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MICHAEL D. KRAFT, PHARM.D., is Clinical Assistant Professor, Department of Clinical Sciences, College of Pharmacy, University of Michigan (UM), Ann Arbor, and Clinical Pharmacist, Department of Pharmacy Services, University of Michigan Health System (UMHS), Ann Arbor. IMAD F. BTAICHE, PHARM.D., BCNSP, is Clinical Associate Professor, Department of Clinical Sciences, College of Pharmacy, UM, and Clinical Pharmacist, Department of Pharmacy Services, UMHS. GORDON S. SACKS, PHARM.D., BCNSP, is Clinical Associate Professor, Pharmacy Practice Division, School of Pharmacy; and KENNETH A. KUDSK, M.D., is Professor of Surgery, Department of Surgery, University of Wisconsin—Madison.

Address correspondence to Dr. Kraft at the Department of Pharmacy Services, University of Michigan Health System, UH/B2 D301, Box 0008, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0008 (mdkraft{at}umich.edu).

Purpose. The treatment of electrolyte disorders in adult patients in the intensive care unit (ICU), including guidelines for correcting specific electrolyte disorders, is reviewed. Summary. Electrolytes are involved in many metabolic and homeostatic functions. Electrolyte disorders are common in adult patients in the ICU and have been associated with increased morbidity and mortality, as has the improper treatment of electrolyte disorders. A limited number of prospective, randomized, controlled studies have been conducted evaluating the optimal treatment of electrolyte disorders. Recommendations for treatment of electrolyte disorders in adult patients in the ICU are provided based on these studies, as well as case reports, expert opinion, and clinical experience. The etiologies of and treatments for hyponatremia hypotonic and hypernatremia (hypovolemic, isovolemic, and hypervolemic), hypokalemia and hyperkalemia, hypophosphatemia and hyperphosphatemia, hypocalcemia and hypercalcemia, and hypomagnesemia and hypermagnesemia are discussed, and equations for determining the proper dosages for adult patients in the ICU are provided. Treatment is often empirical, based on published literature, expert recommendations, and the patient’s response to the initial treatment. Actual electrolyte correction requires individual adjustment based on the patient’s clinical condition and response to therapy. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders in order to provide the optimal therapy to patients. Conclusion. Treatment of electrolyte disorders is often empirical, based on published literature, expert opinion and recommendations, and patient’s response to the initial treatment. Clinicians should be knowledgeable about electrolyte homeostasis and the underlying pathophysiology of electrolyte disorders to provide optimal therapy for patients. Index terms: Calculations; Critical illness; Dosage; Electrolytes; Equations; Methodology; Mortality; Protocols; Water-electrolyte imbalance

 

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