Acid-Base and Electrolyte Disorders

Whether it was during my medical training, leading group Knowledge Self-Assessments, or treating patients, few topics were met with a greater abundance of blank stares or groans than acid-base disorders. Unless you treat critically ill patients on a regular basis, the process of ordering the proper testing, applying the appropriate equations, reaching the correct differential diagnosis, and treating the causes of these disorders feels overwhelming to many.

While the concepts can seem complicated, they are often necessary for the management of patients even in the outpatient setting. As I reviewed this monograph, I thought of my 90-year-old patient who recently was hospitalized after developing hyponatremia. She lives in the community with the support of family and is generally very active. She has a long-standing history of hypertension, and it was no longer being controlled with amlodipine, ramipril, and hydrochlorothiazide. I added spironolactone to her medication regimen, which achieved control of her blood pressure. However, on blood work a week later, her sodium level was less than 130 mEq/L and she was experiencing significant fatigue, so she was admitted to the hospital for a few days for intravenous fluid therapy. She is now back home and off diuretics, has a normal sodium level, and is feeling much better.

Sections One and Two of this monograph review electrolyte disorders of sodium and potassium. They discuss the importance of normal electrolyte levels for cellular function, and the clinical manifestations of and evaluations and treatments for abnormalities. Section Three explores acid-base disorders, with a focus on how family physicians can correctly interpret laboratory values to determine which acid-base disturbance is affecting their patient. Section Four reviews calcium disorders and includes the clinical presentation, diagnosis, and treatment of hypocalcemia and hypercalcemia.

The authors have done a fabulous job of explaining the complicated topics of acid-base and electrolyte disorders in ways that make them easy to understand, even if you do not deal with them every day. If you are not sure about the next steps in the management of your patient with these complex disorders, the many algorithms in this monograph simplify evaluation and treatment.

Ryan D. Kauffman, MD, FAAFP, CCFP
Associate Medical Editor
Family Medicine Physician
Erie Shores Family Health Team
Leamington, Ontario, Canada

Jennifer Wipperman MD, MPH, is an associate professor in the Department of Family and Community Medicine at the University of Kansas School of Medicine–Wichita (KUSMW). She is also a core faculty member at the KUSMW Family Medicine Residency at Ascension Via Christi. Dr. Wipperman has served as faculty for the American Academy of Family Physicians’ FMX and Adult Medicine CME courses on various topics, including chronic kidney disease. She has published peer-reviewed research in national journals such as Family Medicine and American Family Physician. She currently serves on the American Board of Family Medicine’s National Journal Club Committee and provides inpatient, outpatient, and maternity care as a family medicine residency faculty member.

Jeff Beekhuizen, DO, FAAFP, is an associate program director at the KUSMW Family Medicine Residency at Ascension Via Christi and a clinical assistant professor in the Department of Family and Community Medicine at KUSMW. His clinical interests include care of under-served populations in the United States and internationally. He enjoys clinic operations and supervising residents in the inpatient and outpatient settings.

Aaron Olson, MD, is an internal medicine and pediatric hospitalist at Ascension Via Christi hospitals, the Robert J. Dole VA Medical Center, and Wesley Medical Center. He is also an assistant professor of pediatrics at KUSMW and an adjunct faculty member at the KUSMW Family Medicine Residency at Ascension Via Christi.

Jared Regehr, MD, is an assistant professor in the Department of Family and Community Medicine at KUSMW and a core faculty member at the KUSMW Family Medicine Residency at Ascension Via Christi. He has published a peer-reviewed article in American Family Physician, and has presented at the Society of Teachers of Family Medicine Annual Conference and at regional conferences. Dr. Regehr has received several teaching awards and is passionate about teaching residents and medical students. He currently provides inpatient, outpatient, and maternity care as a family medicine residency faculty member.

Author disclosure: No relevant financial relationships.