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Fluid and Electrolyte Imbalances in CKD

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Hyperkalemia

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Typical causes in CKD: Reduced renal excretion, metabolic acidosis, catabolism. Clinical manifestations: Cardiac arrhythmias, muscle weakness, fatigue. Treatment: Dietary potassium restriction, loop or thiazide diuretics, potassium binders.

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Metabolic Acidosis

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Typical causes in CKD: Reduced renal ammonia synthesis and excretion of acid. Clinical manifestations: Bone demineralization, muscle wasting, altered enzyme activity. Treatment: Oral bicarbonate supplementation, dietary protein modification.

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Hyponatremia

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Typical causes in CKD: Dilutional from fluid overload, low dietary intake, loss from dialysis. Clinical manifestations: Headache, confusion, seizures. Treatment: Fluid restriction, sodium chloride tablets, loop diuretics.

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Hypernatremia

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Typical causes in CKD: Inadequate water intake, loss through dialysis, hypercatabolism. Clinical manifestations: Thirst, lethargy, restlessness, muscle twitching. Treatment: Controlled water intake, diuretics adjustment, appropriate dialysis settings.

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Hypervolemia

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Typical causes in CKD: Sodium and water retention due to reduced renal clearance. Clinical manifestations: Edema, hypertension, pulmonary congestion. Treatment: Sodium restriction, diuretics, optimize dialysis.

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Hypokalemia

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Typical causes in CKD: Use of potassium-wasting diuretics, poor dietary intake, dialysis. Clinical manifestations: Muscle weakness, cramps, arrhythmias. Treatment: Increased dietary potassium intake, potassium-sparing diuretics, potassium supplements.

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Hypocalcemia

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Typical causes in CKD: Decreased renal synthesis of 1,25-dihydroxyvitamin D, hyperphosphatemia. Clinical manifestations: Tetany, muscle spasms, paresthesia. Treatment: Calcium supplementation, vitamin D analogs, phosphate binders.

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Anemia

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Typical causes in CKD: Erythropoietin deficiency due to kidney damage, iron deficiency. Clinical manifestations: Fatigue, pallor, dyspnea. Treatment: Erythropoiesis-stimulating agents, iron supplements, blood transfusions if needed.

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Hyperphosphatemia

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Typical causes in CKD: Decreased renal phosphate excretion. Clinical manifestations: Extraskeletal calcification, secondary hyperparathyroidism. Treatment: Dietary phosphate restriction, phosphate binders, dialysis.

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Hypomagnesemia

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Typical causes in CKD: Malabsorption, dietary deficiency, increased losses through dialysis. Clinical manifestations: Neuromuscular irritability, tetany, arrhythmias. Treatment: Magnesium supplements, dietary adjustment.

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