Early recognition and treatment of electrolyte abnormalities protect the patient from derangements in the renal, myocardiac, and central nervous systems. Correction of electrolyte derangements decreases both morbidity and mortality. This issue reviews sodium, potassium, calcium, magnesium, and phosphorus abnormalities and provides a systematic approach to the evaluation and management of the ill child with an electrolyte emergency.
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1. “I was waiting on exact lab results before I acted on the presentation.” Laboratory results may be delayed, resulting in worsening morbidity. If possible, obtain point-of-care testing to confirm suspicion of electrolyte derangement based on history. Nevertheless, if needed, resuscitate patients with basic airway, breathing, and circulatory techniques until further laboratory results guide exact treatment.
2. “I repleted the calcium, but the level did not respond.” It is important to understand that certain electrolytes are intertwined and require concomitant repletion, such as magnesium and calcium, for levels to respond.
6. “My team tried for a peripheral IV for 10 minutes, and the patient went into torsades de pointes.” IO access is a viable option in pediatric patients, and basic electrolyte replacement may be given via IO line. Delay in obtaining IV access may result in worsening morbidity and mortality.
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Following are the most informative references cited in this paper, as determined by the authors.
1. * Rothrock SG, Green SM, McArthur CL, et al. Detection of electrolyte abnormalities in children presenting to the emergency department: a multicenter, prospective analysis. Detection of Electrolyte Abnormalities in Children Observational National Study (DEACONS) investigators. Acad Emerg Med. 1997;4(11):1025-1031. (Prospective; 300 patients) DOI: 10.1111/j.1553-2712.1997.tb03674.x
4. * Friedman A. Fluid and electrolyte therapy: a primer. Pediatr Nephrol. 2010;25(5):843-846. (Review article) DOI: 10.1007/s00467-009-1189-7
8. Kight B. Pediatric fluid management. StatPearls, 2022. Accessed January 1, 2023. (Review article)
13. * Lynch RE, Wood EG. Fluid and electrolyte issues in pediatric critical illness. In: Fuhrman BP, Zimmerman JJ, eds. Pediatric Critical Care. 4th ed. Mosby-Elsevier Saunders; 2011:944-962. (Textbook chapter)
28. * Hoffman RJ, Wang VJ, Scarfone RJ, et al. Fleisher & Ludwig’s 5-Minute Pediatric Emergency Medicine Consult. Lippincott Williams & Wilkins; 2019. (Textbook)
39. Lexi-Comp. Lexi-Drugs: sodium bicarbonate. 2020. Accessed, January 1, 2023. (Review article)
44. ClinicalTrials.gov. An open-label study to assess safety and efficacy of SZC in paediatric patients with hyperkalaemia (PEDZ-K). Accessed on January 1, 2023. (Clinical trial)
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Keywords: electrolyte, electrolyte emergency, electrolyte abnormality, electrolyte derangement, sodium abnormality, hyponatremia, hypernatremia, potassium abnormality, hypokalemia, hyperkalemia, calcium abnormality, hypocalcemia, hypercalcemia, magnesium abnormality, hypomagnesemia, phosphorus abnormality, hypophosphatemia, laboratory testing, point-of-care electrolyte analysis, electrocardiogram, electrolyte correction, electrolyte repletion
Thomas Conway, DO
Nicole Gerber, MD; Alfred Sacchetti, MD, FACEP
February 1, 2023
February 1, 2026   CME Information
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 1 Pharmacology credit, subject to your state and institutional approval.