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Flashcards in (2) Common problems in acute care Deck (47):
1

Hyponatremia - evaluation

Most common electrolyte abnormality

Urine sodium - normal 10-20
Serum osmolality - normal 275-285
Clinical status

2

Urine sodium > 20

suggests kidney issue

3

Urine sodium < 10

suggests problem outside of kidney

4

Isotonic Hyponatremia - s/s and treatment

Pseudohyponatremia
- occurs with extreme HLD, high protein leves
s/s - asymptomatic - usually found on labs

Treatment - cut down on fat

5

Hypotonic Hyponatremia - assessment

Serum osmo < 280
Are they hyper/hypovolemic?
If Hypervolemic - assess for extrarenal salt loss or renal salt wasting?

6

Any time in acute care you see diarrhea, what should you test for?

C-difficile

7

Hypovolemic Hypotonic Hypernatremia
w/ urine sodium < 10
Causes (3)

Dehydration
Diarrhea
Vomiting or prolonged NGT suctioning

8

Hypovolemic Hypotonic Hypernatremia
w/ urine sodium > 20
Causes (3)

Low volume - kidneys cannot conserve NA
-- Diuretics**
-- ACE inhibitors
-- Mineralocorticoid deficiency

9

Hypervolemic Hypotonic Hypernatremia
**MOST COMMON**
Causes (3)

Treatment

Any Edematous states
-- CHF
-- Liver disease
-- Advanced renal failure
Treatment - restrict fluids

10

Hypertonic Hyponatremia
serum osmo is?
Most common cause?

Serum osmo > 290
Hyperglycemia - usually HHNK

11

Hyponatremia management?

Treatment based on cause
Hypervolemic - fluid restriction
Hypovolemic - give IVF - normal saline
Symptomatic - give NS with loop diuretic
CNS symptoms - consider 3% and lasix

12

What rate do you administer 3% saline to a hyponatremic patient?

slow and calculated

13

Hypernatremia

Management

Usually due to excess water loss

Depends on cause
Hypovolemia -- NS followed by half
Euvolemia -- D5W
Hypervolemia - D5W and lasix or dialysis

14

Normal potassium levels

3-5.5

15

Normal sodium levels

135-145

16

Hypokalemia - causes

Diuretics
Alkalosis
GI loss
Excess renal loss

17

Elevated serum epinephrine in trauma patients may contribute to:

Hypokalemia

18

Hypokalemia - s/s (4)

Muscular weakness
Fatigue
Muscle cramps - legs hurt early afternoon
Constipation

19

Severe Hypokalemia s/s (4)

Severe < 2.5
-- flaccid paralysis
-- tetany
-- hyporeflexia
-- rhabdomyolosis

20

Hypokalemia - diagnostics

Decreased amplitude on ECG
Broad T waves
Prominent U waves
multifocal PVCs, V-tach, V-fib

21

Hypokalemia managemet

2.5-4 give PO or 10 mEq/hr IV
< 2.5 or severe s/s may give 40 mEq/hr
-- Give magnesium if refractory hypokalemia

22

Hyperkalemia - causes

excess intake
renal failure
drugs - NSAIDS
hypoaldosteronism
cell death
acidosis - shifts extracellular

23

At what rate does K increase with drop in pH?

0.7 mEq/L for every 0.1 drop in pH

24

If you replace K 3 times in 8 hours and potassium doesn't move, what is likely the issue?

Hypomagnesemia

25

Hyperkalemia - diagnosis

ECG - tall peaked T-waves

26

Hyperkalemia - management

Kayexalate
Insulin 10 U regular with D50

27

How does insulin and d50 reduce K?

It pushes it into the cell.

28

Why is Calcium important?

Important as a mediator of neuromuscular and cardiac function

29

What is normal ionized calcium

4.5-5.5 mg/dl and does not vary with albumin level

30

Hypocalcemia

Pancreatitis
Renal failure
Severe trauma
Blood transfusions

31

Hypocalcemia

Increased DTR
Trousseau's sign - Caropopedal spasm
Chvostek's - cheek blink

32

Hypercalcemia

Sluggish
-- Fatigue
-- muscle weakness
-- Depression
-- Anorexia
-- N/V
--Constipation

33

Severe Hypercalcemia

Can cause coma and death
> 12 is considered a medical emergency

34

Hypercalcemia treatment

Calcitonin
Dialysis
If > 12 NS infusion with loop diuretic

35

HYPOcalcemia management

ABG - check pH
Acute - Calcium gluconate
Chronic - Oral supplements
-- Vitamin D
-- Aluminum hydroxide

36

If a patient has a normal calcium level (8.5-10.5 mg/dl) but a low albumin, what does this suggest?

Hypercalcemia - because 50% of calcium is bound to albumin

37

Corrected calcium formula

total Ca + 0.8 or (4-serum albumin)

38

What is Chvostek's sign?

twitching of the facial muscles in response to tapping over the area of the facial nerve

Hypocalcemia

39

What is Trousseau's sign?

Blood pressure cuff around arm for 3 minutes will induce spasm in the forarm and hand

Hypocalcemia

40

Acid-base imbalances
Respiratory Acidosis

pH < 7.35

41

pH - 7.28
CO2 - 50
Bicarb - 25

Respiratory acidosis
- Lethargic
- Overdose

Treatment - ventilation, narcan

42

pH 7.50
CO2 - 25
Bicarb 25

Respiratory alkalosis
- Hyperventilation

Treatment - sedation

43

pH < 7.35
CO2 - 35-45
Bicarb < 22

Metabolic acidosis

44

Anion Gap

{Na + K} - {HCO3 + Cl}

45

Higher the anion gap

The more acutely ill the patient is

46

Acetazolamide - Diamox

Metabolic alkalosis

47

"ROME"

Respiratory opposite
Metabolic equal