Diagnosing Electrolyte Disorders

Algorithms for Diagnosing Some Electrolyte Disorders

MILFORD FULOP MD

From the Department of Medicine, Albert Einstein College of Medicine, and Jacobi Medical Center, Bronx, NY.
The differential diagnosis of electrolyte disorders has traditionally been framed in terms of pathophysiology, and analysis of clinical problems has usually proceeded in the same way. However, easier access to rapid-response laboratory analysis has prompted physicians who encounter patients with serious electrolyte abnormalities to try to establish the cause by quickly obtaining further simple tests. In that vein, this article and the algorithms that are presented are intended to assist the preliminary laboratory differential diagnosis of low and high serum levels of sodium, potassium, and calcium.
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Evidence for a tubular defect in the loop of Henle

Impaired response to furosemide in Hyperprostaglandin E syndrome: Evidence for a tubular defect in the loop of Henle

In hyperprostaglandin E syndrome (HPS) renal wasting of electrolytes and water is consistently associated with enhanced synthesis of prostaglandin E2 . In contrast to Bartter or Gitelman syndrome (BS/GS), HPS is characterized by its severe prenatal manifestation, leading to fetal polyuria, development of polyhydramnios, and premature birth. This disorder mimics furosemide treatment with hypokalemic alkalosis, hypochloremia, isosthenuria, and impaired renal conservation of both calcium and magnesium. Therefore the thick ascending limb of the loop of Henle seems to be involved in HPS.

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Nephrolithiasis

By David A. Bushinsky, University of Rochester School of Medicine and Dentistry, Nephrology Unit, Strong Memorial Hospital, Rochester, New York.

The incidence of nephrolithiasis appears to be slightly in excess of one case per 1000 patients per year and has been slowly increasing in recent decades [1] [2] . Kidney stones often cause severe pain, which may lead to emergent hospitalization, shock-wave lithotripsy, and/or surgery. An understanding of the mechanisms involved in kidney stone formation leads to rational treatment which has been documented to decrease the incidence of nephrolithiasis and its associated morbidity.

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Urolithiasis

Medical Therapy and New Approaches to Urolithiasis

The introduction of extracorporeal shock-wave lithotripsy (ESWL) has revolutionized the urologic practice in urolithiasis. [1] This technology has reduced considerably the morbidity of stone disease, by allowing relatively noninvasive removal of stones.  Unfortunately, the facilitated removal of stones by ESWL has led some urologists to abandon or disparage the medical approach to stone management. This development is unfortunate, because the need for medical diagnosis and prevention has not diminished. Renal stone disease is characterized by a high rate of recurrence. [3] The propensity for stone recurrence is not altered by removal of stones with ESWL. [5] Ample evidence has accumulated, however, showing that a variety of medical treatments can prevent recurrence of stones. [9]

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Amounts of Potassium & Magnesium in Snack Foods

If you have Bartter’s or Gitelman’s Syndrome you should know that diet alone cannot come close to correcting the potassium and magnesium deficiencies. At the same time, if you are going to eat a snack, you might as well have something that adds rather than detracts from your levels. Looks like a bag of peanuts would be a good choice, and popcorn would be a poor choice.
You may also be interested in a Chart of Foods High in Magnesium

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Serum Creatinine

Brenner & Rector’s The Kidney, 6th ed., Copyright ? 2000 W. B. Saunders Company

Creatinine is a metabolic product of creatine and phosphocreatine, which are both found almost exclusively in muscle. Thus, creatinine production is proportional to muscle mass and varies little from day to day. However, production can change over longer periods of time if there are changes in muscle mass. Although diet ordinarily accounts for only a relatively small proportion of overall creatinine excretion, it is another source of variability in serum creatinine levels. Read the rest »

Full Journal Articles

On this page we have full journal articles of the selected topics. These are not as easy to create or find so I don’t have as many of them as I do the abstracts. There are 22 articles listed.

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Nephrocalcinosis

Definition: Deposits of calcium (in the form of calcium phosphate and calcium oxalate) in the kidney, a process that may result in reduced kidney function.

Nephrocalcinosis can be caused by several conditions including: the excess excretion of calcium by the kidney, renal tubular acidosis, medullary sponge kidney, hypercalcemia (high calcium levels in the blood), renal cortical necrosis, and tuberculosis.

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Kidney Tutorial

One of the easiest ways to learn about Bartter’s and Gitelman’s syndrome is to learn how the normal kidney functions. This page is to teach you more information about the kidneys and how they function. Take your time and read the information a few times. Remember when we went to college for nursing it took a while to learn all of this stuff. So don’t expect it to make sense the first time you read it. The more you read the more you will learn. Learning this will help you understand your disease, why it happens and what affect it has on you and your kidneys.

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Kidney Basics

The kidneys maintain the body’s delicate balance of fluid, acid, and alkaline constituents by disposing of surplus water, sodium, potassium, and other elements. They also help determine bone strength, activate vitamin D, and make a hormone needed for red blood cell production. Poor kidney function can lead to anemia, weaker bones, high blood pressure, a greater risk of general infection, and kidney stones.

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