20 - Electrolyte Imbalance Flashcards Preview

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Flashcards in 20 - Electrolyte Imbalance Deck (43):
1

What causes potassium imbalances?

- Kidneys
- Medicines
- pH changes
- GI issues

2

Describe hypokalemia

Very common

Causes
- Loop diuretics
- GI losses
- Alkalosis
- pH changes

3

What are the signs and symptoms of hypokalemia?

Board question***

- Fatigue/muscle cramps
- Paresthesias (tingling)
- Flat t waves/ dysrhythmias***
- ileus (nauseous, bowels not moving right)

4

What is the treatment for hypokalemia?

- Replace slowly***
- Can do orally or IV

5

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***
- Rhabdo
- Steroid issues
- Too much K medicines

All of these were underlined

6

What are the signs and symptoms of hyperkalemia?

*** TEST QUESTION ***

- Paresthesias, weak
- *** Tented t waves ***
- V-fib, heart block, death

7

What is the treatment of hyperkalemia?

- Albuterol
- Lasix
- Insulin/glucose
- Calcium gluconate or CaCl (cardiac protection)
- Kayoxolate (?)
- Dialysis if severe

Stop any meds that provoke this condition

8

Describe hypglycemia

***

- 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***

9

What is the treatment for hypoglycemia?

***

Treatment with oral glucose, IV glucose, food, IM or IV glucagon

***

10

What are the signs and symptoms of hypoglycemia?

***

- Sweaty
- Weak
- Anxious
- Nauseated
- Confused

In diabetics, often no symptoms

11

What is the issue with hyperglycemia?

- Delayed healing
- Vascular injury

12

What causes the blood glucose to go up?

***

- DM
- Steroids
- Stress (illness, seizure)
- Trauma
- Infections

13

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

14

Describe DKA

Life threatening consequence of DM (type 1)

15

What is the treatment of DKA?

********

- FLUIDS essential***
- Insulin – slowly
- Potassium
- Glucose

KNOW FLUIDS ***

16

Describe calcium imbalances

****

- Skin, liver, kidneys, GI system
- Regulated by PTH, Vit D, Calcitonin

KNOW THIS = ***Calcium and Phosphorus Inversely Related*** TEST QUESTION

17

What are the causes of hypocalcemia?

- Meds
- Metabolic disorders
- Surgical (snipped PT glands)
- Pancreatitis, cancers
- Renal/liver issues

18

What are the signs and symptoms of hypocalcemia?

***

- Tetany and muscle spasm
- Chvostek sign (facial tap)
- Trousseau sign (BP cuff)
- Seizures
- Fractures
- Decreased cardiac output

*** All underlined ***

19

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

20

What is the treatment for hypocalcemia?

- Replace slowly (oral or IV)
- HCTZ

21

What are the causes of HYPERcalcemia?

- PTH
- Meds (thiazides)
- Cancers
- Immobilizations
- Metabolic (low phos; high thyroid levels)

This is when I start thinking about cancer (bone mets)

22

What are the signs and symptoms of hypercalcemia?

- Weakness
- Fatigue
- Nausea
- Bone pain
- Anorexia

23

What is the treatment for hypercalcemia?

- Calcitonin
- IV phos
- Lasix
- Bisphosphonates

24

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

25

What are the signs and symptoms of hyponatremia?

*** TEST QUESTION ***

- Confusion*****
- N/V
- Often none

26

What are the three types of hyponatremia?

- Hypovolemic
- Euvolemic
- Hypervolemic

27

Describe hypovolemic hyponatremia

Pt is severely dehydrated with salt losses > water
- Burns
- Exercise
- GI losses
- Meds
- Pancreatitis

28

Describe the treatment options for hypovolemic hyponatremia?

Correct the dehydration, the sodium will correct

29

Describe euvolemic hyponatremia

Normal volume, low sodium
- SIADH
- Hyperglycemia
- Meds
- Infection
- High triglycerides

30

What is SIADH

Low plasma osmolality, high urine osmo and high urine Na

Urinating out too much sodium

31

What are the causes of SIADH?

- Meds
- Trauma
- Infection
- Cancers

32

What is the treatment of SIADH (euvolemic)

- Fluid Restriction
- Oral Na
- Democlocycline (blocks ADH)

33

Describe hypervolemic hypernatremia

- Too much fluid, not enough NA
- CHF, renal, liver disease causes

You won't get sodium down until CHF is better

34

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

35

If you replace sodium too fast, what happens?

BOARD QUESTIONS

- Can lead to irreversible Central Pontine Myelinolysis *****
- This is brain cell death
- Why the pharmacy gets nervous when you order the high Na saline

36

Describe hypernatremia

- Uncommon
- Burns, old/dehydrated, renal

37

What are the signs and symptoms of hypernatremia?

- Anxiety
- Tremor
- Seizures

38

Describe diabetes insipitus

- Failure of ADH by central (brain) or renal failure or certain meds
- Water wasting – get hypotonic urine

39

What is the treatment for diabetes insipitus?

Treatment
- Central ddvap
- Renal - thiazides

40

What is the treatment for hypernatremia?

**************

- Give fluids (slowly)
- If replace fluids too fast and bring down sodium too fast – brain swelling

*************

41

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

42

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

43

Describe normal urine output

- Kids 1-2 ml/kg/hr
- Adults 0.5-1 ml/kg/hr