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Flashcards in electrolytes Deck (180):
1

role of 1,25 OH vit D

absorption of calcium and phosphate

2

cause of low 1,25 OH vit D

malabsorption

3

hypocalcemia and hypophosphatemia

1,25 OH vit d deficiency

4

quid of winter foormula

to see if metabolic acidosis has respiratory compensation

5

expected PACO2 in metabolic acidosis with good respiratory compensation

1,5(hco3-)+8 +-2

6

calculation of anion gap acidosis

Nacl-(cl +Bicarb)

7

Normal anion gap

< 12

8

quid CO2 acid ou basique

acide

9

respiratory compensation in alkalosis metabolic

Increase of co2

10

clue for respiratory acidosis

increase of co2

11

compensation of respiratory acidosis

increase bicarb to compensate

12

quid of bicarb acid ou base

basique

13

what happen in metabolic acidosis(2)

decreased HCO3
CO2 decreases to compensate

14

what happen in respiratory alkalosis(2)

co2 decreased
bicarb decreased to compensate

15

what happen in metabolic alkalosis(2)

bicarb increased
increase co2 to compensate

16

pregnant women with bicarb 44 PH 7,49 why

hyperemesis gravidarum causing metabolic alkalosis

17

physiopatho of high bicarb in vomiting(2)

Perte de H+ in vomiting
stimulation of RAA --->retention d'eau de sodium et de HCO3 -

18

causes of metabolic alkalosis(3)

vomiting
excess of mineralocorticoid
diuretic use

19

hypocalcemia in patient receiving large amount of blood

chelation of calcium by citrate in blood product

20

when to suspect hypocalcemia

in any case of massive transfusion

21

why hypomagnesemia can mimic hypocalcemia(2)

because it causes low PTH
decrease peripheral responsiveness to PTH

22

clue for alveolar hypoventilation

high Paco2 in a context of acidosis

23

Normal Pao2

75-105

24

normal PaCO2

33-45 mm de Hg

25

cause of alveolar hypoventilation and respiratory acidosis(4)

pulmonary thoracic disease
neuro muscular disease
drug induced hypoventilation
primary central nervous system dysfunction

26

pulmonary thoracic disease causing alveolar hypoventilation(4)

COPD
obstruction sleep apnea
scoliosis
obesity hypoventilation

27

neuro muscular disease causing alveolar hypoventilation(3)

Myastheni gravis
lambert eaton syndrome
GB syndrome

28

drugs induced alveolar hypoventilation(3)

sedatives
narcotics
anesthetics

29

primary nervous system disease causing hypoventilation(3)

brainstem lesion
infection
stroke

30

how's A-A nin hypoventilation syndrome

normal < 15

31

cause of hypoxemia(5)

reduced inspired o2 tension
hypoventilation
diffusion limitation
shunt
V/q mismatch

32

abnormal acid base disturbance in house fire

metabolic acidosis

33

why metabolic acidosis in house fire(2)

low o2 delivery in tissue
accumulation of lactic acid

34

what happen in metabolic acidosis in house fire

it's carbon monoxyde poisonning

35

quid of Type A lactic acidosis(2)

co poisonning
circulatory failure

36

why co poisonning causes acid lactic accumulation

because 02 delivery is decreased in tissues

37

hypotension in a context of TB and hypereosinophilia

primary adrenal insufficiency

38

acid base disturbance in primary adrenal insufficiency(4)

acidose metabolic with normal anion gap
hyponatrmia
hyperkaliemia
hypercalcemia

39

cause of primary adrenal insufficiency(4)

autoimmune
infection
metastatic
hemorragic infarction

40

infection causing primary adrenal insufficiency(3)

TB
cryptococus
HIV

41

patinet seen with hypotension,hyperpigmentation of skin on palamr creases what metabolic problem you expect to find ?

hyperkaliemia

42

the most common electrolytes abnormality in adrenal insufficiency

hyponatremia

43

patient with PCP develops hyperkaliemia why

rx with TMS

44

why TMS causes high K+

by blocking the epithelial sodium channelin the collecting tubule

45

what other drug has the same action than TMS in the physiopatho of HyperK+

K+ sparing diuretic

46

why Creat can be high during TMS intake

it inhibits renal tubular of creat secretion

47

side effect of lithium

diabetes insipidus

48

clue for DI

plasma osmolarity > urine osmolarity

49

clue for central DI(4)

Trauma
hemorrage
infection
tumors

50

cause of renal DI(4)

Lithium
hypercalcemia
hypokaliemia
tubulointersticial disease

51

drugs causing nephrogenic DI(5)

lithium
memeclocycline
foscarnet
cidofovir
amphotericin B

52

rx of lithium induced DI(2)

salt restriction
stop lithium

53

rx of vomiting induce metabolic alkalosis

NACL 0,9%
plus
K+

54

why HCO- is elevated during vomiting(2)

retention of Hco3- in blood
stimulation of RAA

55

why you have retention of HCO3 - in blood(2)

acid stimulates pancreas to release HCO3- in intestinal lumen
vomiting----->no Hcl --->no pancreas stimulation

56

quid of generation phase(2)

acid stimulates pancreas to release HCO3- in intestinal lumen
vomiting----->no Hcl --->no pancreas stimulation

57

quid of maintenance phase of HCO3- (2)

stimulation of RAA system
retention of HCO3_

58

how they call alkalosis induce by vomiting

contracting alkalosis

59

edema and red blood cells cast and HTA

acute nephritic syndrome

60

cause of edema in acute nephritic syndrome

decrease filtration rate
retention of Na+ and H2O by kidneys

61

primary mechanism in nephritic syndrome

primary glomerular damage

62

patient with exacerbation of COPD ,what medication can be used to treat hyperkaliemia in this patient

succinylcholine

63

action succcinyl choline(2)

K+ release
neuromuscular blocker depolarising

64

patient for whom we can't use succinylcholine(3)

crush injury or burn injuries >8 H
demyelinating syndrome like GBS
tumor lysis syndrome

65

crush injury or burn injuries >8 H
demyelinating syndrome like GBS
tumor lysis syndrome
med can be used to rx hyperkaliemia in this patients(2)

vecuronium
rocuronium

66

electrolyte problem in alcoholism

hypophosphatemia
hypokaliemia
hypomg++

67

rebellious hypokaliemia in alcoholic next step

rx hypomagnesemia

68

why hypo Mg++ causes rebelious hypokaliemia

Mg++ is a cofactor of K+ intake

69

what to do in rx of hypokaliemia in patient alcoholic

check Mg++ level

70

other cause of hypoMg++

diuretics

71

patients with severe abdominal pain develops lactic acidosis with anion gap

bowel ischemia

72

whe to suspect bowel ischemia(2)

any patient with AFIB or atherosclerosis
and abdominal pain

73

main symptom of hyponatremia

seizures

74

what rate should be used inthe rx of hypokaliemia

hypertonic saline or 3%
rate no more 0,5meq/l /h

75

why hyponatremia should be corrected slowly

to avoid osmotic demyelinating syndrome

76

what will happen if you correct hyponatremia too quickly

cerebral edema will occur

77

most common cause of cushing syndrome

iatrogenic use of corticosteroid

78

electrolyte problem in cushing(2)

hypokaliemia
hypernatremia
corticoid=aldosterone

79

quid of normal anion gap

6-12

80

cause of normal anion gap

presence of acid molecule

81

quid of acid molecule(4)

protein
citrate
phosphate
sulfate

82

most common cause of high anion gap metabolic acidosis(6)

lasctic acidosis
ketoacidosis
methanol formaldehyde ingestion
ethylene glycol ingestion
salycilate poisonning
uremia

83

acid found in ketoacidosis

b hydroxybutyrate
acetoacetic acid

84

why uremia is marked by acidosis in end stage renal disease

impaired excretion of ion H+

85

first thing to check in front of metabolic acidosis

check the anion gap

86

why anion gap metabolic acidosis in post seizure

accumulation of lactic acid in blood

87

what to in metabolic acidosis after seizure

do nothing
recheck after 60-90 mn(2 hours )

88

electrolyte problem in vomiting

low chlore
low H+
high HCO3_
low K+

89

why hypochloremia in vomiting

GI loss

90

why low K+(2) in vomiting

stimulation of RAA
aldosterone causes secretion of H+ et K+

91

cause of ketoacidosis(3)

diabete type 1
starvation
alcoholism

92

acid accumulation in formaldehyde ingestion

acid formic

93

substance causing primary metabolic acidosis with high anion gap and primary respiratory alkalosis

salycylate

94

acid causing anion gap acidosis in glycolene ethylene ingestion(2)

acid oxalic
acid glycolic

95

salycilate intox clue(3)

fever
tinnitus
tachypnea
vomiting

96

metabolic problem ion salycilate ingestion(3)

Normal PH
low PAco2
low HCO3-

97

best indicator to talk about metabolic acidosis(2)

HCO3-
not the PH

98

why primary respiratory alkalosis in aspirin toxicity

increase respiratory drive

99

cause of metabolic acidosis in aspirin intox(2)

increase production of acid
decrease renal clearance of organic acids

100

what's the appropriate respiratory compensation in front of metabolic alkalosis

1 meq rise of hco3-=0,77 mm de hg rise of co2

101

compensation ina cute respiratory alkalosis

decrease serum HCO3- de 2 meq/l for every 10mm de HG decrease of Paco2

102

the most common cause of hypernatremia

hypovolemia

103

people at risk for hypovolemia(2)

debilitated
unconscious

104

proof of severe hypernatremia

altered mental status

105

rx of severe hypernatremia

o,9 normal saline

106

rx of moderate hypernatremia

d/s 0,45

107

calculation of PH

6,1+log(hco3-/0,03*paco2

108

logic of rx of metabolic alkalosis

increase excretion of HCO3-

109

classification of metabolic alkalosis(2)

saline responsive
saline resistant

110

cause of saline responsive metabolic alkalosis(5)

vomiting
gastric suctionning
diuretics
laxative abuse
low oral fluid intake

111

saline resistant alkalosis(4)

primary hyperaldosteronism
cushing
severe hypokaliemia <2 meq
barter /gitelman syndrome

112

action of NACL during rx of saline responsive metabolic alkalosis(3)

increase of chlore
restore arterial volume
increase bicarb excretion

113

complication of tumor lysis syndrome

hyper K+

114

3 ways in Rx Hyper K+

stabilization of the membrane with IV gluconate de calcium
shift K intracelularly
decrease K+ in the body

115

best way to shift K+ intra cellularly

insulin plus glucose

116

patient with metabolic acidosis develops lethargy and high PCO2 why

hypoventilation

117

high PCO2 in a context of metabolic acidosis Dx

hypoventilation

118

cause of accumulation of CO2(2)

confusion
lethargy

119

good compensation of metabolic acidosis(2)

tachypnee
low co2

120

clue for SIADH(5)

euvolemic hyponatremia
low serum osmolarity
high urine osmolarity
increassed sodium excretion
failure to correct with normal saline infusion

121

clue for chloride sensitive metabolic alkalosis

urine chloride <20

122

clue for chloride resistant metabolic alkalosis

urine chloride > 20

123

2 grandes cause of hyponatremia(2)

SIADH
primary polydipsia

124

hyponatremia plus low urine osmolarity < 100 mosm/kg

primary polydypsia
malnutrition(beer potomania)

125

patient at risk for primary polydypsia

psychiatric conditions (schizophrenia)

126

consequence of hyponatremia(4)

lethargy
confusion
convulsion
psychosis

127

role of B2 agonist in rx of hyperkaliemia

shift K+ intracellurlarly

128

medication used tor x hyperkaliemia(3)

insulin/glucose
sodium bicarb
B2 agonist

129

patient after breakup develops orthostatic hypotension,hypokaliemia hyponatremia,high K+ and Na+ in Urine why

diuretic abuse

130

most common cause of hyperkaliemia(5)

renal failure acute or chronic
medication
disruption of SRAA axis
hyperglycemia
tumor lysis syndrome

131

symptom of hyperkaliemia

flaccid paralysis

132

medication causing hyper k+(6)

Non B2 adrenergic blockers
ACE inhibitor
ARBS
K+ sparing diuretics
cardiac glycosid
NSAIDS

133

patient with cirrhosis develops metabolic alkalosis with high creat and hypok+ cause

loop diuretic use

134

what to do when creat is high

determine if it 's prenal or renal failure

135

IR induce d by loop diuretics

prerenal problem

136

2 things to do in front of any metabolic acidosis(2)

1-calculation of anion gap
2-winter formula

137

patient with COPD exacerbation and right ventricular failure how will be the PH

PH <7,35=7,32
respiratory acidosis
high bicarb to compensate

138

for the patient with COPD exacerbation and right ventricular failure furosemide is given ,ph is 7,31(avant 7,32) bicarb: 18 why decrease of bicarb

because of uremia=metabolic acidosis

139

the patient on diuretics develop hypokaliemia and renal failure why

because of the diuretics given

140

action of diuretics

diuretic loops cause high excretion of NA+ et K+
causes metabolic alkalosis
but when you have high BUN,you can have a drastic decrease of Hco3_causing metabolic acidosis

141

acute renal injury caused by diuretic consequence and why

metabolic acidosis will develop
defaut d'excretion d'ion H+

142

level of BUN to have metabolic acidosis in acute kidney failure

a partir de 60mg/dl

143

reflexes in hypomagnesemia

decreased tendon reflexes

144

GBS

guillain barre

145

mechanism of heparin induced hyper K+

block aldosterone production

146

mechanism of NSAIDS induced hyper K+

decreased renal perfusion causes decrease K+ delivery in the collectinf tubules

147

mechanism of succynilcholine induced hyper K+

cause extracellular leakage of K+ through acetylcholine receptor

148

mechanism of cyclosporine induced hyper K+

blocks aldosterone activity

149

mechanism of digitalis induced hyper K+

inhibition of NA+K-ATPASE pump

150

mechanism of ACE inhibitor induced hyper K+

inhibition of aldosterone or the ENAC channel

151

mechanism of b blocker induced hyper K+

interferes with b2 mediated intracellular k+ intake

152

Patient with cirrhosis and vomitind developsmetabolic alkalosis,best next step

volume resucitation to rx alkalosis

153

mechanism of edema(4)

increased capillary hydrostatic pressure
decreased capillary oncotic pressure
increased capillary permeability
lymphatic obstruction/increased intersticial oncotic pressure

154

cause of increased capillary hydrostatic pressure(3)

heart failure
primary brenal sodium retention (renal disease)
venous obstruction

155

cause of venous obstruction(2)

cirrhosis
venous insufficiency

156

cause of decreased capillary oncotic pressure(2)

protein loss
decreased albumin synthesis

157

cause of protein loss(2)

SN
protein losing enteropathy

158

cause of decreased protein synthesis(2)

cirrhosis
malnutrition

159

cause of increased capillary permeability(4)

burn trauma sepsis
allergic rx
ARDS
malignant ascites

160

cause of lymphatic obstruction and increased intersticial oncotic presure(3)

malignant ascites
hypothyroidism
lymph node dissection

161

risk factor for bowel ischemia(2)

AFIB
PAD

162

acid base disturbance in bowel ischemia

metabolic acidosis

163

symptom of severe hypernatremia

neurologic symptom

164

envelope shaped crystals in ethylene glycol poisonning

calcium oxalate crystals

165

quid of hypotension plus hypovolemia

hypovolemic hyponatremia

166

cause of hypovolemic hyponatremia(4)

volume depletion
primary adrenal insufficiency
GI losses
renal losses

167

why hyponatremia in hypovolemia(3)

hypovolemia causes stimulation of Renine AA axis
-relargage of ADH
ADH causes retentionn of water and sodium dilution

168

inappropriate ADH elevation(2)

hypervolemic hyponatremia
euvolemic hyponatremia

169

cause of hypervolemic hyponatremia(4)

cirrhosis
haert failure
chronic kidney disease
SN

170

euvolemic hyponatremia(4)

SIADH
primary polydipsia
secondary adrenal insufficiency
hypothyroidism

171

fever a 40 plus hypotension

septic shock

172

acid base disturbance in septic shock

anion gap metabolic acidosis

173

rx of anion gap metabolic acidosis caaused by shock

IV 0,9% saline solution

174

metabolic acidosis with low urine excretion

chlorine sensitive metabolic acidosis

175

quid of low urine Na+ excretion

< 20 Meq/day

176

cause of chlorine sensitive metabolic acidosis

volume contraction

177

quid of volume contraction(2)

vomiting
diarrhee

178

patient with metabolic acidosis develops high PACO2 ,more than normal compensation according to winter formula DX

mixed respiratory and metabolic acidosis

179

acid base in loop diuretic (3)

Metabolis alkalosis
hypokaliemia
high creat

180

condition to have metabolic acidosis during loop diuretic failure

when loop diuretics cause acute kidney injury with uremia >60