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Sodium Homeostasis

Inpatient Management Guide Definition Hyponatremia Excess of water relative to sodium, almost always due to ↑ADH (either appropriately, or inappropriately) Hypernatremia Deficit of water relative to sodium. Almost always due to restricted access to H2O → e.g. intubated, elderly, ΔMS. Alternatively, renal mediated process e.g. diabetes insipidus. Etiology Hyponatremia Hypotonic: < 280 mOsm/kg of water: … Read more

Potassium Homeostasis

Inpatient Management Guide Definition Hypokalemia Mild hypokalemia—potassium 3.1–3.5 mEq/L Moderate hypokalemia—potassium 2.5–3 mEq/L Severe hypokalemia—potassium < 2.5 mEq/L, or symptomatic Hyperkalemia Mild hyperkalemia—potassium 5.1–5.4 mEq/L Moderate hyperkalemia—potassium 5.5–5.9 mEq/L Severe hyperkalemia—potassium >6.0 mEq/L. Etiology Hypokalemia Most common causes: GI losses—vomiting, diarrhea, laxative abuse Diuretic use (thiazides, metolazone, loop diuretics) Other drugs (beta agonists, caffeine, verapamil, … Read more

Malignancy Associated Hypercalcemia

Inpatient Management Guide Definition Oncologic Emergencies Superior vena cava syndrome: Compression or invasion of the SVC causing impaired blood return to the heart and edema of the face or upper body. The large majority of cases are malignancy related (compression of enlarged mediastinal lymph node or directly by tumor) with concomitant venous thrombosis. Malignant pericardial … Read more

Magnesium and Phosphorus Homeostasis

Inpatient Management Guide Definition Magnesium Hypomagnesemia: serum magnesium < 1.5-1.7 mg/dL (depeding on the assay) Hypermagnesemia: serum magnesium > 2.2-2.5 mg/dL (depending on the assay) Phosphorus Hypophosphatemia: Moderate hypophosphatemia, 1-2.5 mg/dL Severe hypophosphatemia, < 1 mg/dL Hyperphosphatemia: serum phosphate, >4.5 mg/dL Etiology Magnesium Hypomagnesemia: Inadequate intake: alcoholism, malnutrition, anorexia Increased GI losses: diarrhea, malabsorption, vomiting, … Read more

Hypophosphatemia

Inpatient Management Guide Definition Magnesium Hypomagnesemia: serum magnesium < 1.5-1.7 mg/dL (depeding on the assay) Hypermagnesemia: serum magnesium > 2.2-2.5 mg/dL (depending on the assay) Phosphorus Hypophosphatemia: Moderate hypophosphatemia, 1-2.5 mg/dL Severe hypophosphatemia, < 1 mg/dL Hyperphosphatemia: serum phosphate, >4.5 mg/dL Etiology Magnesium Hypomagnesemia: Inadequate intake: alcoholism, malnutrition, anorexia Increased GI losses: diarrhea, malabsorption, vomiting, … Read more

Hyponatremia

Inpatient Management Guide Definition Hyponatremia Excess of water relative to sodium, almost always due to ↑ADH (either appropriately, or inappropriately) Hypernatremia Deficit of water relative to sodium. Almost always due to restricted access to H2O → e.g. intubated, elderly, ΔMS. Alternatively, renal mediated process e.g. diabetes insipidus. Etiology Hyponatremia Hypotonic: < 280 mOsm/kg of water: … Read more

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