Chapter 12: Management of life Threatening Electrolyte and Metabolic Disturbances

Question 1

What value constitutes hypo k

Answer 1

<3.5

Question 2

Manifestations oh Hypo K

Answer 2

Dysrhythmias (ventricular and supra ventricular conduction delays, sinus Brady), U waves, QT prolongation, flat or inverted t waves, muscular weakness or paresthesia, ileum, abdominal cramps, nausea, and vomiting

Question 3

Besides K what might need to be corrected in hypo k

Answer 3

Mg and alkalosis or acidosis

Question 4

Do you correct pH or potassium first in hypo k

Answer 4

K since potassium will shift inter cellularly as pH rises

Question 5

4 broad catagories that cause hypo k

Answer 5

transcellular shift, renal loss, extra renal loss, decreased intake

Question 6

Hyper K most common cause and cutoff

Answer 6

renal dysfunction, >5.5

Question 7

Causes of pseudo hyper k

Answer 7

WBC >100,000 or platelets count >600,000

Question 8

causes of hyper k

Answer 8

Renal dysfunction
academia
hypoaldosteronism
meds- Aldosterone inhibitors, 
acei, succinylcholine,NSAIDS, TMP-SMX
cell death
excessive intake

Question 9

Manifestations of hyper k

Answer 9

diffuse peaked t ears, pr prolongation, QRS widening, diminished p waves, sine waves, muscle weakness, paralysis, paresthesia. HYPOactive reflexes

Question 10

In hyper K if significant EKG abnormalities are present give

Answer 10

IV calcium chloride 5-10ml 10% solution over 5-10 minutes. can use calcium gluconate 10-20ml 10% solution.

Question 11

how long do the effects of calcium last in hyper k

Answer 11

30-60min so you will need another agent

Question 12

For redistribution of k (3 options)

Answer 12

Insulin and glucose
Sodium Bicarb
Inhaled B2 agonist

Question 13

For removal of potassium from the body 3 things (don’t always need to do all 3)

Answer 13

loop diuretic and isotonic fluids
sodium polystyrene
dialysis

Question 14

Euvolemic hyponatremia is almost always secondary to ___

Answer 14

elevated ADH

Question 15

how to calculate serum osmolarity

Answer 15

[(2X serum sodium) + glucose/18 + BUN/2.8)

Question 16

Signs of osmotic demyelination syndrome

Answer 16

focal motor deficits, respiratory insufficiency, progressive loss of consciousness

Question 17

RF for osmotic demyelination syndrome

Answer 17

Malnutrition 
Female 
hypo k
OH abuse
elderly

Question 18

[Na+} in 3% NaCl, .9NaCl, and LR

Answer 18

513, 154, 130

Question 19

cutoff for hypo Na

Answer 19

<135

Question 20

What receptor does vasopressin work on

Answer 20

V2

Question 21

Contraindications to vasopressin

Answer 21

severe neuro sx, do not co administer with hypertonic saline

Question 22

Hyper Na clinical manifestations

Answer 22

AMS, Lethargy, seizure, coma, weakness

Question 23

Polyuria with Hyper Na indicates ___ or ____

Answer 23

DI or excess salt intake

Question 24

Water deficit formula

Answer 24

.6 X weight(kg) [measured Na/normal Na)-1]

Question 25

Hyper Na cutoff

Answer 25

>145

Question 26

What is calcium often bound to

Answer 26

albumin

Question 27

for 1g/dl change in albumin how do you adjust calcium

Answer 27

.8mg/dl- less reliable in critically ill Patients

Question 28

hypocalcemia cutoff

Answer 28

<8.5

Question 29

hypercalcemia cutoff

Answer 29

11.5

Question 30

manifestations of hyper calcemia

Answer 30

HTN, cardiac ischemia, arrhythmias,, bradykardiam conduction abnormalities, dig toxicity, dehydration, hypotension, weakness, depressed mentation, coma, seizure, sudden death

Question 31

manifestations of hypocalcemnia

Answer 31

hypotension, bradycardia, arrhythmias, heart failure, cardiac arrest, digitalis insensitivity, qt and st prolongation, weakness, muscle spas,, larygospasm, hyperreflexia, e=seizures, tenant, paresthesias

Question 32

hypo phos cutoff

Answer 32

<2.5

Question 33

hypophos clinical manifestations

Answer 33

muscle weakness, respiratory failure, rhabdo, paresthesias, lethargy, disorientation, obtundation, coma, seizure

Question 34

hypophos is uncommon except in critically ill patients with

Answer 34

renal failure

Question 35

hypo mg cutoff

Answer 35

<1.8

Question 36

does hypotension in the setting of acute adrenal insufficiency respond to fluids

Answer 36

no

Question 37

lab findings acute adrenal insufficiency

Answer 37

eiosinophillia, hypoNa, Hyper K, acidosis, hypoglycemia

Question 38

what is the main ketone responsible for acidosis in DKA

Answer 38

Alpha hydroxybuterate

Question 39

what does hyper Na in DKA suggest

Answer 39

DKA

Question 40

Initial things to get for DKA workup

Answer 40

``` fluid status mental status elctrolytes renal function glucose serum ketones blood gas EKG cultures if infection suspected UA ```

Question 41

Patients with renal dysfunction require ___ rates if insulin infusion

Answer 41

slower

Question 42

how fast to raise Na in hypo NA

Answer 42

6-8 in 24 hours