Updated: 10/31/2019

Electrolyte Disturbances

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  • A 22-year-old man is brought to the emergency department by his friend after witnessing him fall to the ground and shaking his upper and lower extremities. His friend reports that he prevented the patient from hitting his head. Prior to developing this symptom the patient felt numbness in his hands and feet, muscle cramps, and mild palpitations. Medical history is significant for DiGeorge syndrome. On physical exam, there is facial muscle twitching with ipsilateral tapping of the facial nerve anterior to the ear. An electrocardiogram shows QTc prolongation. Laboratory testing is significant for an ionized calcium level of 4.0 mg/dL. (Provoked seizure secondary to hypocalcemia)
Introduction
 
Electrolyte Disturbances
Electrolyte Low Serum Concentration High Serum Concentration
Sodium
  • Stupor
  • Coma
  • Seizures 
  • Nausea
  • Malaise
  • Stupor
  • Coma
  • Seizure
Potassium
  • Palpitations
  • Parasthesias
  • Muscle weakness
  • U waves and flattened T waves
  • Palpitations
  • Arrythmias
  • Parasthesias
  • Muscles weakness
  • Peaked T waves and wide QRS
Calcium 
  • Seizures
  • Tetany
  • Chvostek sign
    • ipsilateral facial muscle contraction caused by tapping the facial nerve
  • Trousseau sign
    • carpopedal spasms by inflating the sphygmomanometer above systolic blood pressure
  • QTc prolongation
  • Nephrolithiasis
  • Polyuria
  • Muscle weakness
  • Bone pain
  • Abdominal pain
    • secondary to bowel hypomotility and constipation
  • Confusion
  • Stupor
  • Coma
  • Shortened QTc interval
  • mnemonic: stones (renal), bones (pain), groans (abdominal pain), thrones (↑ urinary frequency), psychiatric
    overtones (altered mental status)
Magnesium 
  • Tetany
  • Torsades de pointes
  • Hypokalemia
  • Hypocalcemia
    • when significant (< 1.2 mg/dL)
  • ↓ deep tendon reflexes
  • Bradycardia
  • Cardiac arrest
  • Hypocalcemia
Phosphate
  • Osteomalacia
  • Rickets
  • Nephrolithiasis
  • Metastatic calcifications
  • Hypocalcemia
 
 

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