CB Endo Electrolytes

Question 1

PT: Heart Palpatations

Prominent T waves and a shortened QT interval

can progress to a prolonged PR interval, QRS widening, and eventually a sine wave appearance

Answer 1

Hyperkalemia CB PT

> 5.0 mEq/L.

Question 2

Pt: muscle pain, depressed mood, polyuria, and constipation.

Answer 2

Hypercalcemia

serum calcium levels > 10.5 mg/dL.

Question 3

_altered mental status, lethargy, headache, and nausea.
a tonic clonic seizure that resolves spontaneously after 1 minute.
Small Cell Carcinoma

Answer 3

HypoNatremia CB pt

Question 4

Causes of Hyperkalemia

Answer 4

Causes: impaired renal excretion,increased potassium intake, or shift from the intracellular to extracellular space (beta-blockers or statins, metabolic acidosis, or rhabdomyolysis)
chronic kidney disease are at the highest risk for hyperkalemia.

Question 5

Sxs Hyperkalemia

Answer 5

Sxs: skeletal muscle weakness and cardiac abnormalities. do not occur until the potassium level exceeds 6 mEq/L.

Question 6

Tx of Hyperkalemia

Answer 6

Tx: 1) stabilization of the cardiac membrane with calcium chloride or gluconate; 2) shifting potassium intracellularly with insulin and glucose, bicarbonate, or high-dose beta agonists; 3) promoting potassium excretion through diuretics, sodium polystyrene sulfonate, or dialysis.

Question 7

Causes of Hypercalcemia

Answer 7

Causes: increased ingestion or absorption, increased bone turnover, or decreased renal excretion.
Most common: hyperparathyroidism and malignancy,….
vitamin D toxicity, renal failure, hyperthyroidism, sarcoidosis, and milk alkali syndrome

Question 8

Hypercalcemia Sxs

Answer 8

Sxs: “stones, bones, abdominal groans, and psychiatric overtones,”
EKG: shortened QT interval calcium directly shortening the myocardial action potential.

Question 9

Hyperca tx

Answer 9

TX: vigorous fluid resuscitation, bisphosphonate therapy, and calcitonin.

Question 10

HypoNa causes

Answer 10

excess free water in relation to sodium and can result from excess free water intake, low solute intake or excessive solute excretion, or elevated antidiuretic hormone levels causing water retention.

Question 11

HypoNa Classification

Answer 11

Hyponatremia is often sub-classified based on volume status into hypovolemic hyponatremia (diarrhea, vomiting, diuretic use), euvolemic hyponatremia (syndrome of inappropriate antidiuretic hormone secretion, psychogenic polydipsia, beer potomania, adrenocorticotropic hormone deficiency, and hypervolemic hyponatremia (congestive heart failure, nephrotic syndrome, cirrhosis).

Question 12

HypoNa Sxs

Answer 12

Hyponatremia may be asymptomatic or may cause severe symptoms at very low sodium levels. Symptoms can include fatigue, lethargy, and headache. Coma and seizures can result if the symptoms progress.

Question 13

HypoNa Tx

Answer 13

Treatment of hyponatremia is based on the underlying etiology, but if severe symptomatic hyponatremia is present, typically 3% NaCl (hypertonic saline) is given to quickly raise the sodium level. In treating hyponatremia, care should be given to not raise the sodium by more than 8-10 mEq/L in 24 hours given the risk of central pontine myelinolysis.

Question 14

obesity, hypertension, and hyperlipidemia
nausea, vomiting, abdominal pain, and mild confusion
positive for increased urination during that last 3 months and a 2.3 kg (5 lb) weight loss.

Answer 14

Hyperglycemia

Hyperglycemia is defined as serum glucose concentration > 200 mg/dL.

Question 15

hyperglycemia causes

Answer 15

The most common cause of hyperglycemia is diabetes, but stress and steroid administration are also causes of transient elevations in glucose

Question 16

Hyperglycemia can lead to:

Answer 16

cardiovascular disease, stroke, kidney disease, neuropathy, and retinopathy.

Question 17

Sxs of hyperglycemia

Answer 17

polydipsia, polyuria, and polyphagia.

chronic hyperglycemia include blurred vision, delayed wound healing, weight loss, and erectile dysfunction.

Question 18

Signs of DM ketoacidosis

Answer 18

Symptoms of diabetic ketoacidosis include deep and rapid breathing, confusion, and fruity breath.
mental obtundation, hyporeflexia, and focal signs can occur.

Question 19

Hyperglyc tx

Answer 19

Acute symptomatic episodes of hyperglycemia are treated with insulin.

Question 20

tremor.
hyperreflexia and tetany.
ECG reveals ST segment depression and a prolonged QT interval.

Answer 20

Hypomg

serum magnesium < 1.5 mEq/L

Question 21

Hypomg causes

Answer 21

alcoholics due to malnutrition and increased magnesium diuresis.

Question 22

Subclasses of hypomg

Answer 22

renal and gastrointestinal losses.

gastrointestinal loss is through diarrhea
Renal: medications such as diuretics or amphotericin, alcoholism, diabetes, or hypercalcemia.

Question 23

Sxs and Signs of hypomg

Answer 23

Low serum magnesium affects the cardiovascular and peripheral nervous systems.
nonspecific T wave changes and a prolonged QT interval.
As the deficit progresses, Torsades de pointes, a polymorphic ventricular tachycardia, may result.

Other symptoms of hypomagnesemia look clinically indistinguishable from hypocalcemia and can include tremor, hyperactive deep tendon reflexes, and tetany. Patients may have a positive Chvostek and Trousseau sign.

Question 24

Tx for Hypomg

Answer 24

Treatment of acute hypomagnesemia is with IV magnesium sulfate.

Question 25

HypoCa sxs

Answer 25

acute-onset muscle cramps with distal extremity numbness.
Tingling in fingers
Trousseau sign
Chvostek’s sign

Symptomatic hypoca serum calcium below 7.0 mg/dL, or ionized calcium below 0.8 mmol/L

Question 26

Hypo Ca Tx

Answer 26

treated promptly with IV calcium.

Calcium gluconate is cardioprotective and is preferred over calcium chloride because it is less likely to cause tissue necrosis. Treatment is usually performed by slow infusion of 0.5 to 1.5 mg/kg/h

Question 27

Vitamin B12 Def causes

Answer 27

Vitamin B12 deficiency is most often due to inadequate dietary intake, malabsorption associated with pernicious anemia and other gastric abnormalities such as Crohn’s disease or Celiac disease.

Vegans and vegetarians

oral contraceptive pills and proton pump inhibitors can reduce absorption of the vitamin.

Question 28

Vit B 12 sxs defeciency

Answer 28

weakness, sore tongue and paresthesias.
impaired vibration sense, ataxia and paresthesias due to posterior spinal cord demyelination
Chapman point in the proximal right thigh

Question 29

Hypoglycemia

Answer 29

Most patients become symptomatic at a serum glucose less than 50 mg/dL.

mental status, lethargy and dizziness. You note paravertebral hypertonicity from T6-10.
headache, confusion, nausea and vomiting, and fatigue
diaphoresis, tremor, paresthesias, dizziness and diplopia.

Question 30

A 30-year-old female being treated for tuberculosis presents for routine laboratory work. A blood smear is significant for sideroblasts. Which Vitamin are they deficient

Answer 30

The patient in the above scenario is most likely suffering from vitamin B6 (pyridoxine) deficiency which can be induced by drugs like isoniazid and birth control pills. It is also a common vitamin deficiency in alcoholics. It presents as sideroblastic anemia, neuropathy, seizures and cheilosis. Patients undergoing treatment for tuberculosis are often treated with prophylactic pyridoxine to prevent deficiency.

Question 31

Diphyllobothrium latum

Answer 31

neurological dysfunction, such as dementia, paresthesias, and megaloblastic anemia.

those who are strict vegetarians and patients with gastrointestinal pathologies that affect the ileum, like Crohn’s disease.

Vitamin 12

Question 32

An 86-year-old woman is brought in by her daughter who is concerned about her mother’s memory loss. Further questioning reveals she also has been having diarrhea for the last few months. Physical examination is significant for severe dermatitis.

Answer 32

vitamin B3

The patient in the above scenario is most likely suffering from niacin, vitamin B3, deficiency which causes pellagra. Pellagra can be remembered by the 3 D’s: diarrhea, dermatitis and dementia. Like many vitamin deficiencies, vitamin B3 deficiency can be caused by inflammatory bowel disease or anatomic bowel resection of the terminal ileum. Both interfere with enteral niacin absorption. Of note, niacin is the precursor of NAD/NADP, which are used in important metabolic reactions.

Question 33

A 64-year-old woman presents to her ophthalmologist for a routine exam. She has never used glasses or contact lenses. Corneal exam is significant for increased vascularization. Redness at the corners of her mouth is also noted.

Answer 33

The patient in the above scenario is most likely suffering from vitamin B2, riboflavin, deficiency which can be remembered by the two C’s: corneal vascularization and cheilosis. Patients may also have glossitis, and growth retardation can be observed in infants and children with vitamin B2 deficiency. Milk and other dairy products represent the major source of riboflavin in the diet. It is essential in the manufacturing of FAD, important for many metabolic reactions, especially the TCA cycle and the synthesis of ATP via oxidative phosphorylation.

Question 34

A recent immigrant from a refugee camp in Somalia presents with swelling and shortness of breath. Physical exam is significant for systolic and diastolic murmurs and pitting edema of the lower extremities. An echocardiogram shows a dilated heart.

Answer 34

The patient in the above scenario is most likely suffering from thiamine, vitamin B1, deficiency. It is most common in people who are malnourished and alcoholics. It can present as Wernicke-Korsakoff syndrome (personality changes, ataxia and ophthalmoplegia), dry beriberi (muscle wasting and neuritis) or wet beriberi (dilated cardiomyopathy and edema).