Multiple Electrolyte and Metabolic Emergencies in a Single Patient

Figure 1

Algorithm for the treatment of multiple concurrent life-threatening disturbances. hyponatremia, correction resulted from both potassium infusion (indirect therapy) and fine adjustment with intermittent free water infusion and single administration of desmopressin (direct therapy) to achieve rate of correction goal during an episode of aquaresis. volume depletion, patient received two liters of normal saline on presentation to the emergency department (direct therapy) and continuous KCl infusion at 200 mL/hour (indirect therapy, i.e., the main purpose for KCl infusion, was potassium replacement, but patient benefited from the infusion as maintenance intravenous fluid) over the following 2 to 3 days while his oral intake was poor. ODS: osmotic demyelination syndrome; ED: emergency department; DDAVP: desmopressin.