Dr. Griffith Electorlytes and Liver Failure Flashcards Preview

Internal Med > Dr. Griffith Electorlytes and Liver Failure > Flashcards

Flashcards in Dr. Griffith Electorlytes and Liver Failure Deck (39):
1

first step in assessing hyponatremia

volume status
hypovolemic
eu volemic
hypervolemic

2

hyponatremia - hypovelmic

renal vs. nonrenal

3

hyponatremia - hypovolemic - renal causes

Urine sodium > 20
nephropathies (recovery from ATN)

4

hyponatremia - hypovolemic - non renal causes

Urine sodium <10
vomiting, diarrhea, dehydration

5

hyponatremia - hypervolemic - renal causes

urine sodium > 20
ARF, nephrotic syndrome, CRF

6

hyponatremia - hypervolemic - non renal causes

urine sodium <10
CHF, cirrhosis (ascites)

7

hyponatremia - euvolemic causes

1) SIADH 2) Addison's 3) drugs (thiazides) 4) hypothyroidism 5) psychogenic polydypsia 6) beer potamnia

8

SIADH diagnosis

one of exclusion
usually BUN <4

9

normal kidneys w/ low serum osmolity

low serum osm <280
urine should maximally dilute 50-100

10

when is 3% NS given?

rarely: coma, seizures

11

Addison's disease

adrenal insuff
low sodium
high/normal K+

12

hypothyroidism - cause of hyponatremia

osmolality receptor reset

13

beer potamnia

solute poor beer

14

hypernatremia

dehydration or DI
check urine output (low - dehydration, high - DI) necrosis

15

hyperkalemia, think

1) pseudohyperkalemia
2) shifts
3) increased total body K

16

pseudohyperkalemia

lab artifact
- hemolysis
- WBC > 50,000
- platelets > 750,000

17

hyperkalemia - shifts

acidosis
insulin deficiency (DKA)
tissue necrosis

18

increased total body K+

1) increased intake (decreased excretion)
2) limited excretion

19

hyperkalemia - limited excretion

renal failure
type IV RTA
mineralocorticoid deficiency
drugs (ACEI, NSAIDs, heparin, etc)

20

hyperkalemia level

>6

21

hyperkalemia EKG changes

non urgent - normal EKG
urgent - peaked T waves
emergent - widened QRS, loss of P wave, sine wave pattern

22

"spurious" cause of hyperkalemia

blood taken above IV

23

EKG changes in hyperkalemia per Mr. Sawaya

peaked T waves
prolonged PR
lose P waves
widened QRS
sine wave
v tach/ v fib

24

hyperkalemia treatment

IV calcium
IV dextrose + insulin
IV sodium bicarb
albuterol
kayexelate
dialysis
limit K+ intake and observe
correct underlying disorder

25

IV calcium for hyperkalemia

immediate effect, short duration
stabilize cardiac membranes
given via large vein

26

IV dextrose and insulin for hyperkalemia

slower onset of action, longer duration of effect
shifts K+ into cells

27

IV sodium bicarb for hyperkalemia

gradual onset
shifts k+ into cells
complications of intracellular fluid shifts

28

albuterol for hyperkalemia

COPD exacerbates patient's low K+ often from overuse of B-agonists

29

Kayexelate for hyperkalemia

exchange resin
slow onset
K+ is exchanged for Na+
removes K+ from body

30

hypercalcemia symptoms!

constipation
groans - PUD
moans - depression, AMS
stones - renal

31

causes of hypercalcemia in elderly invidiuals

malignacy (breast, kidney, lung)
multiple myeloma
primary PTHism
less common - paget's, drugs (thiazides)

32

causes of hypercalcemia in younger inviduals

sarcoidosis
primary PTHism
less common: familal hypocalciuric hypercalcemia, lithium, vit d intox, milk-alkalia

33

multiple myeloma symptoms

anemia, proteinuria, hypercalcemia

34

chloride/phosphate ratio >35

hyperparathyroidism

35

uremia - acidosis

BUN >40
Cr >4
usually associated with hyperphosphatemia

36

Lactic Acidosis causes

shock, severe anemia/hypoxia, seizures, DKA

37

high albumin

carries calcium
free low calcium

38

low albumin

free calcium high

39

calcium correction

(0.8 * (4 - Pt's Albumin)) + Serum Ca)