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Fluid and Electrolyte Imbalances in CKD
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Hyperkalemia
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.
Metabolic Acidosis
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.
Hyponatremia
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.
Hypernatremia
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.
Hypervolemia
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.
Hypokalemia
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.
Hypocalcemia
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.
Anemia
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.
Hyperphosphatemia
Typical causes in CKD: Decreased renal phosphate excretion. Clinical manifestations: Extraskeletal calcification, secondary hyperparathyroidism. Treatment: Dietary phosphate restriction, phosphate binders, dialysis.
Hypomagnesemia
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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