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Therapeutics > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

Normal Plasma Potassium Levels?

A

3.5-5.1 mEq/L

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2
Q

Hypokalemia is Potassium below what value?
Categorize Mild, Moderate and Severe

A
  1. <3.5
  2. Mild = 3.1-3.5
  3. Moderate = 2.5-3
  4. Severe = <2.5
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3
Q

What can cause hypokalemia? (4)

A
  1. Decr intake (rare)
  2. Incr potassium loss (kidney, GI, sweat, V/D)
  3. Hypomagnesemia -> renal K wasting and decr of intracellular K
  4. Drug induced
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4
Q

Name some drugs that can cause Hypokalemia

A
  1. beta 2 agonists
  2. Theophylline
  3. Levothyroxine
  4. Thiazide and loop diuretics
  5. High dose penicillin
  6. Laxatives
  7. Sodium polystyrene sulfonate
  8. Patiromer
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5
Q

Clinical presentation of Mild vs Moderate to severe

A

Mild = usually no sx’s

Mod to severe : depends on severity and rapidity of onset
- cramping, weakness, malaise and myalgias
Cardiac : ECG changes and arryhthmias

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6
Q
  1. What to do about hypokalemia and hypomagnesemia together?
  2. What agents preferred for asx pt’s and symptomatic pt’s w/severe depletion?
A

tx for magnesium first! Mg is needed for K uptake

  1. Oral preferred
    - IV may be necessary
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7
Q

Hypokalemia : Non pharm?

A

Food : OJ, spinach, bananas, tomatoes, nuts, chocolate

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8
Q

Hypokalemia : oral Potassium

  1. best for?
  2. Which is often used?
  3. adverse effects?
A
  1. asx patients
  2. potassium chloride
  3. Abdominal pain or cramping
    -diarrhea, nausea, flatulence
    -Hyperkalemia
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9
Q

General rules
1. Admin of 10 mEq of Kcl = increase in serum K by how much?
2. Divide doses to minimize ?

  1. common dosing?
A
  1. 0.1 mEq/L
  2. GI effects
  3. 10-40 mEq daily to qid
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10
Q

Hypokalemia and Iv products
1. For severe or ____ pt’s or pt’s unable to ?
2. Cons? (3)
3. MUST BE ____ before use. USe as infusion
4. What’s used to dilute it?

  1. Dosing schemes? (2)
  2. Recheck K after _____
A
  1. symptomatic , take oral
  2. Considered high risk and high alert meds , pain at infusion site , can be fatal if admined undiluted or IV push
  3. DILUTED
  4. NS or 0.45% saline, avoid D5W
  5. 10 meq/100 mL over 1 hr (peripheral admin ok)

20mEq/50 mL over 1 hr via central line only (recc to check ECG)

  1. 30-40 meq total. At least 30-60 mins after end of last infusion.
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11
Q

Hyperkalemia
1. K greater than?
2. What’s Mild, mod, and severe?
3. Caused by?

A
  1. 5.1
  2. 5.2-5.9 , 6-6.4, >6.5
  3. Incr dietary intake. Incr endog K (tumor lysis syndrome)
    Decr renal CL , Drug induced, Low renin and aldosterone state , adrenal insufficiency, hyperglycemia
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12
Q

What drugs can cause Hyperkalemia?

A

Nsaids, beta blockers, cyclosporine, diabetes, elderly
Spironolactone , ACEI’s and ARBS

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13
Q

Hyperkalemia : Clinical presentation ?

A

Sx’s range from asx to severe
- heart palpitations or skipped heartbeats
-Cardiac can be life threatening

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14
Q

Hyperkalemia TX for MILD cases with NO ecg change

A
  1. Remove potassium from Body using any K+ Binder
  2. Can use furosemide 20-40 mg IVP x 1
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15
Q

Moderate TX with NO ECG CHANGE?
- Name agents and process

A
  1. Shift potassium intracellularly
    - use Insulin 0.1 units/kg IVP or Albuterol nebulizer 10 mg
    -or sodium bicarb infusion 50-125 mL/hr or 50 meq IVP if pH <7.15 or HCO3 <15
  2. REMOVE K FROM BODY
    -Use any potassium binder
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16
Q

SEVERE Hyperkalemia tx with ECG changes?
-3 steps and agents

A
  1. Stabilize myocardium
    - Calc Gluc 2g IVP x1 over 10 min
    -Calc Cl 1G IVP over 5 min central line only
  2. SHift potassium intracellulary (Insulin )
  3. Remove potassium (K+ binders or Furosemide)
17
Q

Calc Gluconate
1. What does it do?
2. Dose and route
3. onset and duration
4. ae’s
5. MOA

A
  1. stabilize heart
  2. 2g IV over 10 mins
  3. 1-2 mins /10-30 mins
  4. Local irritation, hypercalcemia, hypotension, bradycardia
  5. INCR cardiac threshold potential and reverse ECG changes
18
Q

Regular Insulin
1. What does it do?
2. Dose and route
3. onset and duration
4. ae’s
5. MOA

Dextrose 50%
1. only given with insulin to prevent ____ if glucose < ____
2. DOse and route?
3. AE’s?

A
  1. shift K intracellularly
  2. 10 units IV or 0.1 units/kg
  3. 30 mins / 2-6 hrs
  4. hypoglycemia
  5. incr K uptake into cells
  6. hypoglycemia, 300
  7. BG < 150 (25 g or 50 mL IV over 5 mins for 2 doses)
    -BG 150-300 : 25 g (50 mL) IV over 5 mins x 1 dose
  8. Hyperglycemia
19
Q

Albuterol : Shift K

  1. Dose?
  2. AE’s

Sodium Bicarb : Shift K

  1. For what conditions?
  2. Dose and route?
  3. Ae’s ?
A
  1. 10-20 mg nebulized
  2. tachycardia and tremor
  3. pH < 7.15 or HCO3 < 15
  4. 50 meq IV over 5 mins or 50-125 mL/hr infusion
  5. hypernatremia , metabolic alkalosis
20
Q

Remove the K

  1. Furosemide
    Dose? AE’s?
  2. Sodium Polystyrene sulfonate (Kayexalate)
    Dose? AE?s Instructions?
A
  1. 20-40 mg IV push x 1 dose
    - low electrolytes , metab alkalosis, dehydration
  2. Oral : 15-30 grams every 4-6 hrs as needed. Rectal : 30 g in 100 mL, retain 30 mins
  • N/V, diarrhea, Decr Mg, K, and Ca, Incr Na, edema and colon necrosis
    -sep from other meds by 3 hrs
21
Q

Remove the K

  1. Patiromer (Veltassa) Powder
    Dose? AE’s
  2. Sodium zirconium cyclosilicate (Lokelma powder)
    - Dose and AE’s ?
A
  1. 8.4 mg by mouth once daily (Max is 25.2 g/day)
  • GI Upset, constipation , DECR Mg and K, sep from other meds by 3 hrs and store in fridge
  1. 10 g TID for up to 48 hrs; then 10 g once daily
  • GI upset, DECR K, Edema, Separate from other meds by 2 hrs, store at room temp
22
Q

Which can be used for recurrent episodes or chornic hyperkalemia?

Most commonly used in pt’s with ?

A

Patiromer and sodium zirc cylclo

-CKD , HF. Can help facilitate optimal RAASi therapy

23
Q

MAGNESIUM
1. Normal?
2. Causes of HYPO?
3. Most pt’s are?
4. What general sx’s?

A
  1. 1.7-2.6
  2. GI like malnutrition of alcoholism, Vomiting, diarrhea. Drug induced like laxatives, aminoglycosides, amphotericin B
  3. Asymptomatic
  4. Neuro –> convulsions in severe
    Neuromusc –> Muscle twitching, tremor, weakness, cramping
    Cardio –> Changes in ECG , wide QRS, peaked T wave
    - if severe, prolonged pr and diminished T wave
24
Q

What’s Moderate and severe hypomag?

A

Mod : 1.2-1.6
Severe <1.2

25
Q

Hypomag tx

  1. If Severe Mag with life threatening sx’s?
  2. If severe, but sx’s are NOT life threatening?
A
  1. Mag sulfate 2g IV over 2 mins (Hypotension, flush, sweat) -only used in emerg
  • followed by 2g IV over 20 mins
    -followed by 2-4g IV over 2-4 hrs then repeat serum Mg
  1. Mag sulfate 8 grams IV over 8 hrs, then repeat serum Mg
    - If mag levels are 1.2-1.6 but umable to take oral, Mg sulfate 4 g IV over 4 hrs, repeat serum Mg
26
Q

How do you tx moderate or asymptomatic (1.2-1.6)?

A

Incr dietary mg
- oral mag replacement
-Usually magOX 400 mg tab 1-2 tabs BID or TID. HIghest risk of diarrhea

27
Q

HYPERmagnesemia
- rare except in ?
-___ disease, hypo___, DKA
- Drug induced ?? (3)

A
  1. Kidney disease (AKI or CKD stages 4 or 5)
    -renal impairment + taking mag containing antacids

Addison’s. thyroidism.

lithium, overusing mag citrate or mag antacids
-parenteral mag for preeclampsia

28
Q

HYPERmag Clinical manifestations ?

TX 3 steps

A

lethargy, confusionn, dysrhythmias, muscle weakness

  1. Protect myocard
    -1-2 g IV calc gluc to antag Mg effects
  2. INCR Mg Output
    - lasix 20-40 mg IV with 0.45% sodium chloride if normal renal function or CKD stage 1-4

-pt’s with ESRD –> dialysis

  1. STOP input. Limit mag in diet or meds
29
Q

Normal Plasma Ca2+ ?
Normal Ionized or free calcium thats active?

A

8.6-10.2

1.13 -1.32

30
Q

What’s the corrected calcium equation?

-Not recommended to use in ?

A

measured Ca (mg/dL) + 0.8 (4-albumin g/dL)

-critically ill pt’s

31
Q

Hypocalcemia Values?

-caused by?

A

calcium < 8.6 mg/dL; ionized Ca <1.1 mMol/L

Alteration in PTH or VITD
-Vit D deficiency (most common)
-Hypomag(Impairs PTH activity)

32
Q

IV calcium products : describe 2 and elemental Ca per each product

A
  1. Calc chloride
    -elemental Ca = 27.3%
    -vein irritation! tissue necrosis!
    -best with central line!
    -Max rate 1 g over 10 mins
  2. Calc gluc
    - elemental = 9.3%
    Less vein irritation
    Max rate = 3g IV over 10 mins
33
Q

Oral calcium products? (2)
-elemental ca?

A
  1. Calc acetate
    - 169 mg per 667 tab
  2. Calc carb
34
Q

Hypercalcemia Values ?
Mild-mod
severe

Causes ? meds ?

Sx’s?

Name 1 tx

A

> 10.2

Mild/mod : 10.3-13
Severe > 13

-TZD diuretics, VitD, Lithium, calc, theophylline, tamoxifen, ganciclovir

-Fatigue, weakness, anorexia, cog dysfunction, Polyuria, polydipsia, nocturia

-Normal Saline. 1-2 L bolus followed by 200-300 mL/hr until fluid resuscitated

35
Q

Phosphorous

Normal?

Hypophos can be due to ?

Hypophos acute sx’s?
Severe?

A

2.5-4.5

Impaired intest abs. Diarrhea, alcoholism, diet, binders such as alum and mag antacids
-increased renal elim thru VitD deficiency, hyperparathyroidism, hyperglycemia induced osmotic diuresis
-drugs like diuretics, glucocorticoids (dex, pred), sodium bicarb

ACUTE : organ dysfunction, seizure, coma
SEVERE : Muscle weakness, confusion, seizures, coma

36
Q

IV PHOS
-For what condition?
-Products?
-How much phos in each ?
-How does each product differ?

A
  1. Severe< 1.5 mg/dL or unable to take oral
  2. Sodium phos, potass phos
  3. 3 mmol/mL
  4. Sodium Phos has 4 mEq Na+/mL
    Potass Phos has 4.4 mEq K+/mL
37
Q

For asympt mild-mod do u need tx?

For mild to mod with evidence of deficit what’s the tx?

A

usually no

Oral phos

38
Q

What oral phos products are available and describe how much phos, potassium, and sodium are in them ?

A
  1. K-phos, neutral
    - 8 mmol of phos, 1.1 mEQ of Potass, 13 mEq of Sodium
  2. Neutra phos K
    -8mmol of phos, 14.3 mEq of potassium

Therapeutics (15 decks)

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