Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · May 2014
ReviewCalcium, Magnesium, and Phosphate Abnormalities in the Emergency Department.
Derangements of calcium, magnesium, and phosphate are associated with increased morbidity and mortality. These minerals have vital roles in the cellular physiology of the neuromuscular and cardiovascular systems. This article describes the pathophysiology of these mineral disorders. It aims to provide the emergency practitioner with an overview of the diagnosis and management of these disorders.
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Dysnatremias occur simultaneously with disorders in water balance. The first priority is to correct dehydration; once the patient is euvolemic, the sodium level can be reassessed. ⋯ In stable patients with either hyponatremia or hypernatremia, the clinician should aim for correction over 24 to 48 hours, with the maximal change in serum sodium between 8 to 12 mEq/L over the first 24 hours. This rate of correction decreases the chances of cerebral edema or osmotic demyelination syndrome.
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Emerg. Med. Clin. North Am. · May 2014
ReviewThe Clinical Manifestations, Diagnosis, and Treatment of Adrenal Emergencies.
Emergency medicine physicians should be able to identify and treat patients whose clinical presentations, including key historical, physical examination, and laboratory findings are consistent with diagnoses of primary, secondary, and tertiary adrenal insufficiency, adrenal crisis, and pheochromocytoma. Failure to make a timely diagnosis leads to increased morbidity and mortality. As great mimickers, adrenal emergencies often present with a constellation of nonspecific signs and symptoms that can lead even the most diligent emergency physician astray. The emergency physician must include adrenal emergencies in the differential diagnosis when encountering such clinical pictures.
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Metabolic alkalosis is a common disorder, accounting for half of all acid-base disturbances in hospitalized patients. It is the result of an increase in bicarbonate production, a decrease in bicarbonate excretion, or a loss of hydrogen ions. Most causes of metabolic alkalosis can be divided into 4 categories: chloride depletion alkalosis, mineralocorticoid excess syndromes, apparent mineralocorticoid excess syndromes, and excess alkali administration. Treatment is usually supportive and based on cause of the alkalosis.