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Electrolyte Abnormalities


This could be potassium, sodium, or calcium...generally patients with 2 or more perform poorly in simple observation setting



Inclusion Criteria

  • Acceptable VS
  • Cause of electrolyte disturbance does not require hospitalization
  • No co-moribidity requiring more prolonged hospitalization
  • Mild and rapidly correctable electrolyte abnormality
  • Hyperkalemia < 6.0 mEq/L, ECG with clear p-waves, at most T-wave tenting, no QRS widening after >1 hour in the ED
  • Hypokalemia > 2.5 mEq/L, with no ventricular ectopy on ED monitoring for >1 hour.
  • Hyponatremia >120 mEq/L with normal mentation and a reversible etiology (eg dilutional, drug-induced, gastroenteritis, hyperemesis). Not psychogenic polydipsia, SIADH
  • Hypernatremia < 155 mEq/L with normal mentation and rapidly reversible etiology (e.g. NH patient with infection)
  • Hypercalcemia < 7.0 mEq/L (ionized) rapidly correctible etiology
  • Hypocalcemia > 1.0 mEq/L (ionized), e.g. renal failure
  • Hypomagnesemia >2.0 mEq/L associated with other electrolyte abnormalities

Exclusion Criteria

  • Unstable VS or cardiovascular compromise
  • Severe dehydration or severe electrolyte abnormalities (K >6.0, K <2.5, Na >155, Na <120, iCa >7.0, iCa <1.0, Mg <2.0)
  • Mental status changes
  • Associated cause not amenable to short term treatment: bowel obstruction, appendicitis, bowel ischemia, DTs, DKA, sepsis, some drug effects, etc.
  • Unlikely to be corrected within 15 hours
  • More than two acute electrolyte disturbances

Potential Interventions

  • IV therapy (Normal saline for most) therapy targeting the specific disorder, per CDU physician.
  • Νο volume infusion for dialysis patients
  • Electrolyte replacement / correction, and repeat labs as ordered by CDU physician
  • Serial vital signs and repeat clinical examination

Discharge Criteria

Home

    • Acceptable VS
    • Resolution of symptoms, able to tolerate oral fluids
    • Improved electrolytes

Admit

    • Unstable VS
    • Associated cause found requiring hospitalization
    • Inability to tolerate oral fluids

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