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Flashcards in Electrolytes Deck (180)
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1
Q

role of 1,25 OH vit D

A

absorption of calcium and phosphate

2
Q

cause of low 1,25 OH vit D

A

malabsorption

3
Q

hypocalcemia and hypophosphatemia

A

1,25 OH vit d deficiency

4
Q

quid of winter foormula

A

to see if metabolic acidosis has respiratory compensation

5
Q

expected PACO2 in metabolic acidosis with good respiratory compensation

A

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

6
Q

calculation of anion gap acidosis

A

Nacl-(cl +Bicarb)

7
Q

Normal anion gap

A
8
Q

quid CO2 acid ou basique

A

acide

9
Q

respiratory compensation in alkalosis metabolic

A

Increase of co2

10
Q

clue for respiratory acidosis

A

increase of co2

11
Q

compensation of respiratory acidosis

A

increase bicarb to compensate

12
Q

quid of bicarb acid ou base

A

basique

13
Q

what happen in metabolic acidosis(2)

A

decreased HCO3

CO2 decreases to compensate

14
Q

what happen in respiratory alkalosis(2)

A

co2 decreased

bicarb decreased to compensate

15
Q

what happen in metabolic alkalosis(2)

A

bicarb increased

increase co2 to compensate

16
Q

pregnant women with bicarb 44 PH 7,49 why

A

hyperemesis gravidarum causing metabolic alkalosis

17
Q

physiopatho of high bicarb in vomiting(2)

A

Perte de H+ in vomiting

stimulation of RAA —>retention d’eau de sodium et de HCO3 -

18
Q

causes of metabolic alkalosis(3)

A

vomiting
excess of mineralocorticoid
diuretic use

19
Q

hypocalcemia in patient receiving large amount of blood

A

chelation of calcium by citrate in blood product

20
Q

when to suspect hypocalcemia

A

in any case of massive transfusion

21
Q

why hypomagnesemia can mimic hypocalcemia(2)

A

because it causes low PTH

decrease peripheral responsiveness to PTH

22
Q

clue for alveolar hypoventilation

A

high Paco2 in a context of acidosis

23
Q

Normal Pao2

A

75-105

24
Q

normal PaCO2

A

33-45 mm de Hg

25
Q

cause of alveolar hypoventilation and respiratory acidosis(4)

A

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

26
Q

pulmonary thoracic disease causing alveolar hypoventilation(4)

A

COPD
obstruction sleep apnea
scoliosis
obesity hypoventilation

27
Q

neuro muscular disease causing alveolar hypoventilation(3)

A

Myastheni gravis
lambert eaton syndrome
GB syndrome

28
Q

drugs induced alveolar hypoventilation(3)

A

sedatives
narcotics
anesthetics

29
Q

primary nervous system disease causing hypoventilation(3)

A

brainstem lesion
infection
stroke

30
Q

how’s A-A nin hypoventilation syndrome

A

normal

31
Q

cause of hypoxemia(5)

A
reduced inspired o2 tension
hypoventilation
diffusion limitation
shunt
V/q mismatch
32
Q

abnormal acid base disturbance in house fire

A

metabolic acidosis

33
Q

why metabolic acidosis in house fire(2)

A

low o2 delivery in tissue

accumulation of lactic acid

34
Q

what happen in metabolic acidosis in house fire

A

it’s carbon monoxyde poisonning

35
Q

quid of Type A lactic acidosis(2)

A

co poisonning

circulatory failure

36
Q

why co poisonning causes acid lactic accumulation

A

because 02 delivery is decreased in tissues

37
Q

hypotension in a context of TB and hypereosinophilia

A

primary adrenal insufficiency

38
Q

acid base disturbance in primary adrenal insufficiency(4)

A

acidose metabolic with normal anion gap
hyponatrmia
hyperkaliemia
hypercalcemia

39
Q

cause of primary adrenal insufficiency(4)

A

autoimmune
infection
metastatic
hemorragic infarction

40
Q

infection causing primary adrenal insufficiency(3)

A

TB
cryptococus
HIV

41
Q

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

A

hyperkaliemia

42
Q

the most common electrolytes abnormality in adrenal insufficiency

A

hyponatremia

43
Q

patient with PCP develops hyperkaliemia why

A

rx with TMS

44
Q

why TMS causes high K+

A

by blocking the epithelial sodium channelin the collecting tubule

45
Q

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

A

K+ sparing diuretic

46
Q

why Creat can be high during TMS intake

A

it inhibits renal tubular of creat secretion

47
Q

side effect of lithium

A

diabetes insipidus

48
Q

clue for DI

A

plasma osmolarity > urine osmolarity

49
Q

clue for central DI(4)

A

Trauma
hemorrage
infection
tumors

50
Q

cause of renal DI(4)

A

Lithium
hypercalcemia
hypokaliemia
tubulointersticial disease

51
Q

drugs causing nephrogenic DI(5)

A
lithium
memeclocycline
foscarnet
cidofovir
amphotericin B
52
Q

rx of lithium induced DI(2)

A

salt restriction

stop lithium

53
Q

rx of vomiting induce metabolic alkalosis

A

NACL 0,9%
plus
K+

54
Q

why HCO- is elevated during vomiting(2)

A

retention of Hco3- in blood

stimulation of RAA

55
Q

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

A

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

56
Q

quid of generation phase(2)

A

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

57
Q

quid of maintenance phase of HCO3- (2)

A

stimulation of RAA system

retention of HCO3_

58
Q

how they call alkalosis induce by vomiting

A

contracting alkalosis

59
Q

edema and red blood cells cast and HTA

A

acute nephritic syndrome

60
Q

cause of edema in acute nephritic syndrome

A

decrease filtration rate

retention of Na+ and H2O by kidneys

61
Q

primary mechanism in nephritic syndrome

A

primary glomerular damage

62
Q

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

A

succinylcholine

63
Q

action succcinyl choline(2)

A

K+ release

neuromuscular blocker depolarising

64
Q

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

A

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

65
Q

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)

A

vecuronium

rocuronium

66
Q

electrolyte problem in alcoholism

A

hypophosphatemia
hypokaliemia
hypomg++

67
Q

rebellious hypokaliemia in alcoholic next step

A

rx hypomagnesemia

68
Q

why hypo Mg++ causes rebelious hypokaliemia

A

Mg++ is a cofactor of K+ intake

69
Q

what to do in rx of hypokaliemia in patient alcoholic

A

check Mg++ level

70
Q

other cause of hypoMg++

A

diuretics

71
Q

patients with severe abdominal pain develops lactic acidosis with anion gap

A

bowel ischemia

72
Q

whe to suspect bowel ischemia(2)

A

any patient with AFIB or atherosclerosis

and abdominal pain

73
Q

main symptom of hyponatremia

A

seizures

74
Q

what rate should be used inthe rx of hypokaliemia

A

hypertonic saline or 3%

rate no more 0,5meq/l /h

75
Q

why hyponatremia should be corrected slowly

A

to avoid osmotic demyelinating syndrome

76
Q

what will happen if you correct hyponatremia too quickly

A

cerebral edema will occur

77
Q

most common cause of cushing syndrome

A

iatrogenic use of corticosteroid

78
Q

electrolyte problem in cushing(2)

A

hypokaliemia
hypernatremia
corticoid=aldosterone

79
Q

quid of normal anion gap

A

6-12

80
Q

cause of normal anion gap

A

presence of acid molecule

81
Q

quid of acid molecule(4)

A

protein
citrate
phosphate
sulfate

82
Q

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

A
lasctic acidosis
ketoacidosis
methanol formaldehyde ingestion
ethylene glycol ingestion
salycilate poisonning
uremia
83
Q

acid found in ketoacidosis

A

b hydroxybutyrate

acetoacetic acid

84
Q

why uremia is marked by acidosis in end stage renal disease

A

impaired excretion of ion H+

85
Q

first thing to check in front of metabolic acidosis

A

check the anion gap

86
Q

why anion gap metabolic acidosis in post seizure

A

accumulation of lactic acid in blood

87
Q

what to in metabolic acidosis after seizure

A

do nothing

recheck after 60-90 mn(2 hours )

88
Q

electrolyte problem in vomiting

A

low chlore
low H+
high HCO3_
low K+

89
Q

why hypochloremia in vomiting

A

GI loss

90
Q

why low K+(2) in vomiting

A

stimulation of RAA

aldosterone causes secretion of H+ et K+

91
Q

cause of ketoacidosis(3)

A

diabete type 1
starvation
alcoholism

92
Q

acid accumulation in formaldehyde ingestion

A

acid formic

93
Q

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

A

salycylate

94
Q

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

A

acid oxalic

acid glycolic

95
Q

salycilate intox clue(3)

A

fever
tinnitus
tachypnea
vomiting

96
Q

metabolic problem ion salycilate ingestion(3)

A

Normal PH
low PAco2
low HCO3-

97
Q

best indicator to talk about metabolic acidosis(2)

A

HCO3-

not the PH

98
Q

why primary respiratory alkalosis in aspirin toxicity

A

increase respiratory drive

99
Q

cause of metabolic acidosis in aspirin intox(2)

A

increase production of acid

decrease renal clearance of organic acids

100
Q

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

A

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

101
Q

compensation ina cute respiratory alkalosis

A

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

102
Q

the most common cause of hypernatremia

A

hypovolemia

103
Q

people at risk for hypovolemia(2)

A

debilitated

unconscious

104
Q

proof of severe hypernatremia

A

altered mental status

105
Q

rx of severe hypernatremia

A

o,9 normal saline

106
Q

rx of moderate hypernatremia

A

d/s 0,45

107
Q

calculation of PH

A

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

108
Q

logic of rx of metabolic alkalosis

A

increase excretion of HCO3-

109
Q

classification of metabolic alkalosis(2)

A

saline responsive

saline resistant

110
Q

cause of saline responsive metabolic alkalosis(5)

A
vomiting
gastric suctionning
diuretics
laxative abuse
low oral fluid intake
111
Q

saline resistant alkalosis(4)

A

primary hyperaldosteronism
cushing
severe hypokaliemia

112
Q

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

A

increase of chlore
restore arterial volume
increase bicarb excretion

113
Q

complication of tumor lysis syndrome

A

hyper K+

114
Q

3 ways in Rx Hyper K+

A

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

115
Q

best way to shift K+ intra cellularly

A

insulin plus glucose

116
Q

patient with metabolic acidosis develops lethargy and high PCO2 why

A

hypoventilation

117
Q

high PCO2 in a context of metabolic acidosis Dx

A

hypoventilation

118
Q

cause of accumulation of CO2(2)

A

confusion

lethargy

119
Q

good compensation of metabolic acidosis(2)

A

tachypnee

low co2

120
Q

clue for SIADH(5)

A
euvolemic hyponatremia
low serum osmolarity
high urine osmolarity
increassed sodium excretion
failure to correct with normal saline infusion
121
Q

clue for chloride sensitive metabolic alkalosis

A

urine chloride

122
Q

clue for chloride resistant metabolic alkalosis

A

urine chloride > 20

123
Q

2 grandes cause of hyponatremia(2)

A

SIADH

primary polydipsia

124
Q

hyponatremia plus low urine osmolarity

A

primary polydypsia

malnutrition(beer potomania)

125
Q

patient at risk for primary polydypsia

A

psychiatric conditions (schizophrenia)

126
Q

consequence of hyponatremia(4)

A

lethargy
confusion
convulsion
psychosis

127
Q

role of B2 agonist in rx of hyperkaliemia

A

shift K+ intracellurlarly

128
Q

medication used tor x hyperkaliemia(3)

A

insulin/glucose
sodium bicarb
B2 agonist

129
Q

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

A

diuretic abuse

130
Q

most common cause of hyperkaliemia(5)

A
renal failure acute or chronic
medication
disruption of SRAA axis 
hyperglycemia
tumor lysis syndrome
131
Q

symptom of hyperkaliemia

A

flaccid paralysis

132
Q

medication causing hyper k+(6)

A
Non B2 adrenergic blockers
ACE inhibitor
ARBS
K+ sparing diuretics
cardiac glycosid
NSAIDS
133
Q

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

A

loop diuretic use

134
Q

what to do when creat is high

A

determine if it ‘s prenal or renal failure

135
Q

IR induce d by loop diuretics

A

prerenal problem

136
Q

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

A

1-calculation of anion gap

2-winter formula

137
Q

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

A

PH

138
Q

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

A

because of uremia=metabolic acidosis

139
Q

the patient on diuretics develop hypokaliemia and renal failure why

A

because of the diuretics given

140
Q

action of diuretics

A

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
Q

acute renal injury caused by diuretic consequence and why

A

metabolic acidosis will develop

defaut d’excretion d’ion H+

142
Q

level of BUN to have metabolic acidosis in acute kidney failure

A

a partir de 60mg/dl

143
Q

reflexes in hypomagnesemia

A

decreased tendon reflexes

144
Q

GBS

A

guillain barre

145
Q

mechanism of heparin induced hyper K+

A

block aldosterone production

146
Q

mechanism of NSAIDS induced hyper K+

A

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

147
Q

mechanism of succynilcholine induced hyper K+

A

cause extracellular leakage of K+ through acetylcholine receptor

148
Q

mechanism of cyclosporine induced hyper K+

A

blocks aldosterone activity

149
Q

mechanism of digitalis induced hyper K+

A

inhibition of NA+K-ATPASE pump

150
Q

mechanism of ACE inhibitor induced hyper K+

A

inhibition of aldosterone or the ENAC channel

151
Q

mechanism of b blocker induced hyper K+

A

interferes with b2 mediated intracellular k+ intake

152
Q

Patient with cirrhosis and vomitind developsmetabolic alkalosis,best next step

A

volume resucitation to rx alkalosis

153
Q

mechanism of edema(4)

A

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

154
Q

cause of increased capillary hydrostatic pressure(3)

A

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

155
Q

cause of venous obstruction(2)

A

cirrhosis

venous insufficiency

156
Q

cause of decreased capillary oncotic pressure(2)

A

protein loss

decreased albumin synthesis

157
Q

cause of protein loss(2)

A

SN

protein losing enteropathy

158
Q

cause of decreased protein synthesis(2)

A

cirrhosis

malnutrition

159
Q

cause of increased capillary permeability(4)

A

burn trauma sepsis
allergic rx
ARDS
malignant ascites

160
Q

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

A

malignant ascites
hypothyroidism
lymph node dissection

161
Q

risk factor for bowel ischemia(2)

A

AFIB

PAD

162
Q

acid base disturbance in bowel ischemia

A

metabolic acidosis

163
Q

symptom of severe hypernatremia

A

neurologic symptom

164
Q

envelope shaped crystals in ethylene glycol poisonning

A

calcium oxalate crystals

165
Q

quid of hypotension plus hypovolemia

A

hypovolemic hyponatremia

166
Q

cause of hypovolemic hyponatremia(4)

A

volume depletion
primary adrenal insufficiency
GI losses
renal losses

167
Q

why hyponatremia in hypovolemia(3)

A

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

168
Q

inappropriate ADH elevation(2)

A

hypervolemic hyponatremia

euvolemic hyponatremia

169
Q

cause of hypervolemic hyponatremia(4)

A

cirrhosis
haert failure
chronic kidney disease
SN

170
Q

euvolemic hyponatremia(4)

A

SIADH
primary polydipsia
secondary adrenal insufficiency
hypothyroidism

171
Q

fever a 40 plus hypotension

A

septic shock

172
Q

acid base disturbance in septic shock

A

anion gap metabolic acidosis

173
Q

rx of anion gap metabolic acidosis caaused by shock

A

IV 0,9% saline solution

174
Q

metabolic acidosis with low urine excretion

A

chlorine sensitive metabolic acidosis

175
Q

quid of low urine Na+ excretion

A
176
Q

cause of chlorine sensitive metabolic acidosis

A

volume contraction

177
Q

quid of volume contraction(2)

A

vomiting

diarrhee

178
Q

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

A

mixed respiratory and metabolic acidosis

179
Q

acid base in loop diuretic (3)

A

Metabolis alkalosis
hypokaliemia
high creat

180
Q

condition to have metabolic acidosis during loop diuretic failure

A

when loop diuretics cause acute kidney injury with uremia >60