Pediatric emergency medicine trisk 2858 2858
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and potassium into the cells, followed by intracellular accumulation of
osmolytes.
Management. During sustained hypernatremia, cerebral adaptation
occurs over several days to restore brain cell volume. Rapid correction of
the serum sodium after cerebral adaptation occurs will result in osmotic
movement of water into the brain and cerebral edema. Data suggest that the
plasma sodium concentration should be lowered by less than 0.5 mEq/L/hr
and no more than 12 mEq/L/day. In children with hypernatremia due to salt
loading, treatment should facilitate renal excretion of sodium. This is
typically achieved with salt restriction and free water and may be facilitated
with diuretics. If IV fluids are required, the sodium plus potassium
concentration of the fluid provided should be less than the sum of these
electrolytes in the urine, and the fluid should be given at a rate sufficient to
achieve positive water balance. Adequate intravascular volume should be
assured to allow renal excretion of sodium. The therapy of children with
hypernatremic hypovolemia (sodium and water deficit) was previously
reviewed. In summary, children with clinical signs of decreased effective
circulating volume should be provided with isotonic saline to restore
perfusion. Once intravascular volume is restored, hypotonic fluids should
continue to allow judicious restoration of the estimated free water deficit,
with close monitoring to avoid overly rapid correction.
DISORDERS OF POTASSIUM HOMEOSTASIS
Goals of Treatment
Potassium is the most abundant intracellular cation in the body with only
approximately 2% of total body stores present in the extracellular space.
Abnormalities of serum potassium are associated with abnormal
neuromuscular function and risk of severe cardiac sequelae, especially with
hyperkalemia. Treatment is aimed at preventing emergent cardiac
complications and restoring normal serum potassium levels.
CLINICAL PEARLS AND PITFALLS
