A better deck of flash card on electrolytes

Question 1

what is the most abundant intracellular cation?

Answer 1

Potassium

Question 2

what are functions of potassium

Answer 2

allows transmission of electrical impulses, helps impulses flow smoothly, w/o potassium things slow down. too much and muscle get hyperactive

Question 3

what systems does potassium directly affect

Answer 3

the heart, GI tract, MS system.

Acid base balance - trades places with hydrogen ions to balance charges
0.1 decrease in in pH - a 0.5 increase in K

Question 4

hypokalemia

Answer 4

think low and slow! less than 3.5.
the heart has flattened T waves and prominant U, waves. orthostatic hypotension, weak thready pulse, dysarythmias,
muscular cramping, flaccid paralysis, hyporeflexia, muscle weakness.
neuro changes - include altered mental status, letharfy, decreased LOC
Gi symptoms - hypoactive bowel sounds, constipation, andominal distention, paralytic ileus, can lead to small bowel obstructions

Question 5

therapeutic management of hypokalemia

Answer 5

prevent more loss with IV K or PO K - REPLACE SLOWLY
switch diuretics - no loops diuretics or thiazides
eat k rich foods such as banans, kale, melons
cardiac monitor
assess respiratory function, can cause respiratory depression.

Question 6

hyperkalemia

Answer 6

> 5 think fast!
CV = bradycardia, hypotension
EKG = tall peaked T-waves, prolonged PR intervals, Wide QRS, heart block, asystole, Vfib,
MS = twitching, numbness, weakness
GI - hyperactive bowel sounds, spastic colon, diarrhea.

Question 7

therapeutic management of hyperkalemia

Answer 7

potassium decreasing meds = kayexelate
K-wasting diuretics, insulin and D50, albuterol, bicarb, calcium gluconate.
cardiac monitoring
k restricted diet
salt substitues should have potassium in them
dailysis

Question 8

sodium!

Answer 8

the most abundant ECF cation
it controls fluid distribution between the ICF and ECF
normal levels is 135meq/l - 145meq/l

Question 9

sodium is a real muscle mommy

Answer 9

she is everyone’s best friend.
she controls fluids between the ECF and ICF
inside our vessel we have solvent, and we have sodium. sodium is the solute. sodium will always try to perfectly dissolve solute and solvent while being balanced. thats where osmolarity of blood comes from
if there is a bunch of fluid outside the cell, sodium leaves the cell to help the balance. if theres a lot of solute concentration in the cell then sodium will bust her ass in to the cell to balance that out.

Question 10

main functions of sodium

Answer 10

most abundant ECF cation
balances osmolarity
muscle contraction
nerve impulses

Question 11

hyponatremia causes
(actual loss of Na)

Answer 11

<135meq/l
sweating
wound drainage
low Na diet
diuretics ( thiazide and loop)
hypoaldosternism

Question 12

hyponatremia causes
(increase in fluids like h2o)

Answer 12

SIADH
water intoxication
freshwater submersion
insatiable thirst
hypotonic fluids

Question 13

hypernatremia
(actual increase in Na)

Answer 13

steroids
oral ingestion
table salt
hypertonic saline (1.5%, 3%, 5%)
cushings syndrome

Question 14

hypernatremia
(relative fluid loss)

Answer 14

NPO
fever
hyperventilation
dehydration
infection

Question 15

assessment of hyponatremia

Answer 15

N - behavior changes , increased intracranial pressure, cerebral edema, seizures
ms - weaknes (resp muscles) deacreased DTRs
GI - motility, NVD, stomach cramps,
CV - hypovolemia - weak pulse, tachycardia, hypotension, dizziness,
hypervolemia - bounding pulses, high bp.

Question 16

hypernetremia

Answer 16

N - cellular dehydration in brain cells
hypovolemic - irritable, confused, manic, cranky
hypervolemic - lethargic, drowsy, stupor, coma,
MS - muscle twitching cramps, weakness,
CV - heart contraction deacreases
hypovolemic - deacreased BP, weak pulses
hypervolemic - increased BP, JVD, bounding pulses
extreme thirst
dry mucous membranes
dry/hot skin

Question 17

therapeutic management with hyponatremia

Answer 17

replace fluid slowly
prevent pontine myelionolysis
neuro damage by over correction
locked in syndrome
increase sodium level by 0.5meq/hr - go slow
drugs:
stop Na wasting diuretics
IV 0.9% NaCl if hypovolemic
hypertonic saline 3%
osmotic diuretics
lose h20 not Na
increase sodium intake
free water restriction

Question 18

therapeutic management of hypernatremia

Answer 18

often caused by steroids
bring levels down slowly
hypotonic fluids - 1/2 NS, D5W
if hypervolemic give Na wasting diuretics
get dietician in there
Na restriction
increase free water.

Question 19

calcium !

Answer 19

8.6 - 10.4 mg/dl cation
main functions:
stored mostly in bones
mineralizes bones and keeps them hard
helps nerve impulses and in muscle contraction
activates actin and myosin
neuromuscular processes
coagulation
controlled by pth and thyroid hormone and vitamin D
inverse relationship with phosphorous - when calcium is low phosphorous is high

Question 20

causes of hypocalcemia

Answer 20

<8.6mg/dl
renal failure
malnutrition/malabsorption
alcoholism
defficiency in albumin, Mg, or vitamin D
vitamin D is required for absorption of calcium in the gut
hypoparathyroidism
hyperphosphatemia

Question 21

causes of hypercalcemia

Answer 21

hyperparathyroidism
malgnancy
vitamin D toxicity
excessive nutritional intake

Question 22

assessment of hypocalcemia

Answer 22

neuromuscular - sputtering and irritable
parasthesias - tetany, spasm
chvosteks sign - cheek twitching when stroked \
trousseaus sign - inflate BP cuff - hand and wrist spasm
cv - insufficient contractility, HR decreased, decreased BP, weak pulse
EKG - prolonged st, and qt interval, that means the time it takes the signal to get from the sa node to the AV node and down the ventricles is delayed.
GI - increased bowel sounds, cramping, diarrhea.
skeletal - osteoporosis

Question 23

assessment of hypercalcemia

Answer 23

neuromuscular - exhausting muscles because it overly excites the muscles that they give out
weakness,
decreased DTRs
decreased LOC
CV - decreased HR, peripheral cyanosis, DVT pr clotting
EKG - shortened QT wave
GI - decreased peristalsis, leads to constipation, decreased bowel sounds, abdominal pain, the gut is worn out

Question 24

therapeutic management of hypocalcemia

Answer 24

replace Ca with IV or PO
give with vitamin D or aluminum hydroxide to increase absorption
muscle relaxants
decrease stimuli
increase nutrition intake - broccoli, coconut, milk or any dairy products

Question 25

therapeutic management of hypercalcemia

Answer 25

goal is to decrease calcium levels, rehydrate, the kidneys should excrete excess calcium IV fluids 0.9% NS drugs such as calcium binders, calcium reabsorption inhibitors phosphorous calcitonin biphosphonates NSAIDS dialysis cardiac monitoring

Question 26

chloride cl-!

Answer 26

96-108meq/l main functions: most abundant extracellular anion sodium and chloride are married works with sodium to maintain fluid balance binds with H-HCL - to stomach acid inversely related to hco3 (bicarb) when one goes up the other goes down directly related to Na + K so when on goes up so does the other one

Question 27

hypochloremia

Answer 27

>108meq/l volume overload CHF water intoxication metabolic alkalosis - HCO3 goes up, so Cl goes down actual "salt" losses: burns sweating cystic fibrosis addisons disease with CHF patients or water intoxication we see a low cl patients lose salt through skin and cystic fibrosis, and addisons disease

Question 28

hyperchloremia

Answer 28

<96 meq/l dehydration metabolic acidosis-bicarb is low acute renal failure cushings syndrome

Question 29

assessment hypochloremia

Answer 29

rarely produces obvious symptoms presents s/s of hyponatremia fluid shifting out of th vessels and into th cells and tissues behavior changes increased ICP cerebral edema muscle weakness hyperactivity in the GI tract

Question 30

assessment hyperchloremia

Answer 30

cellular dehydration behavior changes dry mouth, thirst, hot dry skin, muscle twitching and issues with cardiac contractility presents with s/s of hypernatremia

Question 31

therapeutic management of hypochloremia

Answer 31

goal - correct imbalance, treat underlying cause give 0.9% sodium chloride check out other electrolytes like sodium and bicarb could give salt orally but would take too long

Question 32

therapeutic management of hyperchloremia

Answer 32

goal - correct imbalance treat underlying cause give bicarb avoid Na pr NaCl intake give lactated ringers for IV fluids wont be abnormal by itself

Question 33

magnesium!

Answer 33

normal range - 1.6-2.6mg/dl main functions: 60% stored in bones and cartilage skeletal muscle contraction carbohydrate metabolism ATP formation activation of vitamins cellular growth direct relationship with Ca++ so if one goes up then vice versa

Question 34

hypomagnesemia causes

Answer 34

ETOH abuse renal failure malnutrition/malabsorption hypoparathyroidism hypocalcemia diarrhea - Mg is lost in stool

Question 35

hypermagnesemia causes

Answer 35

excess intake of Mg - containing meds overcorrection with Mg supplementation (IV or PO) renal failure fairly uncommon

Question 36

hypomagnesemia assessment

Answer 36

neuromuscular - numbness and tingling, tetany, seizures, increased DTRs CNS - psychosis, confusion GI - decreased motility, constipation, anorexia EKG - prolonged QT

Question 37

hypermagnesemia assessment

Answer 37

Cv - severe bradycardia, cardiac arrest, vasodilation, hypotension EKG - prolonged PR, wide QRS CNS - drowsy, lethargic, coma neuromuscular - slow/weak muscle contraction, decreased DTR

Question 38

therapeutic management hypomagnesemia

Answer 38

replace mg PO - magnesium hydroxide not magnesium citrate IV - 1g per hour (SLOW) treat the cause: diuretics and aminoglycosides, phosphorous monitor EKG and DTRs

Question 39

therapeutic management of hypermagnesemia

Answer 39

treat the cause: MG containing drugs (OTC antacids) or iv fluids loop diuretics give calcium gluconate to protect heart dialysis

Question 40

always give magnesium before potassium. Why?

Answer 40

if potassium is given first, the potassium will not absorbed in the presence of magnesium.

Question 41

phosphorous!

Answer 41

normal range - 3 -4.5 cellular metabolism and energy production ATP production (adenosine triphosphate) forms phospholipid bilayer of cell membranes - not nough phos, not a good cell membrane bones and teeth inverse relationship with Ca++ ( if phos goes up calcium goes down

Question 42

causes hypophosphatemia

Answer 42

malnutrition/starvation TPN Refeeding syndrome the body responds excessively to the extra nutrition and starts shifting fluids around.

Question 43

causes hyperphosphatemia

Answer 43

renal failure tumor lysis syndrome excessive intake hypoparathyroidism hypocalcemia

Question 44

assessment hypophosphatemia

Answer 44

symptoms related to a lack of energy ATP and damage to cell membranes CV - cardiac output and stroke volume and weak pulses MS - weakness, possible rhabdomyolysis (due to cell damage) skeletal - decreased bone density, fractures CNS - irritable -, seizure, coma

Question 45

therepeutic hyperphosphatemia

Answer 45

replace phos IV must be given slowly drugs that reduce phosphate: antacids, calciu, osmotic diuretics, phosphate bonders, phos-lo phos rich foods fish chicken beef ca rich foods such as dairy, greens

Question 46

assessment hyperphosphatemia

Answer 46

typically tolerated well - doesn't produce symptoms often associated with hypocalcemia

Question 47

hyperphosphatemia therapeutic management

Answer 47

phosphate binders give with meals - the whole point is to bind phosphorous with meals so it doesnt get absorbed manage hypocalcemia

Question 48

major intracellular electrolytes

Answer 48

potassium + magnesium

Question 49

major extracellular electrolytes

Answer 49

sodium and chloride

Question 50

cations

Answer 50

sodium potassium calcium magnesium hydrogen

Question 51

anions

Answer 51

bicarbonate phosphate chloride sulfate

Question 52

fluids and electrolytes are regulated by what systems:

Answer 52

endocrine, cardiovascular, kidneys, gastrointestinal