Cause Seru Urine 24hr Urine Seru Hyperkalemia Hypokalemia

m Na Na Urin Osmolalit mK
Decreased Renal Gastrointestinal Loss
e Na y
Excretion - Gastric suction & laxative
Overhydration L L L L L/N
- Acute or chronic renal use
Diuretics L L H L L failure - Intestinal Tumor
SIADH L H H H L/N - Severe dehydration - Malabsorption
Adrenal Failure L ME H N H - Addison’s Disease - Cancer and Radio Therapy
- Salt-losing nephropathy - Vomiting and Diarrhea
Barterr’s L L H L L
- Immunosuppressive
Syndrome
drugs
Diabetic L N N N H
Extracellular shift Intracellular Shift
Hyperosmolality
- Acidosis - Alkalosis
- Muscle/Cellular Injury - Insulin overdose
HYPERNATREMIA HYPONATREMIA - Chemotherapy - Barium &
- Vigorous Exercise hydroxychloroquine poisoning
Increased Increased Water Retention - Digitalis intoxication
Retention/Sodium Content - Renal Failure - Succinylcholine
- Hyperaldosteronism - Nephrotic Syndrome - Fluoride poisoning
(Conn’s Disease) - Aldosterone Deficiency Use of Extrarenal Loss
- Sodium Bicarbonate - Cancer Immunosuppressive drugs - Diuretics Use (Thiazides)
Infusion - Hepatic Cirrhosis and antibiotics - Hyperaldosteronism
- Increased Oral or IV - Primary Polydipsia - Tacrolimus - Nephritis
intake of NaCl - Myxedema - Cyclosporine - Renal Tubular Acidosis
- Ingestion of Sea Water - Drug Intake - Trimethoprim - Hypomagnesemia
- Dialysis Fluid Excess - Meningitis - Cushing syndrome
- Encephalitis - Leukemia
- Multiple Sclerosis - Reninoma
- Shy-Drager Syndrome - Gitelman Syndrome
- Rocky Mountain Spotted - Barterr Syndrome
Fever - Liddle’s Syndrome
- Emotional Stress - Malignant Hypertension
Excess Water Loss Increased Sodium Loss - Iron Deficiency (Magnesium)
- Diabetes Insipidus - Diuretic Use Increased Intake
- Renal Tubular Disorder - Saline Infusion - Oral or IV infusion
- Prolonged Diarrhea - K deficiency
Artifactual Hyperkalemic Drugs
- Profuse Sweating - Ketonuria
- Hemolysis - Captopril, Digoxin,
- Severe Burns - Hypoaldrenalism
- Thrombocytosis Cyclosporine, Heparin
- Vomiting - Prolonged vomiting &
Therapy, Spironolactone
- Fever diarrhea
- Hyperventilation - Severe burns
- Salt-losing nephropathy Hypercalcemia Hypocalcemia
Reduced Water Intake Water Imbalance - Primary - Primary
- Pedia and Geriatrics - SIADH hyperparathyroidism hypoparathyroidism
- Inability to drink water - Excess Water Intake - Cancer (Lung & - Chronic Renal Failure
- Defective thirst due to - Pseudohyponatremia Mammary) - Alkalosis
altered mental state - Acidosis - Vit D Deficiency
- Increased Vit D - Acute Pancreatitis
- Multiple Myeloma - DiGeorge Syndrome
Hyperchloremia Hypochloremia
- Sarcoidosis - Sever hypomagnesemia
- Renal Tubular Acidosis - Prolonged vomiting - Hyperthyroidism - Malabsorption Syndrome
- Diabetes Insipidus - Aldosterone deficiency - Milk-Alkali Syndrome - Fluoride Poisoning
- Salicylate Intoxication - Metabolic Alkalosis
- Primary - Salt-losing nephropathy
hyperparathyroidism Vit D3 – 1,25 Dihydroxycholecalciferol
- Metabolic Acidosis
- Prolonged diarrhea
 Hypermagnesemia Hypomagnesemia Reference Ranges
Decreased Excretion Increased Excretion
Potassium Serum: 3.5 – 5.1 mmol/L
- Acute or chronic renal - Glomerulonephritis
Hyperkalemia: 6.5 mmol/L
failure - Acute Tubular Necrosis
Hypokalemia: 2.5 mmol/L
- Hypothyroidism - Hyperthyroidism
Male: 3.5 – 5.4 mmol/L
- Hypoparathyroidism - Hyperparathyroidism
Females: 3.4 – 4.4 mmol/L
- Hypoaldosteronism - Hypercalcemia
24hr Urine: 25-125 mmol/d
- Hypopituitarism - Diuretics
33-86 mmol/d
- Antibiotics
- Immunosuppressive drugs Sodium Serum: 135-145 mmol/d
Increased Intake Decreased Intake/Absorption Hypernatremia: 160 mmol/L
- Antacids - Malabsorption Syndrome Hyponatremia: 120 mmol/L
- Enemas - Surgical Resection CSF Sodium: 136-150 mmol/L
- Therapeutics - Pancreatitis 24hr Urine: 40-220 mmol/d
- Alcoholism 120-240 mmol/d
- Congenital/Infant Disorder Chloride Serum: 98-107 mmol/L
- Vomiting and Diarrhea 24hours: 110-250 mmol/d
- Laxative Abuse CSF: 110-125 mmol/L
Dehydration Reduced Intake Cryptococcal meningitis: <121.7
Cancer Excess Lactation Calcium
Pregnancy Total Serum 2.24-2.53 mmol/L
Massive Transfusion with Ionized (Serum) 1.15-1.33 mmol/L
Citrate Ionized (Whole) 1.15-1.27 mmol/L
Diabetic Ketoacidosis Magnesium 0.66-1.07 mmol/L
1.7-2.4 mg/dL
Hypo: < 0.5 mmol/L
Hyperphosphatemia Hypophosphatemia Hyper: 1.5 mmol/L
- Hypoparathyroidism - Primary Hyperparathyroidism Life threat: 5 mmol/L
- Renal Failure - Alcohol Abuse CSF: 2 – 2.7 mg/dL
- Lymphoblastic Leukemia - Myxedema Phosphate Adult: 2-4 – 4.5 mg/dL
- Hypervitaminosis D - Avitaminosis D Child: 4-7 mg/dL
- Cytolysis - Diabetic Coma Severe hypo: <1.0 g/dL
- Renal Tubular Acidosis Iron Male: 50 – 160 ug/dL
- Diuretics Female: 45 – 150 ug/dL

Increase HCO3 Decrease HCO3

- IV Infusion of lactate, - Use of diuretics
acetate, HCO3 - Reduced reabsorption
- Chronic Nephritis

Metabolic Acidosis Metabolic Alkalosis Respiratory Acidosis Respiratory Alkalosis

- Diabetic Ketoacidosis - Vomiting - Chronic Obstructive - Anxiety
- Lactic Acidosis - Hypokalemia Pulmonic Disease (COPD) - Severe Pain
- Renal Failure - Hypochloridemia - Myasthenia Gravis - Aspirin Overdose
- Diarrhea - Drug Overdose - Pneumonia
- Drug Ingestion - CNS Disease - Trauma
(Acetaminophen & - Acute Asthma - Hepatic Cirrhosis
Salicylate) - Guillain-Barre Syndrome - Gram Neg Sepsis
- Intoxication (Alcohol & - Intoxication - Pulmonary Embolism
Toluene) - Botulism - Overuse of Salicylates
- Hyperkalemia - Stroke - Progesterone Drugs
- Hyperchloremia - Myxedema - Hypokalemia