A 57 year old man presents to the ED with 18 hours of severe upper abdominal pain, fever, nausea and vomiting. He looks jaundiced, his HR is 120bpm, BP 110/60, RR 22 and his temperature is 37.8oC. He is tender and guarded in his right upper quadrant on abdominal palpation.
Cause of HYPOnatraemia Click to enlarge Clinical Severity of symptoms associated with rapidity of loss and extent of fall Complication Correction Depends on rapidity of onset and clinical symptoms Calculations: Na deficit= (desired Na-current Na) x (0.6 x body weight)…
Water loss in excess of salt deficit. Hypernatremia is usually due to insufficient water (primarily in patients who either do not experience thirst normally, or cannot act on it). Hypernatraemia occurs less commonly associated with excess salt
Syndrome Of Inappropriate ADH secretion (SIADH) is hyponatraemia due to an increase in concentration of ADH inappropriate to the current osmotic or volume status. The differential diagnosis includes ADH analogues
Ca2+ exists in the extracellular plasma two states: (1) free ionized state and (2) bound to other molecules (mostly albumin, rest – beta-globulins, phosphate, citrate)
ionized Ca2+ concentration is inversely related to pH -> an increase in pH results in a decrease in ionized Ca2+
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