Flashcards in 20 - Electrolyte Imbalance Deck (43):
What causes potassium imbalances?
- pH changes
- GI issues
- Loop diuretics
- GI losses
- pH changes
What are the signs and symptoms of hypokalemia?
- Fatigue/muscle cramps
- Paresthesias (tingling)
- Flat t waves/ dysrhythmias***
- ileus (nauseous, bowels not moving right)
What is the treatment for hypokalemia?
- Replace slowly***
- Can do orally or IV
What are the causes of hyperkalemia?
*** KNOW THIS ****
- Hemolysis common reason (lab)
- Meds (spiranolactone, ACE)
- Metabolic acidosis (low pH, high K)
- ***Renal Failure #1 true medical reason***
- Steroid issues
- Too much K medicines
All of these were underlined
What are the signs and symptoms of hyperkalemia?
*** TEST QUESTION ***
- Paresthesias, weak
- *** Tented t waves ***
- V-fib, heart block, death
What is the treatment of hyperkalemia?
- Calcium gluconate or CaCl (cardiac protection)
- Kayoxolate (?)
- Dialysis if severe
Stop any meds that provoke this condition
- Symptoms occur in nml people when BS gets to 50-60
- In diabetics often lose the sensation of low BS
- One of the “electrolytes” you can fix quickly if low***
What is the treatment for hypoglycemia?
Treatment with oral glucose, IV glucose, food, IM or IV glucagon
What are the signs and symptoms of hypoglycemia?
In diabetics, often no symptoms
What is the issue with hyperglycemia?
- Delayed healing
- Vascular injury
What causes the blood glucose to go up?
- Stress (illness, seizure)
What is the treatment of hyperglycemia?
DM – diet/lifestyle, meds, insulin (not too fast)
In hospital usually very aggressive in tight BS control even in non diabetics
Life threatening consequence of DM (type 1)
What is the treatment of DKA?
- FLUIDS essential***
- Insulin – slowly
KNOW FLUIDS ***
Describe calcium imbalances
- Skin, liver, kidneys, GI system
- Regulated by PTH, Vit D, Calcitonin
KNOW THIS = ***Calcium and Phosphorus Inversely Related*** TEST QUESTION
What are the causes of hypocalcemia?
- Metabolic disorders
- Surgical (snipped PT glands)
- Pancreatitis, cancers
- Renal/liver issues
What are the signs and symptoms of hypocalcemia?
- Tetany and muscle spasm
- Chvostek sign (facial tap)
- Trousseau sign (BP cuff)
- Decreased cardiac output
*** All underlined ***
What should you always check before saying someone is low on calcium?
Always check an albumin prior to saying someone is low on Ca
Formula – add .8 of Ca to every decrease in albumin from nml
What is the treatment for hypocalcemia?
- Replace slowly (oral or IV)
What are the causes of HYPERcalcemia?
- Meds (thiazides)
- Metabolic (low phos; high thyroid levels)
This is when I start thinking about cancer (bone mets)
What are the signs and symptoms of hypercalcemia?
- Bone pain
What is the treatment for hypercalcemia?
- IV phos
Describe sodium in the body
- Essential in water/volume balance
- Regulated by thirst, ADH, renin-angiotensin
- Increased osmo stimulates thirst and ADH
- Low volume stimulates Na absorption
What are the signs and symptoms of hyponatremia?
*** TEST QUESTION ***
- Often none
What are the three types of hyponatremia?
Describe hypovolemic hyponatremia
Pt is severely dehydrated with salt losses > water
- GI losses
Describe the treatment options for hypovolemic hyponatremia?
Correct the dehydration, the sodium will correct
Describe euvolemic hyponatremia
Normal volume, low sodium
- High triglycerides
What is SIADH
Low plasma osmolality, high urine osmo and high urine Na
Urinating out too much sodium
What are the causes of SIADH?
What is the treatment of SIADH (euvolemic)
- Fluid Restriction
- Oral Na
- Democlocycline (blocks ADH)
Describe hypervolemic hypernatremia
- Too much fluid, not enough NA
- CHF, renal, liver disease causes
You won't get sodium down until CHF is better
What is the treatment of hypervolemic hypernatremia?
- Restrict oral fluid
- IV fluid and loop diuretics (seems crazy)
Restrict fluid for CHF and increase fluid intake for kidneys
If you replace sodium too fast, what happens?
- Can lead to irreversible Central Pontine Myelinolysis *****
- This is brain cell death
- Why the pharmacy gets nervous when you order the high Na saline
- Burns, old/dehydrated, renal
What are the signs and symptoms of hypernatremia?
Describe diabetes insipitus
- Failure of ADH by central (brain) or renal failure or certain meds
- Water wasting – get hypotonic urine
What is the treatment for diabetes insipitus?
- Central ddvap
- Renal - thiazides
What is the treatment for hypernatremia?
- Give fluids (slowly)
- If replace fluids too fast and bring down sodium too fast – brain swelling
What do you NEED to know?
- If you give Na too fast to correct hyponatremia you can get Central Pontine Myelinolysis.
- If you give fluids too fast to correct hypernatremia, you can get brain swelling
Describe fluid bolus
- To correct vital signs
- Always isotonic (LR or NS)
- Fast if bolus
- Kids 20 ml/kg (don’t worry about chf)
- Adults eye ball
Bolus is done quickly to change vital signs now