجازة
1/1/2014
مكان الإجازة
جامعة عين شمس - كلية الطب - الرعاية المركزة
الفهرس
Only 14 pages are availabe for public view

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from 173

Abstract

English summary
Electrolyte abnormalities are one of the most common problems in the critically ill patients and hospital setting.
Sodium is the most abundant cation in the body, averaging approximately 60 mEq/kg of body weight.
Hyponatremia represents a decrease in plasma sodium concentration below 135 mEq/ L. The underlying cause can often be ascertained from an accurate history and physical examination, and assessment of ECF volume status and circulating arterial volume. The goals of therapy are two folds: (1) to raise the plasma Na+ concentration by restricting water intake and promoting water loss and (2) to correct the underlying disorder.
Hypernatremia implies a plasma sodium level above 145 mEq/ L and a serum osmolality greater than 295 mOsm/ kg. The treatment of hypernatremia includes measures to treat the underlying cause of the disorder and fluid replacement therapy.
Potassium is the second most abundant cation in the body and the major cation in the ICF compartment.
Hypokalemia, defined as a plasma K+ concentration <3.5 mmol/L. Hypokalemia may result from decreased net intake,
English summary
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shift into cells, increased net loss. electrocardiographic changes of hypokalemia are due to delayed ventricular repolarization and do not correlate well with the plasma K+ concentration. Potassium replacement is the corner stone of therapy for hypokalemia.
Hyperkalemia defined as plasma K+ concentration >5.0 mmol/ L, occurs as a result of either K+ release from cells or decreased renal loss.
Remove potassium from the body fluids by three possible routes:
a. The urine: by the administration of furosemide-a loop diuretic-increasing the urinary excretion of potassium.
b. The gastrointestinal tract: with the sodium salt of polystyrene sulfonate (Kayexalate).
c. A potassium-free dialysate during an emergency hemodialysis, especially in the presence of renal failure.
Calcium enters the body through the gastrointestinal tract, absorbed from the intestine under the influence of vitamin D, stored in bone and excreted by the kidney.
Hypocalcemia represents a plasma calcium level of less than 8.5 mg/dL.The causes of hypocalcemia can be divided into four categories: (1) Impaired ability to mobilize calcium
English summary
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bone stores, (2) Abnormal losses of calcium from the kidney, (3) Increased protein binding or chelation such that greater proportions of calcium are in the non-ionized form, and (4) Soft tissue sequestration. Hypocalcemia can manifest as an acute or chronic condition.
The treatment of ionized hypocalcemia should be directed at the underlying cause of the problem. However, symptomatic hypocalcemia is considered a medical emergency, and the treatment of choice is an intravenous calcium. Intravenous calcium replacement can be risky in selected patient populations, Calcium infusions can promote vasoconstriction and ischemia in any of the vital organs.
Hypercalcemia represents a total plasma calcium concentration of greater than 10.5 mg/dL. Clinical manifestations of hypercalcemia include constipation, anorexia, nausea and vomiting, abdominal pain, and ileus. Elevation of plasma Ca > 12 mg/dL (> 3.00 mmol/L) causes emotional lability, confusion, delirium, psychosis, stupor, and coma.
Phosphate is an essential to many body functions .
Hypophosphatemia is commonly defined by a plasma phosphorus level of less than 2.5 mg/dL in adults; Treatment of hypophosphatemia is replacement therapy.
English summary
139
Hyperphosphatemia represents a plasma phosphorus concentration in excess of 4.5 mg/dL in adults. The treatment of hyperphosphatemia is directed at the cause of the disorder. Dietary restriction of foods that are high in phosphate may be used. Hemodialysis is used to reduce phosphate levels in persons with end-stage renal disease.
Magnesium is the second most abundant intracellular cation. The average adult has approximately 24 g of magnesium distributed throughout the body.
Hypomagnesemia represents a plasma magnesium concentration of less than 1.8 mg/dL. It is treated with magnesium replacement. The route of administration depends on the severity of the condition. Symptomatic, moderate to severe magnesium deficiency is treated by parenteral administration.
Hypermagnesemia represents a plasma magnesium concentration in excess of 2.7 mg/dl. The treatment of hypermagnesemia includes cessation of magnesium administration.
There is agreat link between the chloride and the bicarbote as they are important in normal acid base balance. Both of chloride and bicarbonate (anions) are important in maintaining the anion gap in normal ranges.
English summary
140
The normal cations present in plasma are Na+, K+, Ca2+, and Mg2+. The normal anions present in plasma are Cl-, HCO3- negative charges present on albumin, phosphate, sulphate, lactate, and other organic acids. The sums of the positive and negative charges are equal.
Measurement of plasma [Na+], [K+], [Cl-] and [HCO3-] is usually easily available .
Metabolic alkalosis can be classified based on the urinary chloride concentration into chlorde responsive and chloride resistant.
There are a variety of electrolyte disorders in patients with cancer. These disorders occur during the growth of tumors, generally as a consequence of inadequate intake and absorption of electrolytes, renal failure secondary to tumor or rapid tumor destruction and production of metabolically active substances by the tumor, and may be also due to the anti malignant drugs