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Considerations for treatment include symptom severity, time to onset, volume status, underlying cause, and sodium levels. [14] If the sodium level is <120 mEq/L, the person can be treated with hypertonic saline as extremely low levels are associated with severe neurological symptoms. [14]
Emergency lowering of potassium levels is needed when new arrhythmias occur at any level of potassium in the blood, or when potassium levels exceed 6.5 mmol/L. Several agents are used to temporarily lower K + levels. The choice depends on the degree and cause of the hyperkalemia, and other aspects of the person's condition.
Lower levels of plasma sodium are associated with more severe symptoms. However, mild hyponatremia (plasma sodium levels at 131–135 mmol/L) may be associated with complications and subtle symptoms [14] (for example, increased falls, altered posture and gait, reduced attention, impaired cognition, and possibly higher rates of death). [15] [16]
Severe symptoms include confusion, muscle twitching, and bleeding in or around the brain. [1] [2] Normal serum sodium levels are 135–145 mmol/L (135–145 mEq/L). [5] Hypernatremia is generally defined as a serum sodium level of more than 145 mmol/L. [3] Severe symptoms typically only occur when levels are above 160 mmol/L. [1]
Hyponatremia, or blood sodium levels below 135 mEq/L, causes brain cells to swell; the symptoms can be subtle and may include altered personality, lethargy, and confusion. In severe cases, when blood sodium falls below 115 mEq/L, stupor, muscle twitching or spasms, seizures, coma, and death can result. [15]
Treatment includes removing the causative agent (such as licorice), a high-potassium, low-sodium diet (for primary) and high-sodium diet (for secondary), spironolactone and eplerenone, potassium-sparing diuretics that act as aldosterone antagonists, and surgery, depending on the cause. [11] For adrenal adenoma, sometimes surgery is performed.
Some patients also take potassium-sparing diuretics such as spironolactone to help maintain potassium levels. [11] Paralysis attacks can be managed by drinking one of various potassium salts dissolved in water (debate exists over which, if any one in particular, is best used, but potassium chloride and bicarbonate are common).
These actions increase sodium reabsorption and potassium secretion. Since more sodium is reabsorbed than potassium secreted, it also makes the lumen more electrically negative, causing chloride to follow sodium. Water then follows sodium and chloride by osmosis. In Conn syndrome, these actions cause increased extracellular sodium and fluid ...