電解質補充 electrolyte supplement

 電解質補充 electrolyte supplement

以下內容部分來自經驗，部分來自資料庫，僅供參考

藥物	敘述
低血鈉
Normal saline	一般低血鈉用500 ml生理食鹽水即可，盡量不要用3% saline
Sodium chloride 3%	經驗：3% saline 50ml and run 8ml/hr，病人血鈉從127爬升到136 mEq/L，可用0.5 ml/kg/day去補比較安全 ***注意每天補不得超過6-8 mEq/L以防產生central pontine myelinolysis/osmotic demyelination syndrome   Uptodate： l   Asymptomatic, acute serum sodium <130 mEq/L —usually treat with a 50 mL bolus of 3 percent saline (ie, hypertonic saline) to prevent the serum sodium from falling further l   Symptomatic (seizures, obtundation, coma, respiratory arrest, headache, nausea, vomiting, tremors, gait or movement disturbances, or confusion), acute serum sodium <130 mEq/L—100 mL bolus of 3 percent saline, followed, if symptoms persist, with up to two additional 100 mL doses (to a total dose of 300 mL); each bolus is infused over 10 minutes. l   Severe symptoms or known intracranial pathology — In all patients with severe symptoms of hyponatremia (eg, seizures, obtundation, coma, respiratory arrest), 100 mL bolus of 3% saline followed, if symptoms persist, by up to two additional 100 mL doses (to a total dose of 300 mL); each bolus is infused over 10 minutes . l   Patients with severe chronic hyponatremia (serum sodium <120 mEq/L) —initiate intravenous 3% saline beginning at a rate of 15 to 30 mL/hour, administered via a peripheral vein; we use 3 percent saline (rather than normal saline) in patients with and without suspected hypovolemia.
低血鉀
K-supply tab, potassium gluconate, 2.54 mEq	可以3# TID使用，藥物很大顆。
K-Glu oral solution, potassium gluconate, 20 mEq	可以1# TID使用，不是很好喝。
KCl 20 mEq in 500 ml normal saline	個人經驗用在血鉀 < 3 mEq/L <2.5 mEq/L的時候可以BID補2-3天 < 3 mEq/L、>2.5 mEq/L時QD補充3天
KCl 20mEq in 100 ml normal saline	濃度高，從central line給予。
低血鈣
Vitacal, 2% calcium chloride in 20ml 10% glucose solution total 400 mg calcium chloride total 108 mg elemental calcium	一支可以補大概0.5 mg/dl的corrected serum calcium 用於corrected serum calcium <= 7.5 mg/dl或 free calcium <= 0.8 mmol/L
Calcium carbonate tab 500 mg total 200 mg elemental calcium	1# BID-QID, 也可2# QD-BID
Bio-cal plus chewable tab [Tricalcium phosphate 1203 mg + cholecalciferol (D3) 330 IU] total 450 mg elemental calcium	2-3# QD
All-right calcium suspension Ca3(PO4)2 + vitamin A + vitamin D3 40 mg elemental calcium + 40 mcg vitamin A + 4 mcg vitamin D4 / ml	10-15 ml/day
Uptodate： l   Asymptomatic, corrected serum calcium > 7.5 mg/dl或 free calcium > 0.8 mmol/L：口服 l   Asymptomatic, corrected serum calcium <= 7.5 mg/dl或 free calcium <= 0.8 mmol/L：90-180 mg elemental calcium over 10 to 20 minutes，約等於1# vitalcal l   Acute, symptomatic：補200-1,000 mg calcium chloride QD l   Severe, symptomatic (eg, seizure, tetany)：補充1,000 mg calcium chloride over 10 minutes; repeat every 60 minutes until symptoms resolve l   補鉀的時候，若要同時補bicarbonate或磷，需要從另一條管路給予
低血磷
酵母粉yeast powder Phosphate 1477 mg (15.6 mmol)/100 g	2 spoon TID 參考：病人吃三天，血磷從1.3爬到2
Neutral phosphate 4.5 g elemental phosphate (47 mmol)	1.2-1.5 g daily 但可以吃到 3 g daily以上 *** 65 kg F 血磷 0.9 mg/dl，補 1 g TID，隔天4.7 mg/dl (此病人有lung adenocarcinoma w/ bone mets c/w hypocalcemia及central DI)
Potassium phosphate 20 ml 1860 mg (60 mmol) elemental phosphate 88 mEq elemental potassium	使用時要密切監控，建議在加護病房使用，使用時從中心靜脈導管給予，0.5 #混500 ml normal saline跑兩小時 ***經驗則是0.25# in 250 ml NS, run 12 hr
Uptodate： l   Asymptomatic patients with a serum phosphate < 2.0 mg/dL (0.64 mmol/L)：口服補充，因症狀及肌肉病變在此時可能不明顯 l   Symptomatic patients with a serum phosphate between 1.0 to 1.9 mg/dL (0.32 to 0.63 mmol/L)：口服補充 l   Symptomatic patients with a serum phosphate < 1.0 mg/dL (0.32 mmol/L)：點滴補充，當補到1.5 mg/dL時改成口服 l   治療劑量給予方式 n   serum phosphate >= 1.5 mg/dL (0.48 mmol/L)：1 mmol/kg of elemental phosphorus (minimum of 40 mmol and a maximum of 80 mmol)一天內分成三四次給予(腎臟功能不佳需減半) n   serum phosphate < 1.5 mg/dL (0.48 mmol/L)：1.3 mmol/kg of elemental phosphorus (a maximum of 100 mmol)一天內分成三四次給予(腎臟功能不佳需減半) n   serum phosphate >= 1.25 mg/dL (0.40 mmol/L)：0.08-0.24 mmol/kg over 6 hours (up to a maximum total dose of 30 mmol) n   serum phosphate < 1.25 mg/dL (0.40 mmol/L)：0.25-0.50 mmol/kg over 8 to 12 hours (up to a maximum total dose of 80 mmol)
低血鎂
Magnesium oxide 250 mg	Asymptomatic：1# TID-QID (5-10 mg/kg)
Magnesium sulfate 10% 20 ml 16.24 mEq/amp	Uptodate： l   Non severe：32 to 64 mEq (16 to 32 mmol) IVD over 24 hours l   hemodynamically stable patients with severe symptomatic hypomagnesemia (<= 1 mg/dL [0.4 mmol/L or 0.8 mEq/L])：8-16 mEq (4-8 mmol) in 50-100 D5W IVD in 5-60 minutes followed by infusion l   Severe, hemodynamically unstable pts  (including those with arrhythmias consistent with torsade de pointes or hypomagnesemic hypokalemia): 8-16 mEq (4-8 mmol) IVD in 10-15 minutes

 

參考案例：

因samll bowel obstruction住院
(理由不明，沒有手術hx)
NPO超過20天以上
從5/24日開始灌食(當天1000kcal, BW 50.4kg)
昨天拉了6次大便，黃軟便
今天抽血(超過一個月沒抽血)
Na: 131
K: 2.0
IP: 1.4
Mg: 1.29
free Ca: 0.89 mmol/L
Hx: HF, HTN, PAOD
r/o refeeding syndrome
 
建議處置可能如下：
熱量10kcal/kg=> 500kcal給起
KCl 20mEq BID 2天
vitacal 1# QD 4天
mag. sulfate 1# once
yeast powder 2 spoons TID $
vitamin B1 1# BID 5天