Electrolyte/ Acid-Base Disturbances

Question 1

Hypernatremic patients are more often associated with -?

Answer 1

Increased water losses rather than increased sodium intake or retention

Question 2

Patients with acute or severe hypernatremia are often associated with what clinical signs?

Answer 2

Obtundation, head pressing, seizures, coma and death

Question 3

Normovolemic, hypernatremic patients are treated with -?

Answer 3

Free water intake PO or IV (5% Dextrose), Mannitol 0.5 - 1 g/kg IV over 20 to 30 minutes (1:1 with sterile water), and or 7.2% Sodium chloride at 3-5 ml/kg over 20 minutes

Question 4

A decreased effective circulating volume can result from hypoadrenocorticism. Explain this pathway.

What are some differentials diagnoses for decreased effective circulating volume?

Answer 4

Hypoadrenocorticism = result of decreased aldosterone, or decreased cortisol leading to increased ADH release (atypical)

Decreased ECV = CHF, GI losses (parasitism, etc.), urinary losses, cavitary effusions, edema, inflammatory/ infectious diseases, pregnancy

Question 5

True or False: Clinical signs associated with hyponatremia are non specific.

Answer 5

True

Question 6

Symptomatic hyponatremic patients require what therapies for electrolyte correction?

Answer 6

Mannitol and Furosemide administration concurrently

Hypertonic saline fluid therapy

Question 7

What are some examples for hypokalemia?

Answer 7

Metabolic alkalosis, insulin administration, refeeding syndrome, diuretic therapy, chronic liver disease, severe diarrhea, DKA, and renal tubular acidosis

Question 8

What clinical signs can be associated with hypokalemia?

Answer 8

Skeletal muscle weakness, ventral flexion of the head and neck, stiffened gait, plantigrade stance, and tachyarrhythmias

Question 9

What abnormal findings can be seen on the ECG of hypokalemia patients? What is this due to?

Answer 9

Increased P amplitude, prolonged PR interval, depressed ST segment, and prolonged QT interval

An increased myocardial cell hyperpolarization leading to prolonged action potentials

Question 10

The rate of potassium infusion should never exceed ___ mEq/kg/hr in mild to moderate hypokalemia, and ____ mEq/kg/hr in severely hypokalemic patients.

Answer 10

0.5 mEq/kg/hr = mild to moderate hypokalemia

1 - 1.5 mEq/ kg/hr = severe hypokalemia

Question 11

Causes of hyperkalemia include -?

Answer 11

DM with ketoacidosis, nautical or oliguric renal failure, urethral obstruction, ruptured urinary bladder, and hypoadrenocorticism

Question 12

Treatment for hyperkalemic patients includes -?

Answer 12

Diuretics, insulin (0.5 U/kg IV with IV 25% dextrose at 2 g/U of insulin administered), calcium gluconate (increase threshold voltage),

Question 13

Causes for hypercalcemia include -?

Answer 13

Granulomatous disease (fungal, sterile dermatitis), skeletal lesions (osteomyelitis, HOD, osteoporosis, bone infarction, neoplasia), AKI/ CRF, hypervitaminosis A or D, neoplasia (LSA, MM, leukemia, anal sac ACA, thymoma), raisin toxicity, or primary hyperparathyroidism

Question 14

Treatment options for hypercalcemia include -?

Answer 14

0.9% NaCl at 4-6 ml/kg/hr CRI or Furosemide 1-2 mg/kg IV, SQ or PO; CRI 0.2-1 mg/kg/hr if in crisis

Question 15

What effects do glucocorticoids have on serum calcium concentrations?

Answer 15

Reduce bone resorption, decreased intestinal calcium absorption, and increased renal calcium excretion

Question 16

Causes for hypocalcemia include -?

Answer 16

Hypomagnesemia, AKI/CRF, pancreatitis, hypoparathyroidism, ehtylene glycol toxicity, hypovitaminosis D, chelating agents, acute tumor lysis syndrome

Question 17

True or False: Patients with decreased total calcium concentrations, but normal ionized calcium concentrations require no treatment.

Answer 17

True

Question 18

Treatment options for hypocalcemic patients includes -?

Answer 18

Calcium gluconate (0.5-1.5 ml/kg IV slowly to effect), CRI of calcium salts, calcitriol, or oral calcium supplementation

Question 19

Common clinical signs associated with hypocalcemia include -?

Answer 19

Aggression, muscle cramping/ stiffness, facial rubbing, muscle tremors or fasciculations

Question 20

What is known of hypomagnesemia?

Answer 20

It’s a common electrolyte disorder, and associated with a broad number of diseases, and it is commonly associated with arrhythmias (Afib, SVT, Vtach, and Vfib).

Question 21

Treatment options for hypomagnesemia include -?

Answer 21

Fluid therapy, oral supplementation

Question 22

Causes for hypermagenesemia include -?

Answer 22

Endocrinopathies, renal failure, and iatrogenic overdose

Question 23

Treatments for patients that are symptomatically hypermagnesemic include -?

Answer 23

IV saline fluid diuresis, diuretics, and calcium gluconate

Question 24

Causes for an increased anion gap metabolic acidosis include -?

Answer 24

Diabetic ketoacidosis, uremia, ethylene glycol intoxication, or lactic acidosis

Question 25

Causes for a normal or low anion gap metabolic acidosis?

Answer 25

Bicarbonate loss, dilutional acidosis, hypoadrenocorticism, or hypoalbuminemia

Question 26

While bicarbonate administration is contraindicated for patients with respiratory _________, treatment of metabolic acidosis and metabolic alkalosis includes -?

Answer 26

Respiratory acidosis (not treatment is often considered for respiratory alkalosis primarily)

Treating the primary cause and appropriate fluid therapy