Pediatric Electrolyte Correction: Sodium, Potassium, Calcium, Magnesium

About this tool

This tool helps clinicians treat abnormal sodium, potassium, calcium and magnesium in children. You enter the weight and any electrolyte results you have, and abnormal values get a treatment plan with weight-based doses.

Optional glucose corrects sodium (1.6 mmol/L per 100 mg/dL glucose) and albumin corrects total calcium. The tool then asks about symptoms: seizure or coma, ECG changes, tetany, or muscle weakness. Severity depends on these symptoms and on thresholds such as sodium under 125, potassium under 2.5 or 6.5 or higher, ionized calcium under 0.9 mmol/L and magnesium under 1.2 mg/dL. Normal ranges used are Na 135–145, K 3.5–5.0 (5.5 in infants), ionized Ca 1.1–1.35 mmol/L and Mg 1.6–2.4 mg/dL.

For symptomatic hyponatremia it gives a 3% saline bolus of 2 mL/kg (max 100 mL) and limits correction to 8–10 mmol/L in 24 hours. For hypernatremia it calculates the free water deficit. Hyperkalemia steps include calcium gluconate, insulin with dextrose, albuterol and potassium removal. Sources include Moritz and Ayus (Pediatr Rev), the 2014 hyponatraemia guideline (Spasovski, Eur J Endocrinol), Daly and Farrington 2013 and the Harriet Lane Handbook, 23rd ed.

Common questions

What is the 3% saline dose for symptomatic hyponatremia in children?

For seizure, coma or severe headache, the tool gives 3% saline 2 mL/kg (max 100 mL) IV over 10 minutes, repeated up to 2–3 times until symptoms stop, aiming for a rise of 4–6 mmol/L. Sodium should not rise more than 8–10 mmol/L in 24 hours.

How is hyperkalemia treated in children?

Steps listed include calcium gluconate 10% 100 mg/kg (max 3 g) for ECG changes, regular insulin 0.1 units/kg with 0.5 g/kg dextrose, nebulized albuterol, sodium bicarbonate if acidotic, furosemide if passing urine, and potassium binders. Repeat a hemolyzed sample before treating a well child.

How is the free water deficit calculated in hypernatremia?

The tool uses 0.6 × weight × (Na/140 − 1). The deficit is replaced over 48 hours (72 hours if Na is 170 or higher) on top of maintenance, lowering sodium no faster than 0.5 mmol/L per hour.

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