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Emergency Medicine Manual, 6e
| Section 1. Resuscitative Problems and Techniques > |
Chapter 4. Fluids, Electrolytes, and Acid-Base Disorders
Topics Discussed: acid-base disorders; hypercalcemia; hyperkalemia; hypermagnesemia; hypernatremia; hypocalcemia; hypokalemia; hypomagnesemia; hyponatremia; metabolic acidosis; metabolic alkalosis; respiratory acidosis; respiratory alkalosis.
Excerpt:
"When altered, fluids and electrolytes should be corrected in
the following order: (a) volume; (b) pH; (c)
potassium, calcium, and magnesium; and (d)
sodium and chloride. Reestablishment of tissue perfusion often equilibrates
the fluid-electrolyte and acid-base balances. Because the osmolarity
of normal saline (NS) matches that of serum, it is an excellent
fluid for volume replacement. Hypotonic fluids such as 5% dextrose
in water (D5W) should never be used to replace volume. Lactated
Ringer solution is commonly used for surgical patients or trauma
patients; however, only NS can be given in the same line with blood
components. D5½NS, with or without potassium, is given as a maintenance
fluid. The more concentrated dextrose solutions, D10W or D20W, are
used for patients with compromised ability to mobilize glucose stores,
such as patients with hepatic failure, or as part of total parental
nutrition solutions.The clinical manifestations of hyponatremia occur when the [Na+] drops
below 120 mEq/L; they include abdominal pain, headache,
agitation, hallucinations, cramps, confusion,..."
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