TY  - CHAP
M1  - Book, Section
TI  - Management of Patients with Fluid & Electrolyte Disturbances
A1  - Butterworth IV, John F.
A1  - Mackey, David C.
A1  - Wasnick, John D.
PY  - 2018
T2  - Morgan & Mikhail's Clinical Anesthesiology, 6e
AB  - KEY  CONCEPTS  Osmotic  pressure  is  generally  dependent  only  on  the  number  of  nondiffusible  solute  particles.  This  is  because  the  average  kinetic  energy  of  particles  in  solution  is  similar  regardless  of  their  mass.  Potassium  is  the  most  important  determinant  of  intracellular  osmotic  pressure,  whereas  sodium  is  the  most  important  determinant  of  extracellular  osmotic  pressure.  Fluid  exchange  between  the  intracellular  and  interstitial  spaces  is  governed  by  the  osmotic  forces  created  by  differences  in  nondiffusible  solute  concentrations.  Serious  manifestations  of  hyponatremia  are  generally  associated  with  plasma  sodium  concentrations  less  than  120  mEq/L.  Excessively  rapid  correction  of  hyponatremia  has  been  associated  with  demyelinating  lesions  in  the  pons  (central  pontine  myelinolysis),  and  more  generally  in  both  pontine  and  extrapontine  central  nervous  system  structures  (osmotic  demyelination  syndrome),  resulting  in  both  temporary  and  permanent  neurological  sequelae.  A  major  hazard  of  increased  extracellular  volume  is  impaired  gas  exchange  due  to  pulmonary  interstitial  edema,  alveolar  edema,  and/or  large  collections  of  pleural  or  ascitic  fluid.  Intravenous  replacement  of  potassium  chloride  is  usually  reserved  for  patients  with,  or  at  risk  for,  significant  cardiac  manifestations  or  severe  muscle  weakness.  Because  of  its  lethal  potential,  hyperkalemia  exceeding  6  mEq/L  should  always  be  corrected.  Symptomatic  hypercalcemia  requires  rapid  treatment.  The  most  effective  initial  treatment  is  rehydration  followed  by  a  brisk  diuresis  (urinary  output  200–300  mL/h)  utilizing  intravenous  saline  infusion  and  a  loop  diuretic  to  accelerate  calcium  excretion.  Symptomatic  hypocalcemia  is  a  medical  emergency  and  should  be  treated  immediately  with  intravenous  calcium  chloride  (3–5  mL  of  a  10%  solution)  or  calcium  gluconate  (10–20  mL  of  a  10%  solution).  Some  patients  with  severe  hypophosphatemia  may  require  mechanical  ventilation  postoperatively  because  of  muscle  weakness.  Severe  hypermagnesemia  can  lead  to  respiratory  and  cardiac  arrest.  Isolated  hypomagnesemia  should  be  corrected  prior  to  elective  procedures  because  of  its  potential  for  causing  cardiac  arrhythmias.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1161433132
ER  -