Electrolyte Disturbances: Pathology Review

Overview

• Electrolyte disturbances involve imbalances in levels of electrolytes such as potassium, calcium, sodium, and magnesium in the body.
• These imbalances can lead to various clinical manifestations and are often related to underlying pathological processes.

Clinical Case Examples

1. 67-year-old Female

   • Symptoms: Nausea, vomiting, lethargy
   • Background: Undergoing chemotherapy for diffuse large B-cell lymphoma
   • Vital Signs: Temperature 37.0C, Pulse 121/min, Respirations 18/min, Blood Pressure 92/74 mmHg, O2 Saturation 94% on room air.
   • Physical Exam: Pale, ill-appearing, intermittently convulsing, tenderness to left flank
   • Labs: Presence of uric acid crystals, erythrocytes 20/hpf, leukocytes 30/hpf, fractional excretion of sodium >3%
   • Metabolic Derangement: Potential causes include hypercalcemia, hyperkalemia, hypermagnesemia, hypernatremia, hypocalcemia, hypokalemia, hypomagnesemia, hyponatremia.

2. 75-year-old Karen

   • Symptoms: Palpitations, muscle weakness
   • Background: Heart failure, medication with digitalis
   • ECG Findings: Wide QRS complex, peaked T waves
   • Electrolyte Imbalance: High potassium (Hyperkalemia)

3. 25-year-old Carmen

   • Symptoms: Tetany
   • Clinical Findings: Positive Chvostek sign
   • ECG Findings: Prolonged QT interval
   • Electrolyte Imbalance: Low calcium (Hypocalcemia)

Electrolytes and Their Functions

• Potassium (K+)
  • Intracellular cation vital for nerve and muscle function.
  • Maintains resting membrane potential.

Hyperkalemia

• Causes: Decreased renal excretion, internal shift of potassium from cells to extracellular fluid.
• Conditions: Hyperosmolarity, metabolic acidosis.
• Mechanism: Potassium exits cells to balance high extracellular osmolarity or increased hydrogen ions.

Sources

• Key textbooks and articles including "Robbins Basic Pathology" and "Harrison's Principles of Internal Medicine."
• Studies on electrolyte disorders in hospitalized adults and mechanisms in chemotherapy.

Institutional Resources and Support

• Offers resources for various medical professionals including DOs, MDs, NPs, PAs, and RNs.
• Available support through apps, help centers, and extensive educational content.

Additional Notes

• Electrolyte imbalances are critical in medical diagnostics and require immediate attention to prevent severe complications.
• Understanding the underlying causes and physiological changes is important for effective treatment and management.