Chapter 17: Fluids and Electrolytes Flashcards
1
Q
Total body water accounts approximately _ of total body weight
A
60%
2
Q
The ECF is composed of ___ and ___, or interstitial, fluid
A
Intravascular and Extravascular
3
Q
What are the 3 fundamental homeostatic equilibriums?
A
- osmotic equilibrium
- electric equilibrium
- acid-base equilibrium
4
Q
The key point is that sodium is much more concentrated in the ECF (approximately ___ mEq/L) than in the ICF (approximately ___ mEq/L)
A
40
10
5
Q
Why Na is equal in both compartment of ECF?
A
Because the capillary membrane is permeable to water and electrolytes
6
Q
Why Na is increase in extracellular compared to intracellular?
A
Because the cell membrane is only permeable to water but not to electrolytes
7
Q
Measure of solute concentration per unit mass of solvent
A
Osmolality
8
Q
Measure of solute concentration per unit volume of solvent
A
Osmolarity
9
Q
When two solutions are separated by a membrane that is permeable only to water, water crosses into the compartment with ___
A
the more concentrated solution to equalize the ion concentration in each.
10
Q
Contribute the most to osmotic pressure in ECF
A
Na, HCO3 and Cl plus glucose
11
Q
Formula to calculate effective osmolality or Tonicity
A
2 x Na + glucose / 18
12
Q
What will happen if you add 1L of water to the ECF?
A
it will cross the cell membrane into ICF to equalized ECF osmolality. TBW will expand and decrease in osmolality
13
Q
What will happen if you add 1L of isotonic saline to the ECF?
A
no movement of water into cells and will only produce ECF expansion
14
Q
What will happen if you give hypertonic plasma and hypotonic plasma?
A
Hypertonic plasma will shrink the cell
Hypotonic plasma will swell the cell
15
Q
Two types of dehydration
A
water loss (hyper-osmolality) salt loss (hypo-osmolality)
16
Q
Example of salt loss type of dehydration
A
vomiting sweating diarrhea bleeding CKD
17
Q
Hyponatremia is defined as a serum Na
A
<138
18
Q
symptoms of hyponatremia occurs if serum Na
A
=/<15
19
Q
How many percent of heart failure patient has hyponatremia?
A
approximately 20%
20
Q
How many percent has mild hyponatremia in hospitalized patient?
A
15-30%
21
Q
If patient has hyponatremia what is the next step?
A
volume status and calculate plasma osmolalities
Hyperosmolar hyponatremia >295
Isoosmolar hyponatremia 275 - 295
Hypoosmolar hyponatremia >295
22
Q
Pathophysiology of hyperosmolary hyponatremia
A
large amount of osmotically active solutes accumulate in the ECF space. example is Hyperglycemia
23
Q
Each 100mg/dL increase of glucose it will ___
A
decrease plasma Na by 1.6mEq/L
24
Q
administration of mannitol, glycerol and maltose will cause ___
A
osmolar gap and hyponatremia
25
Difference between measured osmolality and calculated osmolality
osmolar gap (NV around 10)
26
Example of isoosmolar hyponatremia
severe hyperproteinemia or hyperlipidemia
27
Two important hyponatremic disorders are the
SIADH and less common cerebral salt-wasting syndrome
28
Difference of SIADH to cerebral salt-wasting syndrome
SIADH may also cased by non cerebral disease and volume status is normal
29
Intoxication of this substance is uncommon but important cause of hyponatremia that may be profound
Methylenedioxymethamphetamine (MDMA or Ecstasy)
30
The most important symptoms of hyponatremia are due to its effects on the
brain
31
Moderately severe symptoms often start when a plasma [Na+] is ___
<130 mEq/L
32
Severe symptoms often start when a plasma [Na+] is ___
<120 mEq/L
33
Initially if hypoosmolar the brain will ___. After 48 hours the brain will adapt and will release
swell producing intracranial hypertension.
| Na, K, Cl, glycine and taurine
34
Symptoms is hypoosmolar hyponatremia is sever and persistent in what population?
SIADH
Children
Menstruating women
Hypoxia
35
Diagnostic criteria of SIADH
```
Hypotonic hyponatremia (<275)
Increase urinary osmolality (>200)
Elevated urinary Na (>20)
Clinically euvolemia
Normal other organs
```
36
Experts recommend that when duration is unknown, the hyponatremia should be assumed to be chronic and treated as ___ with a longer correction time.
chronic
37
Acute vs chronic hyponatremia
24-48 hours
38
If no urinary osmolality, you can compute by
for a specific gravity (π) of 1.005, UOSM = 05 × 35 = 175 mOsm/L.
39
As a rule, only in patients with edematous syndromes and in patients with vomiting and diarrhea will UNa+ be found to be
<10 mEq/L
40
The most important guides for therapy in hyponatremia is
symptoms (hyponatremic encephalopathy)
41
When the patient presents with severe neurologic symptoms (vomiting, seizures, reduced consciousness, cardiorespiratory arrest), the initial treatment
infusion of 3% hypertonic saline as recommended by European guidelines
42
Raising serum sodium by ___ is typically all that is required to see an improvement in severe neurologic symptoms.
5 mEq/L
43
T or F: When symp- toms are mild or moderate (nausea, confusion, headache) or in chronic hyponatremia, the [Na+] correction should be faster than for acute hyponatremia
False. it should be slower
44
For chronic hyponatremia [Na+], the correction rate should not exceed ___ in high-risk patients and ___ h in low-risk patients
6 mEq/24 hour
| 12 mEq/24 hour
45
Hypertonic (3%) saline can be in hyponatremia given at a low infusion rate
0.5 to 1 mL/kg/h
46
In addition in treatment of hyponatremia using saline we can also add what?
Furosemide 20mg IV
47
Osmotic demyelination syndrome is caused by rapid correction of hyponatremia
>12 mEq/L/24 h
48
Treatment for overcorrection of
| Na
5% dextrose in water at 3ml/kg/h
loop diuretics
desmopressin
49
Hypernatremia is defined as serum or plasma ___
[Na+] >145 mEq/L and hyperosmolality (serum osmolality >295 mOsm/L).
50
Population at risk of hypernatremia
Elderly patients, decompensated diabetics, infants, and hospitalized patients
51
If severe hypernatremia develops in the course of minutes to hours, such as from a massive salt overdose in a suicide attempt, a suddenly shrinking brain may prompt ___
intracranial hemorrhage
52
Based on volume status, hypernatremia can be classified into 3
1. hypovolemic hypernatremia (decreased TBW and total body Na+ with a relatively greater decrease in TBW)
2. hypervolemic hypernatremia (increased total body Na+ with normal or increased TBW)
3. normovolemic hypernatre- mia (near normal total body sodium and decreased TBW)
53
FDA recommends against vasopressin antagonists in patients with ___
liver cirrhosis
54
Therapy for cerebral salt wasting
isotonic (-.9%) nacl and Fludrocortisone -- nacl orally at home
55
Therapy for SIADH
Water restriction.
Enhanced Na+ and protein intake + furosemide. Vasopressin antagonists* can be used for [Na+] <125 mEq/L. Demeclocycline. Lithium.
56
Polyuria
>3000ml of urine/24hours
57
Drug may case nephrogenic diabetes insipidus
Demeclocycline
58
Drug may cause interstitial nephritis
NSAIDs
59
Example of normovolemic hypernatremia
```
Central DI (urine osm <300)
Partial DI (urine osm 300-800)
Nephrogenic DI (urine osm <200)
```
60
Patient has Urine osm of more than 800 and urine Na less than 10. What is your consideration?
extrarenal hypovolemia hypernatremia
61
Severe hypernatremia ___ yields a mortality of ___
Severe hypernatremia (i.e., a [Na+] >150 to 160 mEq/L) yields a mortality of 75%
62
A BUN/creatinine ratio ___ is indicative of hyperosmolar dehydration.
A BUN/creatinine ratio >40 is indicative of hyperosmolar dehydration.
63
Steps in treatment of hypernatremia
1. isotonic 0.9% saline
2. treat underlying cause
3. compute for free water deficit
64
When the adaptation of brain cells is incomplete (onset over
| <48 hours), the correction rate of acute hypernatremia can be performed at a rate of ___
1 mEq/L/h
65
If hypernatremia is chronic (onset over >48 hours), the rate of correction should be slower to avoid the risk of cerebral edema, at no more than ___
If hypernatremia is chronic (onset over >48 hours), the rate of correction should be slower to avoid the risk of cerebral edema, at no more than 0.5 mEq/L/h or 10 to 12 mEq/24 h.
66
A disease where the ability of the kidney to reabsorb free water is compromised.
Diabetes insipidus characterized as
- polyuria
- polydipsia
- increased volume of hypoosmolar urine
67
2 types of diabetes insipidus
1. central (also called neurogenic), due to inadequate ADH secretion
2. renal (also called nephrogenic), when ADH secretion is normal or increased but the v2R receptors of the kidney’s collecting duct cells do not respond appro- priately to ADH.
68
The most common clinical symptoms and signs are ___
The most common clinical symptoms and signs are excessive thirst, polydipsia, and polyuria
69
Diabetes insipidus a spot check in the ED without water deprivation will typically reveal a UOSM of
<300 mOsm/L
70
Central diabetes insipidus is treated with
the synthetic hormone desmopressin, as a nasal spray, 10 micrograms (0.1 mL) every 12 hours, or PO, 0.05 milligrams every 12 hours, as starting doses.
71
Nephrogenic diabetes insipidus is treated with
low-salt, low-protein diet, adequate hydration, and the careful use of one to three agents that act together to concentrate urine in these patients: a thiazide diuretic, the potassium- sparing diuretic amiloride, and indomethacin.
72
Hypokalemia is defined as a serum [K+] of
<3.5 mEq/L.
73
Most frequent cause of hypokalemia
1. insufficient dietary intake
2. intracellular shift
3. increase losses
74
Hypokalemia makes the resting potential more electronegative which produces in ECG
- enhancing depolarization; the reduction in [K+] conduction delays repolarization, causing prolonged QTc, flattened T waves, and the appearance of U waves in the ECG
75
Symptoms of hypokalemia with start at serum ___
2.5 mEq/L
76
Arrythmias to watch out in hypokalemia
atrial fibrillation
torsades de pointes
ventricular tachycardia
ventricular fibrillation
77
Cause of hypokalemia that mimics thiazide diuretic use
gitelman;s syndrome
78
Cause of hypokalemia that mimics loop diuretic use
bartter's syndrome
79
UNa+ value <30 mEq/L and a UOSM value less than POSM suggest
polyuria
80
How to compute transtubular K gradient?
(Urinary K+ × POSM)/(UOSM × Plasma K+) with normal result of 8-9 mEq/L
81
transtubular K gradient result of <5 mEq/L suggest ___ and value of <3 mEq/L suggest ___
values <5 mEq/L suggest hyperaldosteronism; if paralysis is present, values <3 mEq/L suggest hypokalemic periodic paralysis.
82
A calcium/phosphate ratio ___ on a spot urine is 100% sensitive and 96% specific for thyrotoxic hypokalemic periodic paralysis.
A calcium/phosphate ratio >1.7 on a spot urine is 100% sensitive and 96% specific for thyrotoxic hypokalemic periodic paralysis.
83
Level of mild, moderate and severe hypokalemia
```
mild = >3 mEq/L
moderate = 2.5 - 3 mEq/L
severe = <2.5 mEq/L
```
84
In tintinally, fluid correction of hypokalemia is ___
500 mL of a saline solution is 40 mEq, to be infused in 4 to 6 hours in a peripheral line
85
In most cases, hypokalemic patients are also hypomagnesemic.
Thus, magnesium (20 to 60 mEq/24 h) may be added to the infusion both to optimize tubular reuptake of potassium and to contrast proar- rhythmic effect of hypokalemia.
86
Hyperkalemia is defined as measured serum [K+] of ___
>5.5 mEq/L
87
The most common cause is factitious hyperkalemia due to
release of intracellular potassium caused by hemolysis during phlebotomy.
88
What is the role of Calcium in hyperkalemia?
calcium antagonizes the effects of hyperkalemia at the level of the cell membrane, raising the threshold potential
89
Death from hyperkalemia is usually the result of ___
diastolic arrest or ventricular fibrillation
90
In hyperkalemia, elevated spot urine K (>20mEq/L) suggest ___
extra renal cause
91
In hyperkalemia, low urine K+ output (<10 mEq/L) suggests ___
oliguric kidney failure or drug effect, such as angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers.
92
Treatment modalities for hyperkalemia
1. membrane stabilization
2. intracellular shift of K
3. removal/excretion of K
93
This study does not recommend the routine administration of sodium bicarbonate for hyperkalemia unless there is concomitant metabolic acidosis.
Cochrane review of 2015
94
Causes of hyperkalemia
1. pseudohyperkalemia
2. intracellular shift to extracellualr
3. potassium load
4. decrease potassium excretion
95
This oral was previously used to excrete potassium but noted with intestinal necrosis
sodium polystyrene sulfonate
96
2 oral K binding agents can be use in ED
patiromer
| sodium zirconium cyclosilicate
97
___ enhances the toxic cardiac effects of digitalis.
hypercalcemia enhances the toxic cardiac effects of digitalis.
98
The total body content of magnesium (Mg2+) is ___
24 grams, or 2000 mEq,
99
____ of which is fixed in bone and only slowly exchange- able.
50% to 70%
100
Most of the remaining Mg2+ is found in the ICF space, with a concentration of approximately ___
40 mEq/L
101
Circulating Mg2+ is ___ to ___ bound to proteins (mainly albumin), ___ to ___ complexed, and ___ to ___ ionized,
Circulating Mg2+ is 25% to 35% bound to proteins (mainly albumin), 10% to 15% complexed, and 50% to 60% ionized
102
How many percent of circulating Mg2+ is active form?
50% - 60% inonized
103
The normal dietary intake of Mg2+ is approximately ___ and is found in vegetables such as dry beans and leafy greens, meat, and cereals.
The normal dietary intake of Mg2+ is approximately 240 to 336 milligrams/d and is found in vegetables such as dry beans and leafy greens, meat, and cereals.
104
Hyperkalemia 12LECG changes levels
Prolonged PR interval, tall peaked T waves, short QT interval
Flattening of the P wave, QRS widening
QRS complex degradation into a sinusoidal pattern
6.5–7.5 = Prolonged PR interval, tall peaked T waves, short QT interval
7.5–8.0 = Flattening of the P wave, QRS widening
10–12 = QRS complex degradation into a sinusoidal pattern
105
Membrane stabilization used for hyperkalemia
```
calcium chloride (5-10ml IV) 1-3 ml
calcium glutinate (10-20ml IV) 1-3 ml
```
106
T or F: Renal reabsorption of Mg2+ is carried out with sodium and water and is unidi- rectional
True
107
___ enhances neuromuscular activity (thus provoking tremors and cramps) by
rapidly decreasing ionized [Mg2+] and [Ca2+] at the same time.
respiratory alkalosis
108
Drug that causes hypomagnesemia
proton pump inhibitor
| diuretic therapy
109
Hypomagnesemia is common in acute illness; it has been found in ___ of hospitalized patients and in up to ___ of medical intensive care patients.
Hypomagnesemia is common in acute illness; it has been found in 12% of hospitalized patients and in up to 65% of medical intensive care patients.
110
Hypo- calcemia does not develop until [Mg2+] falls below ___
Hypo- calcemia does not develop until [Mg2+] falls below 1.2 milligrams/dL
111
Treatment principles for hypomagnesemia
1. treat or stop cause of hypomagnesemia
2. asymptomatic patient may use supplementation
3. for severe and symptomatic hypomagnesemia, urgent IV replacement is mandatory
4. chronic Mg2+ def may require >50 meds of oral Mg (6 grams of MgSO4 per day)
5. spironolactone - reducing incidence of arrhythmias in congestive heart failure
112
In life-threatening conditions hypomagnesemia (torsades de pointes, eclampsia) treatment is
1 to 4 grams or 8 to 32 mEq diluted in at least 100 mL of 5% dextrose or normal saline (0.9%) solution can be administered in 10 to 60 minutes under continuous monitoring
113
Hypermagnesemia is more commonly seen in the ___
Hypermagnesemia is more commonly seen in the perinatal setting secondary to the treatment of preeclampsia or eclampsia
114
The possibility of hypermagnesemia should be considered in patients with ___
hyperkalemia or hypercalcemia
115
Severe symptomatic hypermagnesemia can be treated with ___
Severe symptomatic hypermag- nesemia can be treated with 10 mL of 10% calcium chloride IV over 2 to 3 minutes
116
Signs and symptoms of hypermagnesemia and magnesium level
2. 0–3.0 = Nausea
3. 0–4.0 = Somnolence
4. 0–8.0 = Loss of deep tendon reflexes
8. 0–12.0 = Respiratory depression
12. 0–15.0 = Hypotension, heart block, cardiac arrest
117
___ is the most abundant mineral in the body.
Calcium (Ca2+)
118
Total body Ca is?
15grams/kg of body weight or about 1kg in an average-sized adult
119
Ca2+ is ___ bound in bone as phosphate and carbonate
99%
120
The normal daily intake of Ca2+ is ___ milligrams
The normal daily intake of Ca2+ is 800 to 3000 milligrams
121
Excretion of Ca2+ is primarily via the ___
stool
122
Plasma [Ca2+] is between
Plasma [Ca2+] is between 8.5 and 10.5 milligrams/dL (4.3 to 5.3 mEq/L or 2.2 to 2.7 mmol/L)
1 mEq/L = 2 milligrams/dL = 0.5 mmol/L
123
3 forms of calcium
50% ionized which is active
40% protein bound which is inactive
10 % bound to anions which are phosphate, carbonate and citrate
124
Total serum Ca is equal to?
Ionized [Ca2+] plus the product of 0.8 and total protein.
125
T or F: Alkalosis produces a decrease in ionized fraction with no change in the total serum [Ca2+]
True
126
T or F: Each 0.1 rise in pH lowers ionized [Ca2+] by about 3% to 8%.
True
127
When Ca is increase our body will release ___ and if Ca is decrease our body will release __
```
Calcitonin = resorption
PTH = demineralization
```
128
Ca2+-sensing receptor58,59 is mainly present on plasma membranes of ___
parathyroids
kidney
bones
thyroid
129
Physiology that increases urinary secretion of Ca
- hypercalcemia
- metabolic acidosis
- hypervolemia
- loop diuretics
130
Cause of hypocalcemia that decrease production of 25(OH)D3?
liver failure
131
Cause of hypocalcemia that decrease synthesis of 1,25(OH2)D3
renal failure and hyperphospathemia
132
Hypocalcemia is defined by an ionized [Ca2+] level ___
<2.0 mEq/L (<4 milligrams/dL or <1.1 mmol/L).
133
Example drugs that causes hypocalcemia
* Phosphates (e.g., enemas, laxatives)
* Phenytoin, phenobarbital
* Gentamicin, tobramycin, dactinomycin, foscarnet
* Cisplatin
* Citrate
* Loop diuretics
* Glucocorticoids
* Magnesium sulfate
* Bisphosphonates, calcitonin, denosumab
* Cinacalcet
134
If serum Ca falls the neuronal membranes becomes ___
permeable to sodium which enhancing excitation and cause contraction
135
The most characteristic ECG finding in hypocalcemia is a ___
prolonged QTc interval
136
Serum level of Ca that can produce T wave mimics ischemia
<6.0mg/dL
137
T or F: Chvostek and Trousseau signs only seen in hypocalcemia?
False. can also seen in hypomagnesemia and respiratory alkalosis
138
1 mEq of elemental Ca2+ is equal to ___
20 milligrams of elemental Ca2
139
Regimen of correction of hypocalcemia
Regimens can be 500 to 3000 milligrams of elemental Ca2+ by mouth daily, in one dose or up to three divided doses. The dose must be individualized for each patient, according to the cause and severity of hypocalcemia
140
IV Ca2+ is only recommended is cases of?
symptomatic or severe hypocalcemia (ionized [Ca2+] <1.9 mEq/L or <0.95 mmol/L)
141
T or F: IV Ca2+ gluconate is preferred over IV calcium chloride (CaCl2) in nonemergency settings due to the dangers of extravasation with CaCl2 (calcinosis cutis)
True
142
T or F: With severe acute hypocalcemia, 10 mL of 10% CaCl2 (or 10 to 30 mL of 10% Ca2+ gluconate) may be given IV over 10 to 20 minutes and repeated every 60 minutes until symptoms resolve or followed by a continuous IV infusion of 10% CaCl2 at 0.02 to 0.08 mL/kg/h (1.4 to 5.6 mL/h in a 70-kg patient)
True
143
T or F: IV Ca2+ should be used with caution in patients taking digitalis because hypocalcemia can potentiate digitalis toxicity.
False. hypercalcemia
144
When to give Calcium chloride in massive transfusion?
During massive transfusions, if the blood is being given faster than 1 unit every 5 minutes, 10 mL of 10% CaCl2 can be given after every 4 to 6 units
145
Hypercalcemia is defined as
A total [Ca2+] >10.5 milligrams/dL or an ionized [Ca2+] level >2.7 mEq/L
146
What is the level of Calcium in mild, moderate and severe hypercalcemia?
mild hypercalcemia = 10.5 to 11.9 milligrams/dL
moderate = 12 to 13.9 milligrams/dL
severe = >14 milligrams/dL
147
What is the most frequent renal effect of hypercalcemia?
loss of concentrating ability
148
A mnemonic sometimes used for the signs and symp- toms of hypercalcemia
stones (renal calculi)
bones (osteolysis)
moans (psychiatric disorders) groans (peptic ulcer disease, pancreatitis, and constipation).
149
On ECG, hypercalcemia may be associated with ___
- depressed ST segments
- widened T waves
- shortened ST segments
- QT intervals.
150
Levels of [Ca2+] above ___ may cause cardiac arrest.
20 milligrams/dL
151
corrected Ca2+ (milligrams/dL) equation?
corrected Ca2+ (milligrams/dL) = measured total Ca2+ (milli- grams/dL) + 0.8 (4.0 – serum albumin [grams/dL])
corrected Ca2+ (mmol/L) = measured total Ca2+ (mmol/L) + 0.02 (40 – serum albumin [grams/L])
152
Treatment for hypercalcemia
if patient is symptomatic or >14mg/dL even without symptoms administer 0.9% normal saline at 500 to 1000ml/hr for 2 - 4 hours.
furosemide of 20 -40mg
corticosteroids (prednisone 1to 2 mg/kg PO or hydrocortisone 200 to 300mg tiv)
153
It decreases mobilization of Ca from bone through reduction of osteoclastic activity
Corticosteroids
154
Hypercalcemia associated malignancy can give
IV bisphosphonates are now considered first-line therapy
155
T or F: Zoledronic acid is recommended; for a corrected [Ca2+] level of 12 milligrams/dL or higher, 4 milligrams as a single dose can be given IV over 15 minutes. Calcitonin works more rapidly than bisphos- phonates and can be given at a dose of 4 units/kg SC or IM.
True
156
Phosphorus mainly exist as?
hydroxyapatite (85%)
157
How many percent of phosphorus is found at ECF?
1%
158
Serum phosphorus in newborns and adults?
Serum [PO43–] decreases with age from a range of 4.0 to 7.0 milligrams/dL in newborns to 2.5 to 5.0 milligrams/dL in adults.
159
What is the total phosphorus store in a man?
700 grams (10 - 15grams/kg)
160
Gut absorption of phosphorus is localized in 2 different sites which are?
1st part of duodenum and jejunum and ileum
161
Increase absorption of phosphorus in proximal tubule is?
- hypoparathyroidism
- volume depletion
- hypocalcemia
- presence of growth hormone.
162
Hypophosphatemia is defined as serum [PO 3–]?
Hypophosphatemia is defined as serum [PO 3–] <2.5 milligrams/dL
163
Severe symptoms of phosphorus may occur at what level?
<1mg/dL
164
What drug may cause pseudohypophosphatemia?
mannitol
165
The symptoms of hypophophatemia is due to?
depletion of adenosine triphosphate and reduction of erythrocyte 2,3-diphosphoglycerate
166
In asymptomatic or mildly symptomatic patients, hypophosphatemia may be treated orally with?
ith skim milk ([PO43–] 1 gram/L) or oral prepa- rations such as Neutra-Phos®, one to two tabs PO four times daily, or K-Phos®, one tab PO four times daily, which contain 150 to 250 mil- ligrams per tablet (PO43–: 1 mmol/L = 3.1 milligrams/dL)
167
Hyperphosphatemia is defined as serum [PO43–]?
Hyperphosphatemia is defined as serum [PO43–] >4.5 milligrams/dL
168
Causes of hypophophatemia
- shift of phosphate into cells
- increased renal excretion
- decreased GI absorption
169
Cause of hyperphophatemia
- decrease in renal excretion of PO43–
- addition or movement of PO43– from ICF to ECF
- drugs
170
In clinical practice, the most important cause of hyperphosphatemia is ___
acute or chronic renal failure
171
Ir reduced survival and function of platelets and red and white blood cells and impaired macrophage function
hypophosphatemia
172
Phosphate correction
<1 mEq/L = 0.6 with duration of 6–72
1–1.7 mEq/L = 0.3–0.4 with duration of 6–72
1.8–2.2 mEq/L = 0.15–0.2 with duration of 6–72
