Agua y Electrólitos, Desequilibrio Hidrico, Iónico

7/21/2019 Agua y Electrlitos, Desequilibrio Hidrico, Inico

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AGUA Y ELECTRLITOS, DESEQUILIBRIOHIDRICO, INICO Y ACIDO BSICO

Ral Luna Lugo

Peda!"#a $!o %e&e%!"e


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Ho&eo%!a%%

La 'o&eo%!a%% e% la (a)a(dad del'u&ano de (on!"ola" %u a&*en!en!e"no+ El !"&no de%e-ul*"o'd"oele(!"ol#!(o e% una (ond(.n -ue)od"#a de/n"%e (o&o la )"dda de la'o&eo%!a%% del agua, la o%&ola"dad, el

(o&)onen!e a(do0 *1%(o 2 lo% one%e%)e(#/(o% del (ue")o 'u&ano+


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EL AGUA ES 3IDA

El (o&)onen!e &1% a*undan!e del(ue")o 'u&ano e% el agua+ En el RN)"e!"&no o(u)a 'a%!a 456 de %u )e%o(o")o"al, en el RN a !"&no 7568 en el)"ee%(ola" 2 e%(ola" $96 2 (e"(a del$56 en lo% adole%(en!e%+


4/55

Co&)o%(on de lo% l-udo% delo"gan%&o


5/55

El agua nge"da %e a*%o"*e en :56 en el!"a(!o ga%!"on!e%!nal )o" d/u%.n )a%;a+ Enel e%)a(o n!"a;a%(ula" %e &an!ene en

n!e"(a&*o (on%!an!e )o" e/e(!o de la )"e%.n'd"o%!1!(a 2 la )"e%.n on(.!(aEn el (o&)a"!&en!o n!"a(elula" 2

e, d"gndo%elo% l#-udo% de lo% %!o% de &eno"(on(en!"a(.n a lo% &1% (on(en!"ado%+


6/55

Cuando lo% l#-udo% llegan al (a)la" glo&e"ula" en la)a"!e a%(enden!e del a%a de Henle, %e a)"e(an&e(an%&o% e%)e(ale% -ue /a;o"e(en la %alda deNa? 2 Cl@, d%&nu2endo %u o%&ola"dad, &en!"a%

-ue la )a"!e de%(enden!e %e 'a(e &1% )e"&ea*le ae%!o% one%, /a;o"e(endo %u en!"ada 2 au&en!andola o%&ola"dad )a"a /o"&a" el lla&ado &e(an%&o"enal de (on!"a(o""en!e -ue )"o;ee !on(dad 2o%&ola"dad a la o"na+


7/55

e(an%&o% "egulado"e%

'o"&ona an!du"!(a =HAD> %n!e!ada enlo% nu(leo% )a"a;en!"(ula" 2 %u)"ao)!(o+

Au&en!a la )e"&ea*ldad !u*ula" al agua+

Renna Sn!e!ada )o" el (o&)leo2u


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Pe"dda% de agua

El 50%del agua nge"da %e el&na en /o"&ade o"na, /o"&ando el ga%!o u"na"o -ueno"&al&en!e ;a"#a de 5+9 a F &Lg'+ a!"a;% de la )el %e el&na 31%de lo% l#-udo%

nge"do%8 )o" la ;en!la(.n )ul&ona" 10%2)o" la% 'e(e% 6%,de!e"&nando la% lla&ada%)"dda% n%en%*le%, )ueden au&en!a" % %e)"e%en!a /e*"e, !a-u)nea 2 da/o"e%%,o ;e"%e"e%!"ngda% % %e o*!enen ng"e%o% l#-udo%e


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Co&)onen!e% de lo% l-udo%

Anone% ?

Sodo

Po!a%oagne%o

Cal(o

Ca!one% @

Clo"o

B(a"*ona!oSul/a!o%

/o%!a!o%

A(do% o"gP"o!ena%


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la %u&a de lo% (a!one% e% gual a la de lo% anone%,ee% no"&al&en!e &a2o" -ue la de lo% anone% &ed*le%=B(a"*ona!o 2 Cl@>8 la d/e"en(a en!"e ello% %e (ono(e

(o&o J*"e('a an.n(aK o Janon ga)K 2 de&ue%!"a lo%anone% "e%duale% o no &ed*le% =/o%/a!o%, %ul/a!o% 21(do% o"g1n(o%> 2 -ue no"&al&en!e ;a"#an de 4 a $&E-L


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Anon ga) =Na?> @ =HCO@?Cl@ >

La ele;a(.n del anon ga) %uge"e una /ue"!e/o"&a(.n de 1(do% 2 d/(ul!ad )a"a gene"a"

%u/(en!e *(a"*ona!o+ un &E- e% el )e%o a!.&(o de una %u%!an(a

d;dda en!"e %u ;alen(a8 el %odo !ene una;alen(a de 2 %u )e%o a!.&(o e% de F8 )o"lo !an!o F g de %odo (on%!!u2en une-u;alen!e -u#&(a&en!e 'a*lando+


13/55

la &l%&a )a"!e de un &ol lo (on%!!u2e un &l&ol, 2)o" lo !an!o una %olu(.n &ola" e%!1 (on%!!uda )o" el)e%o &ole(ula" de una %u%!an(a dluda en un l!"o deagua

La l!&a &edda de &)o"!an(a en el e-ul*"o'd"oele(!"ol#!(o e%!1 dada )o" la !"an%/e"en(a deagua en!"e lo% (o&)a"!&en!o% n!"a(elula" 2e

de &lo%&ole% de %olu!o )o" log"a&o de agua+ Un&lo%&ol e% gual a un &l&ol de %olu!o+


14/55

La o%&ola"dad de lo% e%)a(o% n!"a(elula" 2e

El %odo, la glu(o%a 2 la u"ea %on alguna% dela% %u%!an(a% d%uel!a% en lo% l#-udo%(o")o"ale% -ue /a;o"e(en el )a%o de lo%&%&o% a !"a;% de la% &e&*"ana%

%e&)e"&ea*le% del (ue")o 'u&ano,d"gndo%e de la% ona% de &a2o" a la% de&eno" (on(en!"a(.n de ele(!".l!o%, )o"e/e(!o de e%!a /ue"a o%&.!(a+


15/55

La /ue"a -ue )e"&!e el )a%o del#-udo% a uno u o!"o lado de una&e&*"ana %e&)e"&ea*le e% la

)"odu(da )o" la% )"o!e#na% )la%&1!(a%2 %e (ono(e (o&o )"e%.n on(.!(a+El )la%&a %angu#neo !ene una

o%&ola"dad de F49@F:9 &O%&L, 2)uede &ed"%e (on un o%&.&e!"o o(al(ula"%e &edan!e la %guen!e /."&ula


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O%&ola"dad del )la%&a


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Co""e((.n del %odo

)o" (ada 55 &gdL de glu(e&a )o" a""*a dela% (/"a% no"&ale%, el %odo %"(o %e dlu2ede F a &E-L 2 -ue )o" (ada 5 &gdL de

u"ea )o" a""*a de la% (/"a% no"&ale%, el %odo%"(o %e dlu2e de a M &E-L,)o" lo -ue(uando %e )"e%en!a ')e"glu(e&a o')e"u"(e&a %e de*e "eala" la (o""e((.n

del %odo %"(o n/o"&ado a ;alo"e% "eale%+


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Ee&)lo

glu(o%a 955 &gdL, u"ea de $9 &gdL 2%odo %"(o de 5 &E-L, el %odo "eale% de M &E-L 2a -ue la glu(e&a %e

)a%a M !an!o% de lo no"&al 2 la u"ea %e)a%a un !an!o de lo no"&al


19/55

Po" lo !an!o, el (1l(ulo "eal %e"#a la%u&a del %odo %"(o n/o"&ado &a% 4&E-L a)o"!ado% )o" la ')e"glu(e&a,

&a% &E-L a)o"!ado% )o" la')e"u"(e&a, dando el %odo "eal deM &E-L 2 )o" lo !an!o la o%&ola"dad

%"(a e%


20/55

el ;alo" "eal &ue%!"a un e%!ado')e"o%&ola", &en!"a% -ue lade!e"&na(.n no (o""egda no% da (/"a%

no"&ale% de o%&ola"dad 2 %u &aneo%e"#a (o&)le!a&en!e d/e"en!e, %egn el(a%o+


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DESHIDRATACIN

La de%'d"a!a(.n e% un %#nd"o&e -ue ennue%!"o &edo gene"al&en!e e% (ond(onado)o" el ;.&!o, la da""ea 2 en o!"a% o(a%one%(o&o )a"!e de )ade(&en!o% g"a;e% (o&o%e)%%, *"on(oneu&on#a, %a"a&).n, e!(+

A%&%&o, e


22/55

El (uad"o (l#n(o de la de%'d"a!a(.n )o"da""ea e%!1 (on%!!udo )o" lo% an!e(eden!e%o*!endo% en el n!e""oga!o"o, )ue%

gene"al&en!e %e !"a!a de no% )e-ueo% -ue'an )"e%en!ado en 'o"a% o d#a% an!e"o"e%nu&e"o%a% e;a(ua(one% l#-uda%, ;.&!o%,/e*"e 2 ano"e


23/55

P"&e" g"ado

P"&e" g"ado o le;e, (uando el )a(en!e)e"de del al 96 de %u )e%o (o")o"al8 %ede!e(!a )o" la )"e%en(a de ')o!en%.n en la/on!anela an!e"o" en el RN 2 el la(!an!e &eno",en lo% no% &a2o"e% 'a2 llan!o %n l1g"&a%,&u(o%a% o"ale% %e(a% 2 )"dda de la!u"gen(a de la )el, /o"&ando el lla&ado %gnodel leno '&edo+

E%!e g"ado de de%'d"a!a(.n "e-ue"e una)o"!e de 55 a 5 &Lgd de %olu(one% +;+)a"a %u (o""e((.n+


24/55

Segundo g"ado

Se 'a*la de de%'d"a!a(.n de %egundog"ado o &ode"a0 da (uando %e )e"dedel 9 al 56 del )e%o (o")o"al 2 en ella

%e ag"ega, a lo% %gno% dede%'d"a!a(.n de )"&e" g"ado,al!e"a(one% (o&o el eno/!al&o% e')o!e"&a d%!al, "e-u"ndo%e )a"ae%o% (a%o% de 95 a 45 &Lgd#a del#-udo% )a"a %u (o""e((.n+


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Te"(e" g"ado

En la de%'d"a!a(.n de !e"(e" g"ado o %e;e"a %e)e"de 'a%!a 96 del )e%o (o")o"al 2, ade&1% de lo%%gno% an!e"o"e%, %e )"e%en!an 2a al!e"a(one% de la&("o("(ula(.n ;%*le% )o" la )el &a"&."ea, el

llenado (a)la" len!o =&a2o" de %eg>, olgu"a,')o!en%.n a"!e"al, d%&nu(.n de la )"e%.n ;eno%a(en!"al, !a-u(a"da (o&)en%a!o"a 2 %o&nolen(a+

En e%!o% (a%o% %e "e-ue"e una "e%!!u(.n de l#-udo%(on n/u%.n en *olo% a "a.n de F50$5 &Lgdo%% a

)a%a" en una 'o"a 2 )o%!e"o" a %u e%!a*la(.n,l#-udo% a do%% de F55 &Lgd#a+


26/55

El &aneo de %o)o"!e (on!nuo %e 'a"1 (on *a%e a la"e)o%(.n de la% )e"dda% n%en%*le% =M55 a $55&L&FSC>, &1% %u% "e-ue"&en!o% *1%(o% = 955 aF 555 &L&FSCd#a>, &1% la% lla&ada% )e"dda%

a(!uale% -ue ;an a e%!a" dada% )o" la &ed(.n de la%e;a(ua(one% da""e(a%, ;.&!o%, )e"dda%(uan!/(a*le% )o" %onda% de Le;n o ole2 -ue(on/o"&an lo% eg"e%o% )o" !u"no %u%!en!ado% en la'oa de en/e"&e"#a 2 -ue (ono(e&o% (o&o balance

de lquidos+ Den!"o del &%&o e% &)o"!an!e la !o&ada"a del )e%o (o")o"al en a2una%+


27/55

Sodo

(a!.n &1% &)o"!an!e del l#-udo e

aldo%!e"ona 2 o!"a% 'o"&ona% ad"eno(o"!(ale%,a%# (o&o la !a%a de %e("e(.n !u*ula" de'd"ogenone% 2 )o!a%o+


28/55

I%o%od(a %o!on(a

Cuando 'a2 una de%'d"a!a(.n en -ue la)"dda de l#-udo% 2 %odo e% e-u)a"a*le, %e)"e%en!a una de%'d"a!a(.n %ona!"&(a o%o!.n(a, al!e"a(.n /"e(uen!e en (a%o% de

)"dda% n!e%!nale% aguda% (o&o enda""ea%, /#%!ula% n!e%!nale%, ;.&!o%,a%)"a(.n n!e%!nal )o" %onda% o e%!ado% dede%'d"a!a(.n )o" a2uno (uando la% )"dda%no %on &u2 e


29/55

H)o%od(a ')o!on(a

Cuando la )"dda de %odo e% &a2o" a la del#-udo%, %e )"e%en!a una de%'d"a!a(.n')ona!"&(a o ')o!.n(a, lo -ue e%/"e(uen!e en el no de%nu!"do no"&al&en!e'e&odludo,-ue %e 'd"a!a (on %olu(one% aal!o% ;ol&ene% 2 (on e%(a%o% o nulo%ele(!".l!o%8 !a&*n %e )"e%en!a en a-uello%e%!ado% en -ue o(u""en g"ande% )"dda% de%al (o&o en la ')e")la%a ad"enal (ongn!a,la /*"o%% -u#%!(a del )1n("ea%, la% ne/"!%)e"dedo"a% de %al


30/55

H)o!.n(a ')o%od(a

)uede )"e%en!a"%e en (a%o% de da""ea de e;olu(.n)"olongada e n(lu%o (o&o (o&)l(a(.n)o%-u""g(a de leo%!oa% o (e(o%!oa%+

El %odo %"(o %e en(uen!"a en e%!o% (a%o% )o"de*ao de 9 &E-L 2, en lo% (a%o% (on %gnolog#a,e% /"e(uen!e en(on!"a"lo )o" de*ao de F5 &E-L 2 lao%&ola"dad &eno" de F49 &O%&L+ De)endendo dela ;elo(dad (on -ue %e e%!a*le(a la ')ona!"e&a,la% al!e"a(one% )ueden " de%de ano"e


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De%'d"a!a(.n ')e"na!"e&(a

Cuando %e )"odu(e una )"dda e


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Po!a%o

Ca!.n n!"a(elula" &1% a*undan!e %u% "e-ue"&en!o% ;a"#an de a &E-gd#a

en lo% )"odu(!o% )"e!"&no, F &E-gd#a en elRN, M &E-gd#a en lo% la(!an!e% 2)"ee%(ola"e% eu!"./(o% 2 $ &E-gd#a en elde%nu!"do+

Pa"a &an!ene" el *alan(e de )o!a%o )la%&1!(o%e )uede el&na" a !"a;% de la% 'e(e%, el%udo", el ".n a n;el del !*ulo d%!al 2, (uando%e "e-ue"e, "ea*%o"*e"%e en el !*ulo )"o


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')o)o!a%e&a

Ca"en(a en %u a)o"!e,(o&o en lade%nu!"(.n o (uando %e ad&n%!"an%olu(one% )a"en!e"ale% *aa% en )o!a%o+

Po" au&en!o en la% )"dda% a !"a;% del !u*odge%!;o, (o&o en la% da""ea%, ;.&!o%,a%)"a(.n de l#-udo n!e%!nal, e!(+

Po" a((.n a!"ogn(a (on el u%o de(o"!(oe%!e"ode%,!a0 (da%, &an!ol, !eo/lna,

(a"*en(lna, an/o!e"(na B, e!(+Po" )"dda% e


34/55

Cl#n(a&en!e %e &an/e%!a )o" de*ldad&u%(ula", /a!ga, )ul%o d*l, d%!en%.na*do&nal, a""!&a%, !a-u(a"da ;en!"(ula",

al!e"a(one% %&la"e% a la n!o


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TRATAIENTO

El !"a!a&en!o de)ende de la (o""e((.nde la (au%a )"&a"a 2 la "e)o%(.n del)o!a%o )o" ;#a o"al (on al&en!o% "(o%

en e%!e Ion (o&o %on la% )a)a%, (#!"(o%,)l1!ano%, e!(+ o la ad&n%!"a(.n)a"en!e"al de )o!a%o, (al(ulando lado%% &edan!e la /."&ula 2a "e/e"da deelectrolito ideal, menos electrolitoreal por 0"6 por #ilogramo de peso"


37/55

La /o"&a de ad&n%!"a"lo de)ende"1 de la g"a;edad del(a%o 2 la %gnolog#a )udendo ag"ega"%e a la%%olu(one% *a%ale% del d#a o en *olo d"e(!o en 'o"a"e(o"dando -ue de*e !ene"%e la (e"!ea de la)e"&ea*ldad de una ;#a ;eno%a g"ue%a 2 -ue la%olu(.n no %o*"e)a%e %u (on(en!"a(.n del M6 -ue-ue"e de(" no &a% de M &E- de )o!a%o en 55 &L de%olu(.n 2a -ue )uede )"o;o(a" le%.n endo!elal %e;e"a+

Cuando 'a2 %o*"e(a"ga o "e!en(.n de )o!a%o, %e)"e%en!a la ')e")o!a%e&a, -ue (l#n(a&en!e %e&an/e%!a )o" )a"e%!e%a% de e


38/55

El ECG &ue%!"a onda% T al!a% 2 a(u&nada%,

QRS ala"gado (on )"o/unddad de la onda S,a)lana&en!o de la onda P 2 )"olonga(.n deln!e";alo PR+ En el )la%&a %e en(uen!"an (/"a%de )o!a%o )o" a""*a de 9 &E-L en lo% (a%o%

le;e% 2 'a%!a : &E-L en lo% g"a;e%


39/55

T"a!a&en!o

El !"a!a&en!o (on%%!e en d%&nu" el a)o"!e de )o!a%o e


40/55


41/55

Cal(o El ::6 de e%!e on %e en(uen!"a en el 'ue%o+ El (al(o

%"(o no"&al e% de 5 &gdL =9&E-L> 2 e%!1 undo ala% )"o!e#na% )la%&1!(a% en M56, el "e%!o e%!1 en /o"&al*"e o no onada+

El (al(o l*"e e% ne(e%a"o en la (oagula(.n %angu#nea,)a"a la (on!"a((.n no"&al del &%(ulo e%-uel!(o 2

(a"da(o, 2 )a"a la /un(.n ne";o%a+El 5 al 456 del(al(o nge"do %e a*%o"*e )o" !"an%)o"!e a(!;o en eln!e%!no delgado+ Su a*%o"(.n e% /a(l!ada )o" la;!a&na D, la la(!o%a 2 la% )"o!e#na%8 2 e% n'*da )o" la)"e%en(a de /o%/a!o% 2 o


42/55

H)o(al(e&a Cau%a%

)a"a!'o"&ona =')o)a"a!"od%&o,')o0&agne%e&a,')o(al(e&aneona!al,-ue&adu"a%,%e)%%,)an("ea!!%,!"ode(!oa, )a"a!"ode(!oa, u%o de (&e!dna,

(%)la!no> ;!a&na D =n%u/(en(a "enal, de/(en(a de ;!a&naD en la de!a, 'e)a!o)a!#a, "a*do&.l%%, u%o ded/enl'dan!o#na,/eno*a"*!al 2 a&noglu(.%do%>

-uela(.n =')e"/o%/a!e&a a!"ogn(a o )o"

-u&o!e"a)a,e&*ola g"a%a, (1n(e", u%o de&ed(a&en!o% (o&o (!"a!o, 'e)a"na, !eo/lna,du"!(o% de a%a, glu(o(o"!(ode%, e!(+


43/55

Sn!o&a!olog#a

La de!e"&na(.n de n;ele% &eno"e% de 4&gdL %e deno&na ')o(al(e&a 2 %e&an/e%!a )o" ')e"!on#a &u%(ula" 2!endno%a, )o" au&en!o de la ""!a*ldadneu"o&u%(ula" de a(ue"do (on el g"ado dede)le(.n,lleg1ndo%e a )"e%en!a" !e!a0 na,-ue %e (a"a(!e"a )o" la )"e%en(a de/a%((ula(one%, (on!"a((one% !.n(a%

&u%(ula"e%, )a"e%!e%a%,e%)a%&o (a")o)edal,%gno de C';o%!e 2 T"ou%%eau 2 e%)a%&ola"ngo!"a-ueal+


44/55

P"ue*a%

El ECG &ue%!"a *"ad(a"da %nu%al,alargamiento del QT a e$pensas del

segmento ST+ El &aneo de e%!o% (a%o%

(on%%!e en ad&n%!"a" glu(ona!o de (al(o al56 =(ada &L (on!ene 55 &g de (al(o> ado%% de 55 a F55 &ggdo%% (o&o!"a!a&en!o de (o""e((.n, %egudo de do%% de

55 &ggd#a (o&o !e"a)a de &an!en&en!o'a%!a %u "e(u)e"a(.n (l#n(a, la*o"a!o"al 2ele(!"o(a"dog"1/(a+


45/55

')e"(al(e&a

La ')e"(al(e&a e% una en!dad "a"a, (u2a% (au%a%/"e(uen!e&en!e %on la n&o;la(.n )"olongada )o"/"a(!u"a%, la o%!eo)o"o%% )"&a"a, a a*%o"(.ne


46/55

T"a!a&en!o

El &aneo de la ')e"(al(e&a e%!"*a en(o""eg" la (au%a )"&a"a 2 /a;o"e(e" la(al(u"e%%, en (a%o% (".n(o% lo%

glu(o(o"!(ode% %on %egu"o% )a"a n'*"la a(!;dad o%!eo(l1%!(a 2 la a*%o"(.ndel (al(o en el n!e%!no+


47/55

Clo"o

Lo% (lo"u"o% (on%!!u2en lo% anone%)la%&1!(o% &1% a*undan!e%, (on!ando(on (/"a% en!"e 55@59 &E-L en el

)la%&a 'u&ano+La ;#a de el&na(.n )"n()al e% el

".n, %guendo lo% &%&o%

&e(an%&o% -ue )a"a el %odo+


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Clo"o

Lo% (lo"u"o% )e"&!en la de!e((.n de una(an!dad ano"&al de anone% 2 (a!one% node!e(!a*le%, a !"a;% de la (ono(da brecaaninica2a -ue %!a %e a)"e(a au&en!ada

(uando 'a2 dao "enal )o" n("e&en!o en la(on(en!"a(.n de /o%/a!o% 2 %ul/a!o%, en la(e!oa(do%% da*!(a, en la a(do%% l1(!(a,en el (o&a ')e"o%&ola" no (e!.%(o 2 en la%al!e"a(one% )o" a&no1(do% no de!e(!a*le% oden!/(a*le%, )o" a)l(a(.n de g"ande%(an!dade% de )en(lna,(a"*en(lna,al(o'ole!#0 l(o, &e!anol 2 %al(la!o%+


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Su d%&nu(.n %e )"e%en!a en el%#nd"o&e ne/".!(o, la nge%!.n de l!o 2en el &elo&a+ Ta&*n )e"&!e la

de!e((.n de e""o"e% de la*o"a!o"o,(o&o en la% /al%a% ')e"na!"e&a% 2;alo"e% *ao% de *(a"*ona!o+


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agne%o

E%!e (a!.n %e en(uen!"a )"edo&nan!e en lo% 'ue%o%=$56>

%u% n;ele% %"(o% no"&ale% %on de +9 a +4 &E-L+ Se o*!ene de la nge%!a de ;ege!ale% ;e"de%,%e

a*%o"*e en el !"a(!o ga%!"on!e%!nal )o" un&e(an%&o %&la" al del (al(o un !e"(o de l %e en(uen!"a undo a la% )"o!e#na% 2 al

*(a"*ona!o8 do% !e"(o% %e en(uen!"an en /o"&a.n(a+

Se el&na a !"a;% del ".n 2 !ene una &)o"!an!e/un(.n (a!alado"a %o*"e d;e"%o% %%!e&a%en&1!(o% n!"a(elula"e% 2 )a"!()a en la (ondu((.nneu"o&u%(ula"+


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H)o&agne%e&a (au%a%

Su de/(en(a %e )"e%en!a )o" de%(udo en ela)o"!e de la nu!"(.n )a"en!e"al, ende%nu!"do% (".n(o%, e&)leo de la


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E%!a al!e"a(.n %e (o""geade(uada&en!e (on )e-uea% do%% de%ul/a!o de &agne%o al 56 2a -ue %u%

"e-ue"&en0 !o% da"o% %on e%(a%o%85+ a 5+M &E-gd#a+


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')e"&agne%e&a

E%!1 (ond(onada )o" la )"e%en(a de (e!oa(do%%da*!(a o n%u/(en(a %u)"a""enal (".n(a+

Se &an/e%!a )o" ')o""e/le

')o!en%.n 2 )a"o (a"da(o+ El ECG &ue%!"a un n!e";alo PR au&en!ado,

%eg&en!o QT a&)lo 2 onda% T al!a%+ El &aneo de ele((.n de e%!a al!e"a(.n e% la d1l%%

)e"!oneal o 'e&od1l%% 2 el u%o de &edda% de%o)o"!e ;!al+


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B*log"a/#a


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&racias

Agua y Electrólitos, Desequilibrio Hidrico, Iónico

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