Rachel Phillips

more detailed picture is needed before attempting to fix electrolytes levels through PN. Adding right amount of electrolytes can only happen when you identify the causes. Here are some thoughts:

1. Hypomagnesemia: Drug induced i.e. Insulin, Diuretics? Is it hypomagnesemia induced by Hypokalemia? Extra Dextrose? The key is to reduce dextrose in PN and correct hypokalemia.

2. Hypokalemia: Is it due to Alkalosis induced by Diuretics? Extra dextrose/insulin? Excess GI losses? Try ranitidine 100mg in PN. Lower dextrose. Correct acid-base.

3. Hyponatremia: 90% of Hyponatremia is fluid overload. Check blood and urine Osmolarity and identify why Hyponatremia: R/O Hyperglycemia-induced Hyponatremia. Don’t add more than 155mmol/L.

Note: There is no limit on how much Mg and K can be added to PN assuming the patient has massive GI losses. If not, and if the the case is intracellular shift due to acid-base or drug-induced, then be more conservative.

The key to success with electrolytes correction is identifying the of etiologies.

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