eGFR - 15, S. Cr- 3.5, Na - 126, Ca - 7.3, K - wnl. Which electrolyte to correct first, Na or Ca?


Check albumin and magnesium levels and get ionised calcium before correcting calcium if there are no life threatening symptoms to check whether hypocalcemia is due to hypoalbuminemia as patient is having renal issue. This hypocalcemia could also be due to impaired vit d metabolism by kidney . Unless the patient is having serious symptoms there is need for rapid correction.keep him on oral tablets. Same holds for sodium. Hold drugs (diuretics?) If the patient is on.. rule out hyperglycemia or hyperlipidemia . If all are ruled out., Correct sodium very slowly if patient is not having any symptoms. Not more than 4-5meq a day. Hypocalcemia may cause neuromuscular irritability by enhancing sodium channel activity. So it is better to correct calcium first if the hyponatremia is chronic and patient is stable.

Hyponatremia Low eGFR high sr creatinine suggest CKD Yes we need to correct hyponatremia first with gaurded infusion ie 100ml inj NS Need to ad diuretics Or keep on oral sodium like soda bicarb pills or tab resodium

Na .. Ca .. AND.. Mg .. RESPECTIVELY..

Tnx Dr Vipin Bihari Jain sir

First Sodium..Than Calcium.. Check Magnesium also

First Sodium and then calcium Case of CRF

Na, then Ca...


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