Day 3 Potassium, Magnesium, Acid and Base disorders Flashcards
(16 cards)
Hypokalemic signs and symptoms?
Common causes of hypokalemia?
Medications that cause hypokalemia?
Muscle weakness and Cardiovascular disease
poor dietary intake, medications, loss of GI fluids, hypomagnesia(WHEN TREATING HYPOKALEMIA CHECK AND REPLACE MAGNESIUM).
Epinephrine, albuterol, theophylline, insulin, caffeine, diuretics, high-dose penicillins(nafcillin, ampicillin), mineralcorticoids, amphotericin B, cisplatin, aminoglycosides, laxatives, sodium polystyrene sulfonate.
Treatment of hypokalemia general rules?
Should you use oral route for potassium when possible?
When should you use IV potassium?
Replace potassium! General Rule: administering 10mEq will increase serum potassium by 0.1 mEq. Usually target 4 mEq. Check and correct magnesium.
Yes!
Severe cases(<2.5), symptomatic patients, unable to tolerate oral replacement.
What is the primary oral potassium used?
Main side effect of potassium?
Max concentrations for peripheral administration? Central line administration? Concerns?
Potassium chloride.
GI upset. How to reduce? give with food, microencapsulated formula reduces this, divide daily dose into 2-4 doses separated by 2-4 hours.
10mEq/100 mL. 20-40 mEq/100mL. Potassium is a vesicant, can cause tissue damage.
Which fluid do you use for IV potassium?
Should IV potassium be given as an IV push?
Infusion rates for peripheral infusion? Central line infusion? Concerns?
Saline solutions(0.45% or 0.9% Sodium Chloride).
NO!!!! can be instantly fatal, must be diluted and infused properly.
10 mEq/hr. >10mEq/hr(up to 20-40) if greater than 10 ECG recommended. Vesicant, arrythmias.
Hyperkalemia signs and symptoms?
Commons causes of hyperkalemia?
What can drugs can cause decreased potassium excretion?
Most patients are asymptomatic, heart palpitations, ECG changes.
Increased potassium intake, decreased potassium excretion, decreased response to aldosterone, shift of potassium to extracellular space.
ACE and ARB’s. Aliskiren, spironolactone, triamterene, NSAIDS.
Which drugs do cardiac protection in hyperkalemia?
Intracellular K shift?
Excrete K?
Calcium gluconate or calcium chloride. Immediate.
Albuterol, insulin +/- dextrose, sodium bicarbonate. Short term.
Furosemide, Sodium polystyrene, patriomer. Long term.
Which IV calcium is better?
Why do we give insulin with dextrose?
Is albuterol commonly used? Why or why not?
Calcium gluconate. Calcium chloride provides 3x more calcium and causes extravasation.
prevents hypoglycemia from insulin administration.
No, due to high dose use.
How does sodium polystyrene work?
Hypomagnesia GI causes?
signs and symptoms of hypomagnesia?
Exchanges 1 mEq of Na for 1 mEq of potassium. PO route better than rectal route.
GI intake, endocrine causes(hypercalcemia), medications Aminoglycocides, amphotericin B, cisplatin and carboplatin, cyclosporine and tarolimus, diuretics, digoxin, PPI’s, foscarnet.
neuromuscular(convulsing, twtiching, positive trousseau sign(arm twitch during blood pressure cuff) and chvostek sign(twitch in eye), cardiac, serum K and calcium levels low.
Hypomagnesia treatment guidelines for route? IV infusion rate? How to prevent diarrhea?
Magnesium replacement >1? <1?
What causes Hypermagnesemia?
Don’t use IM, oral can cause diarrhea, IV route is commonly used. Supplement over 3-5 days. 1 gram over 60 minutes, if given too quickly it will distribute to tissue slowly.
> 1 can use oral, 3-4 per day, not all at once, sustained release lowers diarrhea. Give IV, 4-6 grams over 12-24 hours.
rare, later stages of CKD, elderly, Large doses of magnesium(treatment of eclampsia in pregnancy), lithium, cathartics(milk of magnesium, epsom salts).
Hypermagnesemia treatment?
How is Acid-Base homeostasis achieved?
Most patients don’t require aggressive treatment. Enhance elimination of magnesium(IV hydration, loop diuretics), can give IV calcium if needed for cardiac stuff.
1: Extracellular buffering, CO2 eliminated by lungs(acid), HCO3 regulated by kidneys(base).
What is Ph normal value?
PCO2 normal value?
metabolic acidosis primary disturbance Ph, disturbance, compensation?
Metabolic alkalosis?
7.36-7.44(7.4 normal).
36-44 mm Hg.
<7.36, decreased HCO3, decrease pCO2(respiratory).
> 7.44, increased HCO3, increase pCO2(respiratory).
Respiratory acidosis pH, primary disturbance, compensation?
Respiratory alkalosis pH, primary disturbance, compensation?
Anion gap stuff(positives - negatives)?
<7.36, increased pCO2, increased HCO3(renal).
> 7.44, decreased pCO2, decreased HCO3(renal).
Na-(Cl+HCO3). Normal range 3-11, abnormal >12, anion gap >17.
Cause of anion gap metabolic acidosis?(MUDPILES)
Causes of non anion gap metabolic acidosis?(CaRDS)
Treatment of metabolic acidosis?
Methanol, uremia, diabetic ketoacidosis, propylene glycol, intoxication or infection or isonazid), lactic acidosis, ethylene glycol, salicylate or sepsis.
Carbonic anhydrase inhibitor, renal tubular acidosis, diarrhea, saline or spironolactone.
Supplement with base, sodium bicarb. IV sodium bicarb, 0.3 N Tromethamine(THAM).
what causes metabolic alkalosis?
How to treat metabolic alkalosis?
Compensation of metabolic acid-base disorders?
Vomiting, diuresis, nasogastric suctioning, hypokalemia, excess mineralcorticoid activity.
Spironolactone, IV saline solution, acetazolimide plus potassium, HCl, Ammonium chloride, arginine monohydrochloride.
Metabolic acidosis–> increase respiratory rate, Metabolic alkalosis–> reduce respiratory rate.
What causes respiratory acidosis?
How to treat respiratory acidosis?
What causes respiratory alkalosis?
Inhibition of respiratory system, decreased pulmonary function, etc.
treat underlying cause.
encountered in pregnant people and those living at high altitudes, central nervous stimulation of respiration, hypoxia induced respiratory stimulation
How to treat respiratory alkalosis?
treat underlying cause, oxygen, adjust ventilator settings.
