ecg & electrolytes disturbance
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ECG & electrolytes disturbance
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• Q/What’s the main significance of ECG paper in any patient with electrolyte disturbance ??
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HyperK+
Normal serum K+ 3.5-5 mmol/lHyperk+ Cause flaccidation of heart m. & may lead
cardiac arrest if the level exceed 7mmol/l
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Causes of hyperk+1.Increase intake
a.During correction of hypoK+b.food(banana)
C.drugs??2.Impaired excretion of K+
a.Acute & chronic renal failureb.Circulatory failure (reduce renal perfusion)c.Addison diseased.Long standing use of B.blockerse.ACEIf.NSAID
3.Shift of K+ from intra to extracellular compartment a.Sever leg ischemia … hypoxia
b.DKAc.ADH deficiency … water depletiond.Aspirin poisoning (acidosis)hemolytic anemia , leukemia ,MM
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Clinical features ??? Tingling sensation over lips &mouth, M weakness,loss of tendon reflex,abdominal distention,collapse
PseudohyperK+ ??? Occur due to destruction of RBCs in delayed investigated blood sample
ECG changes :
1.Prolong PR interval(more than 5 small boxes)2.Prolong QRS complex(more than 3 small boxes)3.Tall tented T wave 4.Some times loss of P wave
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RX of hyperK???+1.Role of 10 10 10 : 10ml of 10% Ca gluconate IV for 10 min.2. 50%hypertonic glucose+IV Insuline *in non diabetic Pt3. Nabicarbonate for metabolic acidosis4. If there’s no response do hemodialysis**prophylaxis**1. 10% dextrose solution2. Calcium resin
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HypoK+Causes:
1.Reduce intake2.loss from GIT
a.vomiting&diarheab.Bowl fistulac.Vellous adenoma
3.Loss in urine a.DKAb.Cushing s.c.Conn’s s.d.Renal tubular acidosis(K+ exchanged w Na instead of H+ )
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• Clinical feature of hypoK+ ???• M.weakness(unable to walk upstairs),in sever
cases : paralysis&renal tubular damage
• ECG changes :• 1.flattened T wave• 2.presence of U waves (in most of leads)• 3.ST depression( in sever cases)
• **most of Pt with hypoK+ my associate with ventricular ectopi ,SVT or Af on ECG
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• RX of hypoK+???
1. In mild moderate cases give oral KCl 3_4 gm/day Or give fruit juice2. In sever cases give IV KCl 100mmol/day
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HyperCa++
• Normal serum Ca++ 2.1-2.6 mmol/l• imp(8.5-10.5 mg/dl)
• 99% Vs 1%
• Calcium regulator ??
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• Causes of hyperCa++ :• 1.with high PTH• a.primary or tertiary hyperparathyroidism• b.familial hypercalciuric hypercalcemia(AD)• 2.with low PTH• a.milk alkali syndrome • b.thiazid diuretic• c.breast ovarian colon thyroid CA• d. MM• e. Paget’s disease of bone• f. vit D intoxication• g. recumbency
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• Clinical features ???• CNS:lethargy• GIT:nausea , vomiting ,constipation , abd. Pain, peptic
ulcer• Urinary:polyurea , polydipsia , kidney stone
• ** in chronic HyperCa … Pt present with traid: Hypertension , Hyperchloremia , Hyperuricemia
• ECG changes :
• Short QT interval• Normal QT ??
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• Rx of hyperCa++ ???• 1. 0.9% normal saline in first 24 hr• 2. frusemide 40mg• 3. calcitonin(shift Ca from plasma to bone)• 4. pamidronate(bisphosphonate : inhibit bone
resorption)• 5. prednisolone• 6. if there’s no response do hemodialysis
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hypoCa++
• Causes :• 1. respiratory or metabolic alkalosis• 2. vit D deficiency• 3.chronic renal failure• 4.Hypoparathyroidism• 5. hypoalbonemia• 6.hypoparathyroidism• 7.pseudohypoparathyroidism• 8.acute pancreatitis
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• Clinical features ???• In young Pt : carpopedal spasm,laryngeal spasm,convulsion• In old Pt : tingling sensation around mouth&finger+ -
carpopedal spasmif spasm not obvious ,, we can make it clear by ::
Trousseau’s sign
Chvostek’s sign
• ECG changes :• Prolong QT interval
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Rx of HypoCa++???
1. Correct alkalosis by rebreathing bag or 5% Co2 along with O2
2. Role of 10 10 103. If no response give Ca chloride or Mg
chloride4. 1alpha cholecalciferole or
1.25 dihydrocholecalceferole
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•Assessment•60 years old male in CCU on continuous
diuretics & digoxin for his CHF , the patient gradually develop cardiac (arrhythmia)..
•What do you suspect electrolyte disturbance if you didn’t see monitor???
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