electrolyte disturbances

Question 1

What are some causes of potassium shifts out of cells?

Answer 1

Patients with hyperkalemia? DO Insulin LAB work:
digitalis, hyperOsmolarity, insulin deficiency, lysis of cells, acidosis, beta adrenergic antagonist (remember, beta2 receptors promote insulin release- may not actually explain the pathophysiology but should help us remember)

Question 2

What are some causes of potassium shifts into the cell?

Answer 2

INsulin shifts K INto cells.

this may be casued by hypo-osmolarity, high insulin (incr. the Na/K/ATPase), alkalosis, beta adrenergic agonists.

Question 3

Na electrolyte disturbances: high vs. low

Answer 3

both cause stupor and coma

low levels may cause nausea and malaise

Question 4

K electrolyte disturbances: low vs. high

Answer 4

Both cause arrhythmia and muscle weakness.
low levels: U waves, flattened (or inverted? T waves) (wide PR inteval, ST depression)
high levels: peaked T waves, wide QRS
ALWAYS CHECK FOR HIGH K LEVELS IN A PATIENT WITH AKI

Question 5

Calcium disturbances: low vs. high

Answer 5

low: tetany, seizures, long QT
high: stones, bones, groans, psych overtones: renal stones, bone pain, abdominal pain, anxiety, alterned mental status.

Question 6

magnesium disturbances: low vs. high

Answer 6

low: tetany, torsades de pointes.
high: decr. DTR, lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia

Question 7

phosphate disturbances: low vs. high

Answer 7

low: bone loss and osteomalacia
high: renal stones, metastatic calcifications, hypocalcemia