Electrolytes

Question 1

Hypercalcemia EKG changes

Answer 1

short QT

Question 2

Hypercalcemia treatment

Answer 2

First: IVF!

• Bisphosphonates, calcitonin
• give steroids if vit D or MM related cause
• dialysis for ESRD pts
• NB: phosphate effective but avoided bc of risk of metastatic calcification

Question 3

Hypocalcemia symptoms

Answer 3

• Numbness/tingling
• Tetany (Chvostek’-facial nerve, Trosseu’s-BP cuff)
• Long QT
• seizures

Question 4

Causes of hypocalcemia

Answer 4

• HyperPTH most common
• Acute pancreatitis
• Renal insufficiency
• Vit D deficiency
• Hyperphosphatemia
• Blood transfusion w/ citrated products
• Hypomagnesemia (dec PTH secretion)

Question 5

What causes a low calcium level with normal free (ionized) calcium?

Answer 5

Low albumin

correction: 0.8 (4-albumin) + serum calcium

Question 6

Treatment of hypocalcemia

Answer 6

Emergent: IV calcium gluconate
Long-term: oral calcium supplements and vitamin D
CORRECT HYPOMAG

Question 7

Alkalosis leads to hypo or hyperkalemia?

Answer 7

Alkalosis –> hypokalemia

Question 8

Acidosis leads to hypo or hyperkalemia?

Answer 8

Acidosis –> hyperkalemia

Question 9

Symptoms of hypokalemia

Answer 9

Weakness, paralysis, ileus, ST depression, flattening of T waves and long QT w/ prominent U waves

Question 10

What are some causes of redistribution hypokalemia?

Answer 10

Alkalosis, beta-agonists (e.g. epi in trauma), insulin excess

Question 11

Treatment of hypokalemia

Answer 11

Treat underlying cause. Usually just use oral KCl. IV KCl can be given if

Question 12

Hyperkalemia EKG

Answer 12

EKG: peaked T waves, widened QRS, PR prolongation, loss of P waves, lastly sine wave pattern

Question 13

Hyperkalemia symptoms

Answer 13

Like hypo- weakness, decreased DTRs, N/V

also diarrhea, respiratory failure

Question 14

Treatment of hyperkalemia

Answer 14

If severe or ECG changess, first give calcium gluconate. Next glucose and insulin, beta agonists, Kayexalate. If desperate, sodium bicarb raises pH which sends K into cells. Dialysis for renal failure. Diuretics (e.g. furosemide).

Question 15

Hypomagnesemia can cause what two other electrolye imbalances?

Answer 15

Hypomagnesemia is assoc with hypocalcemia and hypokalemia

Question 16

Most common cause of hypomag?

Answer 16

Malabsorption, steatorrheic states

Question 17

Most common cause of hypermag?

Answer 17

Renal failure

Question 18

Signs of hypermag?

Answer 18

(remember labor floor..)

Nausea, weakness, loss of DTRs (first sign) –> somnolence, coma, muscular paralysis –> resp failure or cardiac arrest

Question 19

Treatment of hypermag?

Answer 19

Calcium gluconate to stabilize herat. Saline + furosemide. Intubate as needed.

Question 20

Most common causes of severe hypophosphatemia?

Answer 20

Alcoholism, DKA