Electrolyte Blood Press.  2010 Dec;8(2):72-81.

Fluid and Electrolyte Disturbances in Critically Ill Patients

• Lee JW

Abstract

Disturbances in fluid and electrolytes are among the most common clinical problems encountered in the intensive care unit (ICU). Recent studies have reported that fluid and electrolyte imbalances are associated with increased morbidity and mortality among critically ill patients. To provide optimal care, health care providers should be familiar with the principles and practice of fluid and electrolyte physiology and pathophysiology. Fluid resuscitation should be aimed at restoration of normal hemodynamics and tissue perfusion. Early goal-directed therapy has been shown to be effective in patients with severe sepsis or septic shock. On the other hand, liberal fluid administration is associated with adverse outcomes such as prolonged stay in the ICU, higher cost of care, and increased mortality. Development of hyponatremia in critically ill patients is associated with disturbances in the renal mechanism of urinary dilution. Removal of nonosmotic stimuli for vasopressin secretion, judicious use of hypertonic saline, and close monitoring of plasma and urine electrolytes are essential components of therapy. Hypernatremia is associated with cellular dehydration and central nervous system damage. Water deficit should be corrected with hypotonic fluid, and ongoing water loss should be taken into account. Cardiac manifestations should be identified and treated before initiating stepwise diagnostic evaluation of dyskalemias. Divalent ion deficiencies such as hypocalcemia, hypomagnesemia and hypophosphatemia should be identified and corrected, since they are associated with increased adverse events among critically ill patients.

Keyword

intensive care; hyponatremia; hypernatremia; hypokalemia; hyperkalemia; hypocalcemia; hypophosphatemia

MeSH Terms

Central Nervous System
Critical Illness
Dehydration
Delivery of Health Care
Electrolytes
Hand
Hemodynamics
Humans
Hyperkalemia
Hypernatremia
Hypocalcemia
Hypokalemia
Hyponatremia
Hypophosphatemia
Intensive Care Units
Perfusion
Plasma
Resuscitation
Shock, Septic
Vasopressins
Critical Care
Electrolytes
Vasopressins

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