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On call with MedOrganized > Electrolytes > Flashcards

Electrolytes Flashcards

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1
Q

**ORIENTATION**

I hope these flashcards from MedOrganized.com help you learn about managing electrolytes on call. I use them myself, but I am just one person reviewing these and I cannot guarantee that there aren’t errors. Please use your clinical discretion in managing your patients and let me know if you find something amiss.

A

These flashcards are compiled from Toronto Notes 2014, David Hui’s “Approach to Internal Medicine”, the “MD On Call” app by Messil.com, and my own website, MedOrganized.com.

Mark this card as “5” to see it infrequently.

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2
Q

What should you ask a nurse who calls for hyper-K?

A

vitals, GCS, glucose

IV fluids, Foley

renal failure

K supp, TMP/SMX, NSAIDs, digoxin

ACEi, ARB, spironolactone, amiloride, triampterene

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3
Q

What should you ask a nurse who calls for hypo-K?

A

vitals, IV fluids

NG tube, vomiting

furosemide, digoxin

Mg level

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4
Q

What should you ask a nurse who calls for hypo-Na?

A

vitals, GCS

IV fluids

symptoms

glucose, urea, sodium levels in last 48 hours

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5
Q

What should you ask a nurse who calls for hyper-Na?

A

vitals, GCS

symptoms, seizures

other sodium levels in 48 hours

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6
Q

What should you ask a nurse who calls for hypoglycemia?

A

vitals, GCS, IV access

symptoms, diet

insulin, DM meds

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7
Q

What should you ask a nurse who calls for hyperglycemia?

A

vitals, glucose, GCS

symptoms, sugar intake, diabetic diet

diabetes

insulin, insulin pump, diabetic meds, steroids

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8
Q

What should you ask a nurse who calls for hyper-Ca?

A

vitals, GCS

Ca supplements, vitamin D

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9
Q

What should you ask a nurse who calls for hypo-Mg?

A

vitals

IV fluids

heart disease

furosemide

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10
Q

What should you ask a nurse who calls for hypo-Ca?

A

vitals, current IV fluids, IV access

symptoms, paresthesias

Mg, albumin level

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11
Q

What should you ask a nurse who calls for hypo-PO4?

A

CaCO3 and meals

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12
Q

What are the criteria for hyperglycemia?

A

BG > 8.0 mmol/L

(technically, although a random glucose of 11 mmol/L is a negative screen for diabetes)

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13
Q

What are the criteria for mild hypo-Ca?

A

iCa > 0.8 mmol/L

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14
Q

What are the criteria for mild hyper-K?

A

K ≤ 6.5 without ECG changes

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15
Q

What are the criteria for mild hypo-PO4?

A

asymptomatic with PO4 > 0.64

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16
Q

What are the criteria for moderate hyper-Ca?

A

3.0-3.5 mmol/L

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17
Q

What are the criteria for moderate hyper-K?

A

K 6.5-7.0 without ECG changes

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18
Q

What are the criteria for moderate hypo-K?

A

K ≤ 3.0

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19
Q

What are the criteria for moderate hypo-Na?

A

Na ≤ 128 mmol/L

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20
Q

What are the criteria for severe hyper-Ca?

A

> 3.5 mmol/L or symptoms

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21
Q

What are the criteria for moderate hypo-PO4?

A

symptoms or PO4 < 0.64

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22
Q

What are the criteria for severe hyper-K?

A

K > 7.0 or ECG changes

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23
Q

What are the criteria for severe hypo-Ca?

A

iCa ≤ 0.8 mmol/L

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24
Q

What are the criteria for severe hypo-K?

A

K < 3.0 and symptoms

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25
What are the risk factors for osmotic demyelination syndrome?
alcoholism, malnutrition, liver disease chronic Na ≤ 105, hypokalemia (slower correction of Na required)
26
What patients with hypo-Na are at low risk of osmotic demyelination syndrome?
acute hypo-Na over hours primary polydipsia ecstasy
27
What are the investigations for DKA?
\*\* SCROLL DOWN \*\* fingerstick q1h ECG, ABG, VBG CBC corrected Na, lytes, glucose, urea, serum osm, Cr q1h Ca, Mg, PO4, ketones, lactate, lipase, troponin urine ketones, glucose
28
What are the investigations for HHS?
fingerstick q1h ECG CBC ABG, VBG corrected Na, lytes, glucose, urea, Cr q1h Ca, Mg, PO4, serum osm q1h, ketones, lactate urine ketones, glucose
29
What are the investigations for hyperglycemia?
repeat fingerstick in 1 hour lytes, urea, glucose, osm, Cr, ketones
30
What are the investigations for mild hyper-K?
ECG, fingerstick glucose, CBC/d, repeat lytes, glucose, urea, Cr, serum osm CK, dig level urinalysis, urine lytes, urine osm
31
What are the investigations for mild hypo-Ca?
ECG, urea, Cr, iCa, PO4, Mg urine Ca
32
What are the investigations for mild hypo-K?
repeat lytes, urea, Cr, serum osm Mg, urinalysis, urine K, urine Cr, urine osm dig level
33
What are the investigations for mild hypo-Mg?
ECG lytes, urea, Cr, serum osm Ca, Mg, PO4, albumin urinalysis, urine Mg, urine Cr
34
What are the investigations for mild hypo-PO4?
lytes, urea, Cr, serum osm Ca, Mg, PO4 CK PTH urinalysis, urine PO4, urine Cr
35
What are the investigations for moderate hyper-K?
ECG, fingerstick glucose, CBC/d, repeat lytes, glucose, urea, Cr, serum osm CK, dig level urinalysis, urine lytes, urine osm
36
What are the investigations for moderate hyper-Na, hypervolemic?
volume assessment weight q6h lytes, glucose, urea, Cr, serum osm q4h free water deficit q4h urinalysis, urine lytes, urine Cr, urine osm
37
What are the investigations for moderate hyper-Na, hypovolemic?
volume assessment weight q6h lytes, glucose, urea, Cr, serum osm q4h free water deficit q4h urinalysis, urine lytes, urine Cr, urine osm
38
What are the investigations for moderate hypo-K?
ECG repeat lytes, urea, Cr, serum osm Mg urinalysis, urine K, urine Cr, urine osm dig level
39
What are the investigations for moderate hypo-Na?
\*\* SCROLL DOWN \*\* volume assessment lytes, glucose, urea, Cr, serum osm β-HCG, TSH, free T4, cortisol, triglycerides, serum electrophoresis urinalysis, urine lytes, urine Cr, urine osm ±CXR, CT head
40
What are the investigations for severe hyper-Ca?
ECG, lytes, urea, Cr Ca, PO4, Mg ALP, albumin, PTH, vit D, urine Ca, urine Cr
41
What are the investigations for severe hyper-K?
ECG, fingerstick glucose, CBC/d, repeat lytes, glucose, urea, Cr, serum osm CK, dig level urinalysis, urine lytes, urine osm
42
What are the investigations for severe hyper-Na, hypovolemic?
volume assessment weight q4-6h, free water deficit q4h lytes, glucose, urea, Cr, serum osm q4h urinalysis, urine lytes, urine Cr, urine osm
43
What are the investigations for severe hypo-Ca?
ECG, urea, Cr, iCa, Ca, PO4, Mg ALP, albumin, PTH, vit D, urine Ca
44
What are the investigations for severe hypoglycemia?
lytes, glucose, Cr, ketones bilirubin, INR, albumin insulin, C-peptide, proinsulin cortisol, ACTH, TSH, free t4 tox screen
45
What are the investigations for severe hypo-K?
ECG repeat lytes, urea, Cr, serum osm Mg urinalysis, urine K, urine Cr, urine osm dig level
46
What are the investigations for severe hypo-Mg?
ECG lytes, urea, Cr, serum osm Ca, Mg, PO4, albumin urinalysis, urine Mg, urine Cr
47
What are the symptoms of moderate hypo-PO4?
non-specific
48
What are the symptoms of severe hyper-Ca?
altered mental status oliguria/anuria
49
What is the management for hyperglycemia?
insulin SC 1% of daily insulin dose per glucose point
50
What is the management for mild hyper-Ca?
D/C calcium supplements small fluid bolus
51
What is the management for DKA?
IV access, monitors, strict ins/outs, O2 target BG fall 5 mmol/h to 10-15, target AG 8-12 if K \> 3.3 then insulin R 25 units in D5W 250 mL at 0.1 mL/kg/hr fingerstick q1h Plasmalyte 1000 mL/hr IV for 2 hours if BG ≤ 15 then alert MD to consider D5NS + 20 mEq KCl IV 500 mL/hr, do not turn off insulin thiamine 100 mg IV once
52
What is the management for mild hyper-Na, hypovolemic?
free water PO/NG, 2 mL/kg/h (maximum 3 mL/kg/h total)
53
What is the management for HHS?
IV access, monitors, strict ins/outs, O2 target BG 10-15, target AG 8-12 if K \> 3.3 then insulin R 25 units in D5W 250 mL at 0.1 mL/kg/hr fingerstick q1h NS 1000 mL/hr IV for 2 hours if BG ≤ 15 then alert MD to consider D5NS + 20 mEq KCl IV 500 mL/hr
54
In SIADH, what IV fluid should be chosen?
one with higher electrolyte concentration than patient's urine
55
What is the management of overcorrected hypo-Na?
stop IV fluid free water PO/NG or D5W IV to match urine output ddAVP 2 mcg SQ q8h
56
What is the management for mild hyper-K?
hold potassium supplements hold TMP-SMX, NSAID's hold ACEi, ARB's, spironolactone, amiloride, triampterene
57
What is the management for mild hypo-Ca?
confirm PO4, ionized calcium for precipitation CaCO3 1250 mg PO tid between meals (500 mg Ca) MgSO4 2 g IV once vitamin D3 1000 IU PO daily ± calcitriol 0.25 mcg PO daily
58
What is the management for mild hypoglycemia?
IV access glucose tablets 15 g PO once fingerstick q15min until BG \> 5 snack or meal afterward
59
What is the management for mild hypo-K?
KCl 20 mEq PO tid
60
What is the management for mild hypo-Mg?
Mg chloride 2% (20 mg/mL) 10 mL PO bid MgSO4 2 g IV over 2 hours
61
What is the management for mild hypo-Na?
correct hypokalemia high sodium diet fluid restriction 1-1.5 L/day
62
What is the management for mild hypo-PO4?
vitamin D 800 U PO daily hold mealtime CaCO3, Mg, aluminum antacids
63
What is the management for moderate hyper-K?
cardiac monitor rule out digoxin toxicity calcium gluconate 10% 10 mL IV push once D50W 50 mL IV, insulin R 10 units IV once, and then fingerstick q30 min for 2 hours NaHCO3 3 ampoules in 1 L D5W over one hour furosemide 40 mg IV once hold potassium-raising meds
64
What is the management for moderate hyper-Ca?
target euvolemia, target urine output 2.5 L/day Plasmalyte 500 mL IV, repeat up to 5 L after MD reassess furosemide 20 mg IV
65
What is the management for moderate hyper-Na, hypervolemic?
furosemide 40 mg IV once, then MD reassess after 12h D5W 2 ml/kg/hour IV for 12 hours, then MD reassess
66
What is the management for moderate hyper-Na, hypovolemic?
D5W 2 ml/kg/hour IV for 12 hours, then MD reassess
67
What is the management for moderate hypo-Ca?
calcium gluconate 1-2 gram over 10-20 minutes
68
What is the management for moderate hypo-Na?
target increase in Na by less than 8-12 mmol/L per day correct hypokalemia NS IV 3 mL/kg/h for 12 hours, then MD reassess free water (PO) restriction
69
What is the management for moderate hypo-PO4?
reduce feeds NaPO4 1 g PO tid OR NaPO4 16 mmol/4 mmol PO tid vitamin D 800 U PO daily
70
What is the management for severe hyper-Ca?
target euvolemia and urine output 2.5 L/day Plasmalyte 1 litre IV over 2 hours, repeat up to 5 L after MD reassess furosemide 20 mg IV q4h pamidronate 60 mg IV once calcitonin 4 IU/kg IM/SC q12h ± prednisone 60 mg PO daily x 10 days
71
What is the management for severe hyper-K?
cardiac monitor rule out digoxin toxicity calcium gluconate 10% 10 mL IV push once D50W 50 mL IV, insulin R 10 units IV once, and then fingerstick q30 min for 2 hours salbutamol 0.5 mg IV once, vitals after and q30min x 3 NaHCO3 3 ampoules in 1 L D5W over one hour furosemide 40 mg IV once hold potassium-raising meds
72
What is the management for severe hypo-Mg?
MgSO4 5 g IV over 6-12 hours
73
What is the management for severe hyper-Na, hypovolemic?
D5W 2 ml/kg/hour IV for 12 hours, then MD reassess
74
What is the management for severe hypo-Ca?
target low-normal serum calcium calcium gluconate 10%, 10 mL over 10-20 minutes, two or three times then calcium gluconate IV 1 mg/kg/hour MgSO4 2 g IV over 2 hrs
75
What is the management for severe hypoglycemia?
IV access thiamine 100 mg IM once D50W 50 mL IV push glucagon 1 mg SC/IM once fingerstick q15min until BG \> 5 D10NS maintenance fluids
76
What is the management for severe hypo-K?
KCl 10 mEq in 100 mL D5W IV bolus over 30 minutes, repeat once MgSO4 5 mg IV once over 4 hours Plasmalyte (±D5) 1 L IV over two hours
77
What is the management for severe hypo-PO4?
reduce feeds potassium phosphate (22/15 mmol) in 250 mL NS IV over 4 hours sodium phosphate (20/15) in 250 mL NS over 4 hours Ca, Mg, PO4 q6h
78
What is the management for acute hypo-Na?
3% saline 25-100 mL push, repeated q10min if symptoms persist NS IV 1 mL/kg/h for 12 hours, then MD reassess

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