Symptoms are severe including profound hyponatremia leading to hypotension, confusion and muscle weakness, as well as hyperkalemia which may cause ECG changes.
The most important consideration is the management of hypovolemic shock. These patients often require large volumes of IV solutions to maintain adequate perfusion to tissues.
High dose IV hydrocortisone is indicated to replenish depleted cortisol levels and maintain glucose metabolism.
Large volumes of IV normal saline are indicated to maintain blood pressure. Assess patients often for signs and symptoms of fluid overload, monitor intake and output regularly.
Insulin is given to patients with hyperkalemia, as it causes a shift of potassium back into cells decreasing serum potassium levels. Giving dextrose alongside an insulin infusion prevents hypoglycemia.
Sodium polystyrene sulfonate (Kayexalate) is given by mouth, through a gastric tube or in the form of an enema solution. It contains a high salt content that causes an excretion of potassium and is indicated for patients with hyperkalemia.
Diuretics, especially loop diuretics, may be indicated due to their side effect of decreasing potassium levels. It is important to consider additional fluid volume replacement in these patients.
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