Page 82 - JSOM Summer 2022

Prehospital Electrolyte Care

A Review of Symptoms, Evaluation, and Management

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Andrea Painter, BHS, 38BW4, SO-ATP ; Brandon M. Carius, DSc, MPAS *

ABSTRACT
Ongoing evolution of prehospital medical care continues to • A 20-year-old woman is rushed into your medical bay
advance beyond tactical field care scenarios in the consider- screaming. Those carrying her in describe that she was se-
ation of prolonged field care. This is even more important curing loose crates on the deck due to the stormy weather
to consider in theaters with extended evacuation times and when a stack tipped over and fell on her left leg. Her leg
limited local medical assets. The critical regulatory functions appears mangled and bleeding, although the bleeding is
of electrolytes such as sodium, potassium, calcium, and glu- largely controlled by the tourniquet they applied. While
cose require medics operating in these environments to have you look to evacuate her, it appears this may be difficult
a strong, fundamental knowledge of the principles, manifes- due to inclement weather. Could electrolyte evaluation help
tations, and initial stabilization measures to aid their patients you further manage this patient? What treatments would
prior to, or in lieu of evacuation. Continued development and you consider for abnormalities?
access to point of care testing in increasingly forward deployed • A 35-year-old man is brought to your tent by his squad
settings further enables medics to perform these tasks. Here, after “having a seizure” a few minutes ago. His Soldiers de-
we provide a brief review of these vital electrolytes, as well as scribe “shaking all over,” but he appears to be doing better
additional kidney function evaluation considerations, to assist now. They tell you he has been working through today’s
medics in their treatment efforts. Specific concerns for battle- 102°F heat to get their deadline vehicles fixed and that he
field and atraumatic presentations are addressed. has been drinking water throughout the day but are unsure
about food intake. What insight could electrolyte evalua-
Keywords: military; laboratory; sodium; potassium; calcium; glu- tion provide as part of your assessment?
cose; electrolytes; creatinine
Electrolytes help regulate cellular stability and electrical impulse
transmission throughout our body, facilitating skeletal muscle
movements, neural cognition, and routine cardiac function.
Introduction Proper electrolyte function involves maintaining different con-
Electrolyte regulation underlies the basic function and stability centrations within the extracellular fluid (ECF) and intracellular
of most body processes, allowing for cellular and physiologic fluid (ICF), with ECF being the levels tested in blood samples.
homeostasis. Electrolyte evaluation and monitoring may not Most electrolyte concentrations are measured in milliequiva-
be considered a priority in prehospital patient management, lents per liter (mEq/L) unless otherwise specified. Problematic to
however when available its importance in completing an as- initial suspicion of electrolyte derangement is that most symp-
sessment and treatment plan cannot be overstated. Traumatic toms can be broad, nonspecific, overlapping, and in some cases
and atraumatic patients can present with significant electro- concurrent in the atraumatic patient, to include headache, mus-
lyte derangements, ranging from mild and asymptomatic to cle cramping, weakness, lethargy, malaise, confusion, agitation,
severe and life-threatening. The current use of urgent evacua- combativeness, near-syncope and syncope. These include ab-
tion assets is inconsistent between theaters and not guaranteed normal levels of sodium, potassium, calcium, and glucose, with
in future conflicts. As such, it necessitates medic foundational further renal evaluation as available (Table 1). Here, we present
knowledge of electrolyte pathophysiology to manage patients a brief review of basic electrolyte evaluation and management
when movement to higher care is unavailable. for medics in remote and prolonged field care settings.
Scenarios to consider: TABLE 1 Basic Electrolyte Measurements
• A 28-year-old man is brought into your aid station for
“nearly passing out” after filling sandbags for the past sev- Electrolyte Normal Range
+
eral hours. Your junior medic witnessed the event and de- Sodium (Na ) 135–145mEq/L
+
scribes that the patient slowly slumped down to the ground Potassium (K ) 3.5–5.0mEq/L
and that he appeared confused prior to moving him. As your Ionized Calcium (iCa) Hypocalcemia < 1.20 mmol/L
medic starts to get vitals, he asks if you want to run an iSTAT Glucose 70–99mg/dL fasting
(Abbott, www.globalpointofcare.abbott/). What are you 70–140mg/dL nonfasting*
look ing for using this test? How can it help direct your care? *May be as high as 200mg/dL in nonfasting in nondiabetic persons.
*Correspondence to brandon.m.carius.mil@mail.mil
1 SSG Andrea Painter is affiliated with the 92nd Civil Affairs Battalion, 1st Special Forces Command, Fort Bragg, NC. MAJ Brandon M. Carius
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is affiliated with Madigan Army Medical Center Emergency Department, JBLM Fort Lewis, WA, and the 121 Field Hospital, Camp Humphreys,
Republic of Korea.
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