Fluid, Electrolyte and Acid-Base Disorders: Clinical Evaluation and Management

Description

This updated edition provides a clear and concise understanding of the fundamentals of fluid, electrolyte and acid-base disorders that are frequently encountered in clinical practice. Each chapter follows a standard format that begins with pertinent basic physiology followed by its clinical disorder. Cases for each fluid, electrolyte and acid-base disorder are discussed, along with board-type questions with explanations to increase clinicians' knowledge. Revised with new developments in the field, this edition's expanded chapters cover useful information left out of other textbooks. This practical, current, and clinically oriented book is a must-have reference for practicing physicians, students, residents and fellows. In Memoriam Preface Contents Part I: Physiologic Basis and Management of Fluid, Electrolyte, and Acid-Base Disorders 1: Body Fluid Compartments Terminology Units of Solute Measurement Conversions and Electrolyte Composition Osmolarity Versus Osmolality Total Osmolality Versus Effective Osmolality Isosmotic Versus Isotonic Body Fluid Compartments Water Movement Between ECF and ICF Compartments Suggested Reading 2: Interpretation of Urine Electrolytes and Osmolality Certain Pertinent Calculations Fractional Excretion of Na+ (FENa) and Urea (FEUrea) Fractional Excretion of Uric Acid (FEUA) and Phosphate (FEPO4) Urine Potassium (UK) and Urine Creatinine (UCr) Ratio Urine Anion Gap Electrolyte-Free Water Clearance Urine Creatinine and Urine Volume Urine Specific Gravity Versus Urine Osmolality Suggested Reading 3: Kidney Handling of NaCl and Water Proximal Tubule Na+ Reabsorption Cl− Reabsorption Thin Limbs of Henle’s Loop Distal Convoluted Tubule Connecting Tubule Collecting Duct Water Reabsorption Proximal Tubule Loop of Henle Distal Nephron Effect of Various Hormones on NaCl and Water Reabsorption (Transport) Disorders of NaCl Transport Mechanisms Suggested Reading 4: Intravenous Fluids: Composition and Indications Crystalloids Dextrose in Water Sodium Chloride (NaCl) Solutions Dextrose in Saline Balanced Electrolyte Solutions Colloids Albumin Goals of Fluid Therapy How Much Fluid Is Retained in the Intravascular Compartment? Maintenance Fluid and Electrolyte Therapy Fluid Therapy in Special Conditions Volume Contraction Septic Shock Hemorrhagic Shock Due to Gastrointestinal Bleeding Hemorrhagic Shock Due to Trauma Cardiogenic Shock Adult Respiratory Distress Syndrome (ARDS) Phases of Fluid Therapy in Critically Ill Patients Suggested Reading 5: Diuretics Classification of Diuretics Physiologic Effects of Diuretics Clinical Uses of Diuretics Complications of Diuretics Diuretic Breaking Phenomenon Diuretics and Urinary Electrolytes Recently Introduced Diuretics or Drugs with Diuretic-like Effects Finerenone Sodium Glucose Cotransporter-2 (SGLT2) Inhibitors Neprilysin Inhibitor Suggested Reading 6: Disorders of Extracellular Fluid Volume: Basic Concepts Mechanisms of Volume Recognition Conditions of Volume Expansion Concept of Effective Arterial Blood Volume (EABV) Formation of Edema Suggested Reading 7: Disorders of ECF Volume: Heart Failure Clinical Evaluation Treatment of HF Management of Edema Ambulatory Patient In-hospital Patient with Acute Decompensated Heart Failure (ADHF) Postdischarge Management Cardiorenal Syndrome Suggested Reading 8: Disorders of ECF Volume: Cirrhosis of the Liver Clinical Evaluation Treatment of Edema Formation of Ascites Treatment of Ascites Salt Restriction Diuretics Large-Volume Paracentesis Refractory Ascites Hepatorenal Syndrome Pathogenesis Treatment Other Treatment Modalities Suggested Reading 9: Disorders of ECF Volume: Nephrotic Syndrome Clinical Evaluation Treatment Suggested Reading 10: Disorders of ECF Volume: Volume Contraction Dehydration vs. Volume Depletion Causes Types of Fluid Loss Clinical Evaluation Treatment Dehydration Volume Depletion Suggested Reading 11: Disorders of Water Balance: Physiology Control of Thirst Structure and Synthesis of ADH Control of ADH Release Copeptin Distribution of Aquaporins in the Kidney Mechanism and Actions of ADH Mechanism Actions Urinary Concentration and Dilution Measurement of Urinary Concentration and Dilution Calculation of Electrolyte-Free Water Clearance Disorders of Water Balance Study Questions Suggested Reading 12: Disorders of Water Balance: Hyponatremia Development of Hyponatremia Approach to the Patient with Hyponatremia Step 1: Measure Serum Osmolality Step 2: Measure Urine Osmolality and Urine Na+ Concentration Step 3: Estimate Volume Status History Physical Examination Step 4: Obtain Pertinent Laboratory Tests Step 5: Know More About Pseudo- or Factitious Hyponatremia Step 6: Know More About Hypertonic (Translocational) Hyponatremia Step 7: Rule Out Causes Other Than Glucose that Increase Plasma Osmolality Pathophysiology of Hyponatremia Specific Causes of Hyponatremia Syndrome of Inappropriate Antidiuresis Cerebral Salt Wasting or Renal Salt Wasting Syndrome Nephrogenic Syndrome of Inappropriate Antidiuresis Reset Osmostat Thiazide Diuretics Ecstasy Selective Serotonin Reuptake Inhibitors Exercise-Induced Hyponatremia Beer Potomania Poor Oral Intake Postoperative Hyponatremia Hypokalemia and Hyponatremia Psychogenic Polydipsia COVID-19 and Hyponatremia Diagnosis of Hypotonic Hyponatremia Clinical Manifestations of Hyponatremia Brain Adaptation to Hyponatremia Complications of Untreated Chronic Hyponatremia Treatment of Hyponatremia Treatment of Acute Symptomatic Hyponatremia Treatment of Chronic Severe Symptomatic Hyponatremia Complication of Rapid Correction of Hyponatremia Risk Factors Clinical Manifestations Diagnostic Test Management and Prognosis Treatment of Asymptomatic Hyponatremia in Hospitalized Patients Treatment of Asymptomatic Chronic Hyponatremia Due to Syndrome of Inappropriate Antidiuresis: Ambulatory Patients Treatment of General Causes of Hyponatremia Study Questions Suggested Reading 13: Disorders of Water Balance: Hypernatremia Mechanisms of Hypernatremia Patients at Risk for Hypernatremia Approach to a Patient with Hypernatremia Step 1: Estimate Volume Status Step 2: History and Physical Examination History Physical Examination Step 3: Diagnosis of Hypernatremia (See Table 13.1) Brain Adaptation to Hypernatremia Transient Hypernatremia Clinical Manifestations of Persistent Hypernatremia Specific Causes of Hypernatremia Polyuria Central DI Nephrogenic DI Gestational DI Primary Polydipsia Diagnosis of Polyuria Solute Diuresis Hypernatremia in the Elderly Hypodipsic (Adipsic) Hypernatremia Hospital-Acquired Hypernatremia Community-Acquired Hypernatremia Hypernatremia in Intensive Care Units Sodium Toxicity Treatment of Hypernatremia Correction of the Underlying Cause Calculation of Water Deficit Selection and Route of Fluid Administration Volume Status Treatment of Acute Hypernatremia Treatment of Chronic Hypernatremia Treatment of Specific Causes Hypovolemic Hypernatremia Hypervolemic Hypernatremia Normovolemic (Euvolemic) Hypernatremia Nephrogenic DI Study Questions References Suggested Reading 14: Disorders of Potassium: Physiology General Features Handling of K+ Transport by the Kidney Proximal Tubule Loop of Henle Distal Nephron Distal Convoluted Tubule Connecting Tubule Cortical Collecting Duct Outer Medullary Collecting Duct Inner Medullary Collecting Duct Factors Affecting K+ Excretion Dietary Intake and Plasma [K+] Urine Flow Rate and Na+ Delivery Hormones Aldosterone Aldosterone Paradox Antidiuretic Hormone Angiotensin II Tissue Kallikrein Acid–Base Balance Anions Diuretics Suggested Reading 15: Disorders of Potassium: Hypokalemia Some Specific Causes of Hypokalemia Hypokalemic Periodic Paralysis (HypoPP) Familial Thyrotoxic Hypokalemic Hypertensive Disorders Hypertensive Emergency Renal (Kidney) Artery Stenosis Primary Aldosteronism Liddle Syndrome Glucocorticoid-Remediable Aldosteronism (GRA) Apparent Mineralocorticoid Excess Syndrome (AME) Activating Mutations of the Mineralocorticoid Receptor (Geller Syndrome) Congenital Adrenal Hyperplasia Hypokalemic Normotensive Disorders Renal Tubular Acidosis (RTA) Bartter Syndrome Autosomal Dominant Hypocalcemia with Bartter Syndrome Gitelman Syndrome Hypokalemia Due to Aminoglycosides Diagnosis Step 1 Step 2 Step 3 Step 4 Step 5 Electrolyte Pattern in Chronic Hypokalemia Hypokalemia and Progression of Kidney Disease Clinical Manifestations Treatment Severity Underlying Cause Degree of K+ Depletion Study Questions Reference Suggested Reading 16: Disorders of Potassium: Hyperkalemia Some Specific Causes of Hyperkalemia Hyperkalemic Periodic Paralysis (HyperPP) Chronic Kidney Disease Stage G5 (CKD G5) Decreased Effective Arterial Blood Volume Addison Disease Adrenal Hyperplasia Syndrome of Hyporeninemic Hypoaldosteronism (SHH) Pseudohypoaldosteronism Type I (PHA I) Pseudohypoaldosteronism Type II (PHA II) Post-Kidney Transplant Hyperkalemia Diagnosis Step 1 Step 2 History Physical Examination Step 3 Clinical Manifestations Consequences of Hyperkalemia Should Renin-Angiotensin-Aldosterone System (RAAS) Inhibitors Be Continued in CKD G4-G5 With or Without Hyperkalemia Hyperkalemia and Peripheral Neuropathy Acute Treatment Chronic Treatment Study Questions Suggested Reading 17: Disorders of Calcium: Physiology General Features Ca2+ Homeostasis Ca2+-Sensing Receptor (CaSR) PTH Active Vitamin D3 (1,25-Dihydroxycholecalciferol or 1,25(OH)2D3 or Calcitriol) Calcitonin Defense Against Low and High Plasma [Ca2+] Handling of Ca2+ by the Kidney Proximal Tubule Thick Ascending Limb Distal and Connecting Tubule Collecting Duct Factors Influencing Ca2+ Transport Factors Influencing Ca2+ Channel (TRPV5) Suggested Reading 18: Disorders of Calcium: Hypocalcemia Some Specific Causes of Hypocalcemia Hypoparathyroidism Genetic Causes Acquired Causes Pseudohypoparathyroidism (PsHPT) Hungry Bone (Recalcification) Syndrome Vitamin D Deficiency Diagnosis Clinical Manifestations Treatment Acute Hypocalcemia Chronic Hypocalcemia Study Questions Suggested Reading 19: Disorders of Calcium: Hypercalcemia Some Specific Causes of Hypercalcemia Primary Hyperparathyroidism Multiple Endocrine Neoplasia Type 1 and Type 2a Jansen’s Disease Familial Hypocalciuric Hypercalcemia Neonatal Severe Hyperparathyroidism Lithium-Induced Hypercalcemia Kidney Failure Milk (Calcium)-Alkali Syndrome Malignancy Ectopic Hyperparathyroidism Granulomatous Diseases Vitamin D Overdose Hypercalcemia in Critically Ill Immune Checkpoint Inhibitors and Hypercalcemia Clinical Manifestations Diagnosis Treatment Acute Treatment Chronic Treatment Study Questions References Suggested Reading 20: Disorders of Phosphate: Physiology General Features Phosphate Homeostasis Handling of Phosphate by the Kidney Regulation of Kidney Phosphate Handling Parathyroid Hormone (PTH) Fibroblast Growth Factor-23 (FGF-23) Dietary Phosphate Suggested Reading 21: Disorders of Phosphate: Hypophosphatemia Some Specific Causes of Hypophosphatemia X-Linked Hypophosphatemia Autosomal Dominant Hypophosphatemic Rickets (ADHR) Autosomal Recessive Hypophosphatemic Rickets (ARHR1 and ARHR2) Tumor-Induced Osteomalacia (TIO) Hereditary Hypophosphatemic Rickets with Hypercalciuria (HHRH) Due to Type IIc Mutations Hereditary Hypophosphatemic Rickets with Hypercalciuria (HHRH) Due to Type IIa Mutations Na/H Exchanger Regulatory Factor (NHERF)1 Klotho Refeeding Syndrome (RFS) Kidney Transplantation Hypophosphatemia in Critical Care Units Clinical Manifestations Diagnosis Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Treatment Acute Severe Symptomatic Hypophosphatemia Chronic Hypophosphatemia Study Questions Reference Suggested Reading 22: Disorders of Phosphate: Hyperphosphatemia Some Specific Causes of Hyperphosphatemia Acute Kidney Injury (AKI) Chronic Kidney Disease (CKD) Sodium Phosphate Use and Hyperphosphatemia Familial Tumor Calcinosis (FTC) Tumor Lysis Syndrome Clinical Manifestations Diagnosis Step 1 Step 2 Step 3 Step 4 Treatment Acute Hyperphosphatemia Chronic Hyperphosphatemia Phosphate Removal by Dialysis Study Questions References Suggested Reading 23: Disorders of Magnesium: Physiology General Features Mg2+ Homeostasis Handling of Mg2+ by the Kidney Factors that Alter Kidney Handling of Mg2+ in TALH and DCT Suggested Reading 24: Disorders of Magnesium: Hypomagnesemia Some Specific Causes of Hypomagnesemia Familial Hypomagnesemia with Hypercalciuria and Nephrocalcinosis (FHHNC) Familial Hypomagnesemia with Secondary Hypocalcemia Isolated Dominant Hypomagnesemia with Hypocalciuria Isolated Recessive Hypomagnesemia (IRH) with Normocalciuria Bartter and Gitelman Syndromes (see Chaps. 3 and 15) Hypomagnesemia-Induced Hypocalcemia EAST (SeSAME) Syndrome Hypomagnesemia-Induced Hypokalemia Clinical Manifestations Diagnosis Treatment Acute Treatment Severe Symptomatic Hypomagnesemia Hemodynamically Stable Patients with Symptomatic Hypomagnesemia (≥ 1.0 mg/dL) Special Groups of Patients Requiring Intravenous Magnesium Sulfate Chronic Treatment Suggested Reading 25: Disorders of Magnesium: Hypermagnesemia Clinical Manifestations Hypermagnesemia in Hospitalized Patients Treatment Asymptomatic Patient Symptomatic Patient Suggested Reading 26: Introduction to Acid-Base Technique of ABG Measurement pH pO2 pCO2 HCO3− Normal ABG Values Arterial vs. Venous Blood Sample for ABG Primary Acid-Base Disorders Secondary Physiologic Response (or Compensation) Factors Influencing ABG Suggested Reading 27: Basic Acid-Base Chemistry and Physiology Production of Endogenous Acids and Bases Endogenous Acids Endogenous Bases Maintenance of Normal pH Buffers Lungs Kidneys Reabsorption of Filtered HCO3− Proximal Tubule Loop of Henle Distal Nephron Collecting Duct Regulation of HCO3− Reabsorption Generation of New HCO3− from Excretion of Titratable Acid Generation of HCO3− from NH4+ Net Acid Excretion (Urinary Acidification) Suggested Reading 28: Methods to Assess Acid-Base Disorders Physiologic Method Anion Gap Merits Drawbacks Base Excess Method Merits Drawbacks Analysis of Acid-Base Disorders Using Physiologic and Base Excess Methods Physiologic Method Base Excess Method The Trans-Atlantic Acid-Base Debate Physicochemical Method pCO2 Total Concentration of Weak Acids [ATOT] Stewart’s Classification of Acid-Base Disorders Merits Drawbacks Analysis of Acid-Base Disorders Using Physiologic and Physicochemical Methods Physiologic Approach Physicochemical Approach Comment References 29: Acid-Base Disorders: General Considerations and Evaluation Concepts in the Evaluation of an ABG Henderson Equation Anion Gap Normal AG Values Hyperglycemia and AG Clinical Use of AG Mnemonic for High AG Metabolic Acidosis Normal AG Metabolic Acidosis Low AG Metabolic Acidosis and Correction for Low Serum Albumin Use of ∆AG/∆HCO3− Secondary Physiologic Response (or Compensatory Response) Pathogenesis and Clinical Manifestations of Acid-Base Disorders Metabolic Acidosis Clinical Manifestations Metabolic Alkalosis Clinical Manifestations Acute Respiratory Acidosis Clinical Manifestations Chronic Respiratory Acidosis Clinical Manifestations Acute Respiratory Alkalosis Chronic Respiratory Alkalosis Approach to a Patient with an Acid-Base Disorder How to Evaluate an Acid-Base Disorder How to Evaluate a Mixed Acid-Base Disorder Hydration and Acid-Base Disorders-Induced Changes in Serum [Na+] and [Cl−] Study Questions Suggested Reading 30: L-Lactic Acidosis Production Hyperlactatemia vs. Lactic Acidosis Causes Selected Conditions of L-Lactic Acidosis Lactic Acidosis Due to Hereditary or Acquired Enzyme Defects Diagnosis Treatment NaHCO3 Requirements THAM (Tris-Hydroxymethyl Aminomethane) Requirements Tribonat Kidney Replacement Therapies Thiamine and Riboflavin Insulin Dichloroacetate Inhibitors of Na/H Exchanger Vasodilators Methylene Blue Suggested Reading 31: D-Lactic Acidosis Biochemistry of D-Lactate Conditions Associated with Risk for D-Lactate Toxicity in Humans Clinical Manifestations Diagnosis Pathogenesis Treatment Acute Toxicity Lon-term Management Suggested Reading 32: Diabetic, Alcoholic, and Starvation Ketoacidosis Diabetic Ketoacidosis Pathogenesis of DKA Hyperglycemia Ketogenesis Metabolic Acidosis Ketonemia and Ketonuria Precipitating Factors of DKA Clinical Manifestations Laboratory Findings Treatment Correction of Volume Deficit Correction of Electrolyte Deficit Correction of Hyperglycemia and Acidosis Avoid Complications of Treatment Identification and Treatment of Precipitating Factors Euglycemic Ketoacidosis due to SGLT-2 Inhibitors Euglycemic Ketoacidosis due to Continuous Kidney Replacement Therapy Hyperglycemic Hyperosmolar State Treatment Alcoholic Ketoacidosis Starvation Ketoacidosis Suggested Reading 33: Toxin-Induced Acid–Base Disorders General Considerations Methyl Alcohol (Methanol) Without Dialysis With Dialysis Ethylene Glycol (EG) Clinical Manifestations (Classified into Three Stages) Diagnosis Diethylene Glycol Diagnosis Treatment Propylene Glycol (PG) Metabolism Diagnosis Isopropyl Alcohol Diagnosis Salicylate Intoxication Diagnosis 5-Oxoproline (Pyroglutamic Acid) Diagnosis Acetaminophen (paracetamol) Toluene Clinical Manifestations Diagnosis Paraldehyde Reference Suggested Reading 34: Acid–Base Disorders in Kidney Disease Acute Kidney Injury (AKI) Chronic Kidney Disease (CKD) Net Acid Excretion (NAE) in CKD Pattern of Acid–Base Disorders Pathophysiology of Metabolic Acidosis Adverse Effects of Metabolic Acidosis Eubicarbonatemic Metabolic Acidosis in CKD Treatment Use of NaHCO3 or Sodium Citrate Use of Veverimer Reduction of Dietary Acid Load Hemodialysis (HD) Peritoneal Dialysis (PD) Kidney Transplantation References Suggested Reading 35: Renal Tubular Acidosis Types of RTAs Urinary Buffers and Net Acid Excretion (Urinary Acidification) Urine pH Urine Anion Gap (UAG) Urine Osmolal Gap (UOG) Proximal RTA (Type II RTA) Definition of Proximal RTA Pathophysiology of Proximal RTA Causes of Proximal RTA Renal Fanconi Syndrome Definition Pathogenesis Laboratory and Clinical Manifestations Characteristics of Proximal RTA Causes of Proximal RTA Diagnosis of Proximal RTA Clinical Manifestations of Proximal RTA Some Specific Causes of Isolated Proximal RTA Autosomal Recessive Proximal RTA Autosomal-Dominant Proximal RTA Sporadic Form Carbonic Anhydrase (CA) Deficiency Some Specific Causes of Renal Fanconi Syndrome Cystinosis Lowe Syndrome (Oculocerebrorenal Syndrome) Dent Disease Treatment of Proximal RTA Distal (Classic or Type I) RTA Characteristics of Distal RTA Pathophysiology of Distal RTA Causes of Distal RTA Diagnosis of Distal RTA Genetics of Hereditary Distal RTA Complications of Distal RTA Hypokalemia Nephrocalcinosis and Nephrolithiasis Chronic Kidney Disease (CKD) Bone Disease Growth Retardation Sensorineural Hearing Loss (SNHL) Treatment of Distal RTA Toluene Ingestion and Distal RTA Incomplete (Type III) RTA Distal RTA with Hyperkalemia Hyperkalemic Distal RTA (Type 4) with Urine pH 5.5 (Voltage-gradient RTA) Causes of Both Types of Hyperkalemic Distal RTAs Diagnosis of Hyperkalemic Distal RTAs Treatment of Hyperkalemic Distal RTAs Distinguishing Features of Various RTAs An Approach to the Patient with RTA References Suggested Reading 36: Acid–Base Disorders in Gastrointestinal Diseases Water Handling Intestinal Electrolyte Transport Na+ and Cl− Transport in the Small Intestine Na+ and K+ Transport in Colon Intestinal Secretion of Cl− HCO3− Handling in the Colon Volume and Electrolyte Concentrations of GI Fluids Diarrhea Water and Electrolyte Loss Types of Diarrhea Diagnosis Method of Calculating Stool Osmolal Gap Interpretation Types of Acid–Base Disorders in Diarrhea Treatment Biliary and Pancreatic Fistulas Congenital Chloridorrhea Villous Adenoma Urinary–Intestinal Diversions Laxative Abuse Cholestyramine Suggested Reading 37: Metabolic Alkalosis Course of Metabolic Alkalosis Generation Phase Maintenance Phase Recovery Phase Classification Pathophysiology Kidney Mechanisms Kidney Transport Mechanisms Genetic Mechanisms Acquired Causes GI Mechanisms Vomiting and Nasogastric Suction Congenital Chloridorrhea Villous Adenoma Laxative Abuse Clinical Manifestations Diagnosis Treatment Suggested Reading 38: Respiratory Acidosis Physiology CO2 Production CO2 Transport CO2 Elimination CNS Control of Ventilation Sensors Medullary Center Effectors Respiratory Acidosis Pathophysiology Secondary Physiologic Response to Hypercapnia Mechanism of Secondary Physiologic Response Acute Respiratory Acidosis Selected Conditions of Acute Respiratory Acidosis Clinical Manifestations Diagnosis Treatment Chronic Respiratory Acidosis Selected Conditions of Chronic Respiratory Acidosis Clinical Manifestations Diagnosis Treatment Suggesting Reading 39: Respiratory Alkalosis Pathophysiology Secondary Physiologic Response to Respiratory Alkalosis (Hypocapnia) Mechanism of Secondary Physiologic Response Causes of Acute and Chronic Respiratory Alkalosis Selected Conditions of Respiratory Alkalosis Clinical Manifestations Acute Respiratory Alkalosis Chronic Respiratory Alkalosis CNS Effects Diagnosis Suggested Reading 40: Mixed Acid–Base Disorders Analysis of Mixed Acid–Base Disorders Metabolic Acidosis and Metabolic Alkalosis Metabolic Acidosis and Respiratory Alkalosis Metabolic Acidosis and Respiratory Acidosis Metabolic Alkalosis and Respiratory Alkalosis Metabolic Alkalosis and Respiratory Acidosis Hyperchloremic (non-AG) metabolic acidosis and high AG metabolic acidosis Acute Respiratory Acidosis and Chronic Respiratory Acidosis Triple Acid–Base Disorders Treatment Metabolic Acidosis and Metabolic Alkalosis Metabolic Acidosis and Respiratory Alkalosis Metabolic Acidosis and Respiratory Acidosis Metabolic Alkalosis and Respiratory Alkalosis Metabolic Alkalosis and Respiratory Acidosis Suggested Reading 41: Drug-Induced Acid–Base Disorders Metabolic Acidosis Metabolic Alkalosis Respiratory Acidosis Respiratory Alkalosis Suggested Reading Part II: Fluid, Electrolyte, and Acid-Base Disorders in Special Conditions 42: Acute Kidney Injury Definition Fluid and Sodium (Na) Balances Potassium (K) Balance Calcium (Ca) Balance Phosphate Balance Magnesium (Mg) Balance Acid–base Disorders Suggested Reading 43: Chronic Kidney Disease Water Balance Sodium (Na) Balance Potassium (K) Balance Calcium (Ca) Balance Phosphate Balance Magnesium (Mg) Balance Acid–base Disorders (see Chap. 36) Suggested Reading 44: Kidney Transplantation Volume Changes Electrolyte Abnormalities Acid–base Disorders Suggested Reading 45: Liver Disease Water Balance Sodium Balance Potassium (K) Balance Calcium Balance Phosphate Balance Magnesium (mg) Balance Acid–Base Disorders Suggested Reading 46: Pregnancy Hemodynamic Changes Volume Changes Electrolyte Abnormalities Acid–Base Disorders Others Suggested Reading 47: Cancer Fluid Balance Electrolyte Abnormalities Hyponatremia Hypernatremia Hypokalemia Hyperkalemia Hypocalcemia Hypercalcemia Humoral Hypercalcemia of Malignancy Local Osteolytic Hypercalcemia due to Cytokine Release 1,25(OH)2D3 and Hypercalcemia Ectopic Hyperparathyroidism Adult T-Cell Leukemia/Lymphoma Drugs and Hypercalcemia Immune Checkpoint Inhibitors and Hypercalcemia Hypophosphatemia Hyperphosphatemia Hypomagnesemia Acid–Base Disorders Suggested Reading 48: Total Parenteral Nutrition Fluid Balance Electrolyte Abnormalities Total Parenteral Nutrition (TPN): Fluid Balance Hypernatremia Hypokalemia Hyperkalemia Hypocalcemia Hypercalcemia Hypophosphatemia Hyperphosphatemia Hypomagnesemia Hypermagnesemia Acid–Base Disorders Metabolic Acidosis Metabolic Alkalosis Respiratory Acidosis Respiratory Alkalosis Suggested Reading Index