Fluid and Electrolyte Disorders

I.  Program Content

1. Trainees must acquire knowledge and understanding of the following areas during the course of their training.

1. Physiology of sodium balance, including sensors of extracellular volume, effect on  systems, tubular sodium transport processes, and the regulation of renal sodium excretion.

2. Hypovolemia: pathophysiology, causes, clinical feature, diagnosis, and management.

3. Edematous disorders: pathophysiology, causes, clinical features, diagnosis, and management.

4. Clinical use and complications of diuretics.

5. Physiology of water balance, including tonicity sensors, effector system, the countercurrent mechanism for urine concentration, the cellular physiology of collecting duct water reabsorption, and the regulation of water excretion by the kidney.

6. Hyponatremia: pathophysiology, causes, clinical features, diagnosis, and management.

7. Hypernatremia: pathophysiology, causes, clinical features, diagnosis, and management.

8. Evaluation and management of the polyuric patient.

9. Physiology of potassium balance, including the regulation of transcellular potassium movement, tubular transport processes for potassium reabsorption and secretion, and the regulation of potassium excretion by the kidney.

10. Hypokalemia: pathophysiology, causes, clinical features, diagnosis, and management.

11. Hyperkalemia: pathophysiology, causes, clinical features, diagnosis, and management.

12. Disorders of sodium, water, and potassium balance in end-stage renal disease.

II.  Patient Care Experience

1. Trainees should be familiar with and have experience in the direct diagnosis and management of the following areas in both the outpatient and inpatient setting:

1. Trainees must be able to assess the validity and relevance of serum and urine electrolyte measurements for patient management.

2. Trainees must be able to assess volume status (including the interpretation of central venous pressure and Swan-Ganz measurements) and recognize and manage hypovolemic and edematous disorders.

3. Trainees must be familiar with the use and complications of diuretic therapy.

4. Trainees must be able to evaluate and manage hyponatremia in the acute and chronic setting.

5. Trainees must be able to evaluate and manage hypernatremia in the acute and chronic setting.

6. Trainees must be able to evaluate and manage the polyuric patients.

7. Trainees must be able to evaluate and manage the patient with hypokalemia or hyperkalemia.  They must be familiar with the acute as well as the long-term management of these disorders.

8. Trainees must be able to evaluate and manage disorders of sodium, water, and potassium in patients with end-stage renal disease.