ELECTROLYTE DISORDERS

Question 1

What is caused by a serum sodium concentration less than 135mEq/L (135mmol/L)?

Answer 1

Hyponatremia

Question 2

What is the most common electrolyte abnormality in hospitalized patients, often caused by hypotonic solutions, and usually reflects excess water – retention relative to sodium rather than sodium – deficiency?

Answer 2

Hyponatremia

Question 3

True or False

Mismanagement of hyponatremia can result in neurologic catastrophes from cerebral osmotic demyelination

Answer 3

True

Question 4

Evaluation for hyponatremia starts with a careful history for what?

Answer 4

1. new meds
2. changes in fluid intake
3. changes fluid output

Question 5

True or False

Symptoms of hyponatremia depend on the severity and acuity

Answer 5

True

Question 6

Is mild hyponatremia (sodium concentration 130-135mEq/L) usually asymptomatic?

Answer 6

Yes

Question 7

What are mild symptoms of hyponatremia?

Answer 7

1. nausea

2. malaise

Question 8

What are moderate symptoms of hyponatremia?

Answer 8

1. headache
2. lethargy
3. disorientation

Question 9

What are severe symptoms of hyponatremia?

Answer 9

1. Respiratory arrest
2. seizure
3. coma
4. brain damage
5. brainstem herniation
6. death
7. Bad shit

Question 10

What is the initial step in the management of hyponatremia?

Answer 10

restriction of free water and hypotonic fluid intake

free water intake should be less than 1-1.5 L/day

Question 11

What may be necessary in patients with negative free water clearance?

Answer 11

hypertonic solutions

Question 12

What is the most serious complication of hyponatremia caused from overly rapid sodium correction?

Answer 12

iatrogenic cerebral osmotic demyelination

Question 13

What is a sodium concentration greater than 145mEq/L and is typically due to free water losses?

Answer 13

Hypernatremia

Question 14

What are the primary defense mechanisms against hypernatremia?

Answer 14

1. intact thirst mechanism

2. access to water

Question 15

What are these signs and symptoms of?

1. orthostatic hypotension
2. oliguria
3. Lethargy
4. irritability
5. weakness

Answer 15

Dehydration and early signs of hypernatremia

Question 16

What are these signs and symptoms of?

1. hyperthermia
2. delirium
3. seizures
4. coma

Answer 16

Sever signs of hypernatremia

Question 17

What is the treatment for hypernatremia?

Answer 17

1. correcting cause of fluid loss
2. replacing electrolytes
3. replacing water

Question 17

What is the treatment for hypernatremia?

Answer 17

1. correcting cause of fluid loss
2. replacing electrolytes
3. replacing water

Question 18

Hypernatremia

Fluids should be administered over a ____ hour period

Answer 18

48 hour

Aiming for serum sodium correction of 1 mEq/L/hr

Question 19

Rapid correction of hypernatremia may cause what?

Answer 19

1. cerebral edema

2. potentially severe neurologic impairment

Question 20

What is a serum potassium level less then 3.5 mEq/L?

Answer 20

Hypokalemia

Question 21

Severe hypokalemia may induce what?

Answer 21

1. arrhythmias

2. rhabdomyolysis

Question 22

True or False
Hypokalemia can result from insufficient dietary potassium intake and intracellular shifting of potassium from the extracellular space

Answer 22

True

Question 23

What is the most common cause of hypokalemia?

Answer 23

GI loss from infectious diarrhea

Question 24

Potassium concentration in intestinal secretion is ___ times higher than in gastric secretions

Answer 24

10 times

Question 25

What are these symptoms of? 1. muscle weakness 2. fatigue 3. muscle cramps

Answer 25

Mild to moderate hypokalemia

Question 26

What are these symptoms of? 1. flaccid paralysis 2. hyporeflexia 3. hypercrampia 4. tetany 5. rhabdomyolysis

Answer 26

Severe hypokalemia (less than 2.5 mEq/L)

Question 27

What may an electrocardiogram show for a patient with hypokelmia?

Answer 27

1. decreased amplitude and broadening T waves 2. PVC 3. depressed ST segments

Question 28

What is the safest and easiest treatment for mild to moderate hypokalemia?

Answer 28

Oral potassium 40-100mEq/day over a period of days to weeks

Question 29

What is a serum potassium level greater than 5.0mEq/L?

Answer 29

Hyperkalemia

Question 30

Patients taking ACE inhibitors, ARB’s, or Potassium-Sparing diuretics may develop what?

Answer 30

Hyperkalemia

Question 31

Hyperkalemia usually occurs in patients with what?

Answer 31

advanced kidney disease

Question 32

Hyperkalemia | ___ causes intracellular potassium to shift extracellularly

Answer 32

Acidosis

Question 33

Hypernatremia impairs neuromuscular transmission, causing what?

Answer 33

1. muscle weakness 2. flaccid paralysis 3. ileus

Question 34

These are all changes in ECG’s associated with what? 1. bradycardia 2. PR interval prolongation 3. peaked T waves 4. QRS widening 5. Conduction disturbances a. bundle branch block b. atrioventricular block 6. V-fib and cardiac arrest are terminal events

Answer 34

Hyperkalemia

Question 35

Emergent treatment for hyperkalemia is indicated when?

Answer 35

1. Cardiac toxicity 2. muscle paralysis 3. Severe hyperkalemia (greater than 6.5 mEq/L)

Question 36

True or False Insulin, bicarbonate, and beta-agonists all shift potassium intracellularly within minutes of administration for a patient with hyperkalemia

Answer 36

True

Question 37

When giving insulin for treatment of hyperkalemia, should you give insulin to the patient as well?

Answer 37

YES

Question 38

What may be given to a patient with hyperkalemia to antagonize the cell membrane effects of potassium?

Answer 38

IV calcium

Question 39

What are some loop diuretics that can be used to treat hyperkalemia?

Answer 39

1. Furosemide 40-80mg IV | 2. Bumetanide 1mg IV

Question 40

True or False | An IDC can manage severe hyperkalemia on their own.

Answer 40

FALSE | Severe hyperkalemia should be sent to the emergency department for immediate treatment (MEDEVAC DAT HOE)