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Therapy 3 > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

What are the predominant ions within ICF compartments?

A

K, Mg, PO4

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2
Q

What are the normal values of sodium, potassium, calcium, magnesium and phosphorus?

A 
Na = 135-145 mEq/L
K = 3.5 - 5.0 mEq/L
Ca = 4.4 - 5.2 mEq/L
Mg = 1.4 - 1.8 mEq/L
Phos = 1.0 - 1.4 mmol/L
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3
Q

What are the functions of the predominant electrolytes Na, Cl, K, PO4, and Mg?

A 
Na - helps nerve cells and muscle cells interact
Cl - maintains osmotic pressure
K - cell excitability
PO4 - energy metabolism
Mg - enzyme reactions
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4
Q

What is the osmolality calculation? What is the normal plasma osmolality range?

A

2[Na+] + [glucose]/18 + [BUN]/2.8

280-300 mOsm/kg

Note: inc osmolality = TBW DEPLETION
Note: dec osmolality = TBW EXCESS

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5
Q

What are the predominant ions within ECF compartments?

A

Na, Cl

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6
Q

What are the daily requirements of each: Na, K, Ca, Mg, Phos

A 
Na: 1-2 mEq/kg
K: 0.5-1 mEq/kg
Ca: 800-1200mg
Mg: 300-400 mg
Phos: 800-1200 mg
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7
Q

What are the predominant ICF ions?

A

K
PO4
Mg

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8
Q

What is osmolality?

A

The measure of the number of osmotically-active particles per unit of solution

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9
Q

What substances are the common causes of osmolality gap?

A

The toxic alcohols: ethanol, methanol, ethylene glycol, isopropanol
Lorazepam
Mannitol

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10
Q

What is the treatment for hypertonic hyponatremia?

A

Treat this by treating the hyperglycemia. Na will return to normal.

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11
Q

What are the three categories of hypotonic huponatremia?

A

1) hypovolemic: deficit of both Na and TBW
2) euvolemic: normal Na, excess TBW
3) hypervolemic: excess of TBW and Na

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12
Q

What is the cutoff points for urine sodium levels in determining the causes of hyponatremia?

A

Na urine content 30 mEq/L means renal losses.

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13
Q

What is the treatment for Hypovolemic Hyponatremia?

A

Normal Saline

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14
Q

What is the treatment for Euvolemic Hyponatremia?

A 
Fluid restriction (500-1000 mL/day)
Hypertonic Saline (3% NS) if severe!
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15
Q

What most commonly causes Euvolemic Hyponatremia?

A 
Anti-psychotics,
SSRI's
tumors
stroke
trauma
carbamazepine
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16
Q

What is the treatment for hypervolemic hyponatremia?

A

Sodium and fluid restrictions (DASH diet)

Treatment of underlying disorder (loop diuretics, ACE-I, spironolactone)

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17
Q

What is the goal administration rate and target level?

A

0.5 - 1.0 mEq/hr to 125 mEq/L (low normal)

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18
Q

Why should we infuse NS slowly?

A

Fast admin (> 12 mEq/L in 24 hours and > 18 mEq/L in 48 hours) of NS can cause central pontine myelinolysis (irreversible paralysis)

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19
Q

What is the calculation for sodium deficit?

A

Sodium deficit = (TBW) x (desired Na - current Na conc.)

Desired is 140 mEq/L

20
Q

What are two drugs that are used for euvolemic and hypervolemic hyponatremia?

A

Conivaptan (IV)

Tolvaptan (PO)

21
Q

What is an important precaution when using th Vaptans?

A

They should not be used in hypovolemic hyponatremic patients or in patients with CHF

22
Q

What is the relationship between Hypernatremia and TBW?

A

When someone is Hypernatremic, they show the same s/sx of those with TBW depletion.

23
Q

What is the length of time needed to correct Hypernatremia?

A

Over 2-3 days

Rule of thumb is to correct half of the water deficit over the first 24 hours.

24
Q

What is the calculation for water deficit?

A

Water deficit = TBW x [(serum sodium/140) - 1]

25
What fluid do we use for correction of TBW depletion (Hypernatremia)?
D5W
26
What are the predominant s/sx of hypokalemia
``` Muscle weakness/cramps EKG changes Cardiac arrhythmia (bradycardia) Heart block Increases risk of digoxin toxicity Increases pH and bicarb ```
27
What are the main causes of hypokalemia?
``` GI losses (v/d/NG suctioning) Renal losses (high aldosterone, low mag) ```
28
What common medications cause hypokalemia?
Cellular redistribution - B2 agonists (albuterol) - Insulin Renal potassium wasting agents - diuretics - HD abx
29
What are the recommended rates of infusion for potassium?
10 mEq/hr peripherally 40 mEq/hr centrally IF there the patient is on tele!!
30
What other electrolyte is best buds with potassium?
Magnesium
31
What are common s/sx of hyperkalemia?
``` Muscle weakness Paresthesias (pins and needles feeling) GI hypermotility Hypotension Decreased pH ```
32
What are the causes of hyperkalemia
Excessive K intake Blood transfusions Rapid excessive IV admin Meds
33
What medications most likely cause hyperkalemia?
``` Spironolactone (K sparing) ACE-I's Bacrtim Decreases K excretion (renal fail) K release from cells ```
34
What is the treatment for Hyperkalemia?
IV Calcium (if K is over 7.0 and/or EKG changes...it's JUST to prevent arrhythmias Dextrose 50 + insulin +/- sodium bicarb Albuterol shifts K intracellularly, temporarily
35
What do you use for CHRONIC hyperkalemia?
Sodium polystyrene sulfonate, PO-rectal-suspension
36
Calcium has an inverse relationship to what other electrolyte?
Phosphorus and calcitonin
37
What is the calculation for corrected calcium?
CC = observed Ca + 0.8 (normal albumin - observed albumin) Normal albumin = 4 g/dL
38
What are the s/sx of hypocalcemia?
Tetany (muscle spasms, cramps) Hypoactive reflexes Depression/Hallucinations Trousseau's and Chvostek's signs
39
What are the causes of hypocalcemia?
``` Low PTH Hypomag Hyperphos Renal failure Vit D deficiency ```
40
What are the primary medications that cause hypocalcemia?
``` Loop diuretics (furosemide) Corticosteroids ```
41
What is a less-irritating calcium supplement for hypocalcemia?
Calcium gluconate
42
How do you treat hypercalcemia?
0.9% NS then Furosemide
43
Which calcium IV product is less irritating to the vein?
Calcium Gluconate
44
Treatment of acute hypocalcemia
200-300 mg elemental calcium IV
45
What is the treatment for hypermagnesemia?
IV calcium gluconate NS + furosemide D/C all Mg agents

Therapy 3 (12 decks)

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