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Electrolyte Abnormalities

  

Management advice for abnormalities of sodium and potassium in U&Es


Abnormal Potassium Results

High Potassium (K+) result received:

  • Consider spurious cause if urea/creat normal, eGFR is >60mL/min, and risk factors for true hyperkalaemia NOT present.
  • True hyperkalaemia unusual if renal function normal, except in patients receiving multiple (and usually contraindicated) potassium-sparing drugs and/or potassium supplementation.
  • Most common cause spurious hyperkalaemia is delayed transport of blood samples to lab.
  • Other causes include release of intracellular K+ resulting from cooling/refrigeration/tourniquet and EDTA contamination from FBC tube.
  • For more information about investigating Hyperkalaemia in adults (see right or follow this link).

Low Potassium (K+) result received:

  • If cause is obvious: Investigate and treat any underlying cause such as diarrhoea. Consider potassium replacement treatment
  • If cause is unclear: Review medication for drugs known to cause hypokalaemia.
  • Consider nutritional status and dietary potassium intake
  • Low magnesium can cause hypokalaemia.
  • Consider testing random urine potassium:creatinine ratio, >2.5 mmol/mmol suggests renal loss ·
  • If hypertensive, consider need for renin-aldosterone studies.
  • Consider ectopic ACTH production (typically from small cell lung carcinoma), particularly if severe or rapidly developing.
  • For more information about investigating Hypokalaemia in adults (see right or follow this link)

Abnormal Sodium Results

High Sodium (Na) result received:

  • Establish history of thirst, fluid intake/loss and current treatments.
  • Check for clinical features of dehydration and/or hypovolaemia.
  • Repeat sodium to confirm and establish if acute and changing or chronic and stable.
  • Changes of up to 4 mmol/l can reflect non‐ significant variation.
  • For more information about investigating Hypernatraemia in adults (see right or follow this link)

Low Sodium (Na) result received:

  • Establish history of fluid intake and current treatments.
  • Assess fluid status to identify if hypovolaemic or hypervolaemic.
  • Repeat sodium to confirm and establish if acute and changing or chronic and stable.
  • Changes of up to 4 mmol/l can reflect non‐ significant variation.
  • For more information about investigating Hyponatraemia in adults (see right or follow this link)
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