Matheus

CLINICAL REVIEW

Electrolyte disorders

CLINICAL REVIEW

Treatment of electrolyte disorders in adult patients in the intensive care unit
MICHAEL D. KRAFT, IMAD F. BTAICHE, GORDON S. SACKS, AND KENNETH A. KUDSK

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lectrolytes are involved in many metabolic and homeostatic functions, including enzymatic and biochemical reactions, the maintenance of cell membrane structure and function,neurotransmission, nerve signal conduction, hormone function, muscle contraction, cardiovascular function, bone composition, and fluid and acid–base regulation. In addition to serum electrolyte concentrations, signs and symptoms of specific electrolyte disorders should be monitored in patients with electrolyte abnormalities. The severity of symptoms related to electrolyte disorders generallycorrelates with the severity of the disorder and the rate at which the disorder developed. Multiple mechanisms may be involved in electrolyte abnormalities in adult patients in the intensive care unit (ICU), including altered absorption and distribution; excessive or inadequate administration; alterations in hormonal, neuro-

Purpose. The treatment of electrolyte disorders in adult patients in theintensive care unit (ICU), including guidelines for correcting specific electrolyte disorders, is reviewed. Summary. Electrolytes are involved in many metabolic and homeostatic functions. Electrolyte disorders are common in adult patients in the ICU and have been associated with increased morbidity and mortality, as has the improper treatment of electrolyte disorders. A limited number ofprospective, randomized, controlled studies have been conducted evaluating the optimal treatment of electrolyte disorders. Recommendations for treatment of electrolyte disorders in adult patients in the ICU are provided based on these studies, as well as case reports, expert opinion, and clinical experience. The etiologies of and treatments for hyponatremia hypotonic and hypernatremia (hypovolemic,isovolemic, and hypervolemic), hypokalemia and hyperkalemia, hypophosphatemia and hyperphosphatemia, hypocalcemia and hypercalcemia, and hypomagnesemia and hypermagnesemia are discussed, and equations for deter-

mining the proper dosages for adult patients in the ICU are provided. Treatment is often empirical, based on published literature, expert recommendations, and the patient’s response to theinitial treatment. Actual electrolyte correction requires individual adjustment based on the patient’s clinical condition and response to therapy. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders in order to provide the optimal therapy to patients. Conclusion. Treatment of electrolyte disorders is often empirical, based onpublished literature, expert opinion and recommendations, and patient’s response to the initial treatment. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders to provide optimal therapy for patients. Index terms: Calculations; Critical illness; Dosage; Electrolytes; Equations; Methodology; Mortality; Protocols; Water-electrolyteimbalance Am J Health-Syst Pharm. 2005; 62:1663-82

MICHAEL D. KRAFT, PHARM.D., is Clinical Assistant Professor, Department of Clinical Sciences, College of Pharmacy, University of Michigan (UM), Ann Arbor, and Clinical Pharmacist, Department of Pharmacy Services, University of Michigan Health System (UMHS), Ann Arbor. IMAD F. BTAICHE, PHARM.D., BCNSP, is Clinical Associate Professor, Departmentof Clinical Sciences, College of Pharmacy, UM, and Clinical Pharmacist, Department of Pharmacy Services, UMHS. GORDON S. SACKS, PHARM.D., BCNSP, is Clinical Associate Professor, Pharmacy Practice Division, School of Pharmacy; and KENNETH A. KUDSK, M.D., is Professor of Surgery, Department of

Surgery, University of Wisconsin—Madison. Address correspondence to Dr. Kraft at the Department of...