*Electrolytes in the ICU DOI: http://dx.doi.org/10.5772/intechopen.96957*

	- 1.Flattened T wave and U waves
	- 2.Prolonged QT interval and widened QRS complex
	- 3.Prolonged QT interval
	- 1.Medications: Diuretics (except potassium sparing diuretics), antibiotics such as aminoglycoside, amphotericin and pentamidine, cyclosporine and tacrolimus, platinum based chemotherapy and proton pump inhibitors
	- 2.Hypercalcemia, hyperphosphatemia, metabolic acidosis
	- 3.Renal disease: Post-ATN diuresis, osmotic diuresis, renal tubular acidosis
	- 4.GI Losses: Malabsorption, diarrhea/vomiting, pancreatitis
	- 5.Chronic alcoholism, diabetes, large volume transfusion of citrated blood products, sepsis

• In most cases of hypermagnesemia, discontinuing magnesium containing drugs or supplements or volume replacement can sufficiently treat it [48].

• In patients with moderate hypermagnesemia (3.6-10 mg/dl or no cardiac/ respiratory symptoms), the underlying cause should be treated. Furosemide

• In patients with severe hypermagnesemia (causing cardiac/respiratory

symptoms), IV calcium is required to stabilize the myocardium (2 g of calcium gluconate IV over 5-10 min followed by a continuous infusion in severe cases). In patients who are non-oliguric, furosemide with IV fluids can be used for elimination of magnesium. In patients who are oliguric, emergent dialysis is

• Massive transfusion protocol should be used in critically ill bleeding patients

• Hypocalcemia is caused by the presence of the anticoagulant citrate (each bag on pRBC contains 3 g citrate). Normally, this amount can be rapidly cleared by the liver however in critically ill patients receiving multiple units, the process of liver elimination is compromised. Citrate accumulates in the blood where it binds to circulating ionized calcium thereby causing hypocalcemia [49].

• Bedside measurement of calcium can be used to guide calcium management. When administering MTP (around 6 units pRBC), it is reasonable to

• Hyperkalemia has been shown to be a risk when patients are transfused >7 units of pRBC [50]. This can be exacerbated in patients with renal failure, effective circulating volume depletion or more commonly hypoaldosteronism. There have been studies suggesting there may be a link between incidence of hyperkalemia and the use of washed or unwashed blood products and length of

• Two common electrolytes that occur during MTP are hypocalcemia and

can be used to enhance magnesium excretion.

required.

*Electrolytes in the ICU*

hyperkalemia.

RBC storage [51].

ICU Intensive Care Unit

mEQ/L milli-equivalent per liter mMol/L milli-mole per liter V2 receptors Vasopresin 2 receptors NaCl Sodium Chloride Lab Laboratory

ADH Anti-Diuretic Hormone

RAAS Renin Angiotensin Aldosterone System

**Abbreviations**

**159**

**6. Common conditions in the ICU**

*DOI: http://dx.doi.org/10.5772/intechopen.96957*

anticipated to require massive transfusion.

administer 3 g calcium gluconate.

**6.1 Massive transfusion protocol**

**Figure 10.** *Treatment of severe symptomatic hypomagnesemia.*
