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Clin Med Renal > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

Signs and Sx of Intravascular volume loss

A

tachycardia, hypotension, orthostatic HR and BP changes, increased BUN/Cr ratio, dry mucous membranes, decreased skin turgor, reduced urine output, dizziness

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2
Q

osmolality

A

osmoles of solute per kg of solvent

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3
Q

osmolarity

A

osmoles of solute per liter of solution

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4
Q

normal plasma osmolality

A

275-290 mOsm/kg

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5
Q

what is max change in serum sodium in 24 hours that is safe?

A

10-12 mmol/L

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6
Q

what is fluid resuscitation #1 preferred option?

A

crystalloid IV

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7
Q

what is best option for TBI pt?

A

hypertonic saline

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8
Q

what is best option for pulmonary edema or ascites pt?

A

colloid option

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9
Q

if plasma osmolarity increases fluid shifts ___

A

into the plasma = cell shrinkage

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10
Q

what is black box warning of colloid fluids

A

hydroxyethyl starch and dextran = clot risk and kid damage

hydroxyethl starch linked to higher mortality in critically ill pts

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11
Q

sterile H20 should ___ be administered as IV

A

NEVER.. cause cell lysis!!! pt death!

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12
Q

never administer a solution less than ____

A

150 mOsm/L

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13
Q

some examples (6) of hypertonic saline complications

A

osmotic demyelination syndrome –> perm neuro damage = due to too rapid tx of hyponatremia

hypokalemia, hypercholremic acidosis (NaCL), hypernatremia

Phlebitis if given in peripheral vein

Heart failure - lead to fluid overload (draws fluid out of cells)

Platelet dysfunction = clot risk

hypotension of given too rapidly

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14
Q

3 strategies to avoid giving just H20 via IV

A
  1. D5W alone or with .225% NaCl
  2. add Kcl
  3. give H20 po or via feed tube
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15
Q

when do signs of intravascular fluid depletion occur?

A

when 15% of blood volume is lost 750 mL

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16
Q

what are 2 kinds of crystalloid fluids:

A

LR: lactated ringers - used in trauma/surg
- mostly Na and Cl

NS: normal saline

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17
Q

3 ways to aquire hypernatremia

A 
loss of water (burns, fever, DI, GI loss) 
keep extra Na+ (hypertonic saline or any extra Na intake) 
impaired thirst (AMS, infants, intubation)
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18
Q

what is definition of hypernatremia

A

serum Na is over 145 mEq/L and causes water to move out of cells into EC space

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19
Q

what are sx of hypernatremia

A

early: lethargy, weak, irritable
late: twitch, coma, death

all a result of neuro dehydration of brain cells

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20
Q

what is risk of rapid hypernatremia correction?

A

cerebral edema, seizure, permanent neuro change, death

poutine herniation

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21
Q

4 treatment tips for hypernatremia

A

replace water deficit slowly over several days - use lean body weight to estimate water deficit

if sx.. reduce serum NA slow

give free water orally or as D5W

**if also hypotensive due to low volume - replace using .9% NaCl to restore tissue perfusion

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22
Q

definition of hypovolemic hypernatremia

A

plasma Na is over 145 mEq/L

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23
Q

how would hypovlolemic hypernatremia present?

A

tachycardia, hypotension, flat neck veins, orthostatic HR/BP, high BUN/Cr ratio over 10:1, dry mucous membrane / skin turgor, low urine output, dizziness, neuro sx

If due to DI: polyuria, polydipsia, nocturia

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24
Q

DI pts will have ____ even though hypernatremic

A

low urine NA (less than 250)

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25
Q

neurogenic hypernatremia

A

due to not enough ADH from post pit

26
Q

nephrogenic hypernatremia

A

kidneys don’t respond to normal vasopressin levels

usually due to inherited X linked problem or lithium or renal dz

27
Q

3 causes of hypokalemia

A

GI loss of K+ : chronic laxative, N/V
increased urinary loss (diuretics, aldosterone)
hypomagnesemia: common with low K due to renal loss of K+

28
Q

primary intracellular ion

A

K+

29
Q

what would EKG show for hypokalemia

A

flat or inverted T waves, U waves

30
Q

how do I treat hypokalemia?

A
  1. oral supplements (if no sx or ekg change)
  2. can administer via IV but not if over 60mEq/L - want to avoid irritation
  3. recommended infusion rate is 10-20 mEq/hr to a max of 40 mEq/hr
31
Q

rule of thumb for potassium

A

10 mEq raises serum K by 0.1 mEq/L

32
Q

hyperkalemia EKG

A

peaked T waves, prolonged QRS

33
Q

how to treat hyperkalemia

A
  1. Calcium gluconate
  2. insulin, sodium bicarbonate, glucose
  3. sodium bicarbonate
  4. alpha adrenergic agonists (albuterol)
  5. diuretic, action resin exchange, dialysis
34
Q

if pt. is asymptomatic but is hyperkalemia what should you do?

A

treat with caption resin alone (sodium polystyrene sulfonate)

35
Q

rule of thumb for hypokalemia treatment

A

10 mEq raises serum K by 0.1 mEq/L (with normal renal function)

36
Q

what is indication of immediate quick hyperkalemia treatment?

A

if plasma K is over 6.5, mEq/L, severe muscle weakness, EKG changes

37
Q

what are potential causes of hypomagnesemia?

A

impaired intestinal absorption (UC, diarrhea, pancreatitis, chronic laxative abuse, alcoholism)

or inadequate intake, hypokalemia renal excretion from diuretics

38
Q

what does hypomagnesemia usually end up?

A

hypokalemia, and hypocalcemia

39
Q

sx of hypomagnesemia

A

muscle weak, hyperreflexia, neuromuscular - twitch, tetany, seizure,

cardiac: arrhythmia, SCD, HTN

40
Q

hypermagnesemia is associated with ___

A

its rare but found with renal insufficiency

41
Q

sx of hypermagnesemia

A

muscle weakness, bradycardia, N/V, hypotension, heart block, asystole, respiratory failure, death

42
Q

EKG of hypomagnesemia

A

torsades, prolonged QT, PR and wide QRS, V tach

43
Q

EKG of hypermagnesemia

A

prolonged QT, PR and wide QRS

44
Q

definition of hypermagnesemia

A

over 2.3mg/dL

45
Q

def of hypomagnesemia

A

less than 1.7 mg/dL

46
Q

____ usually presents asymptomatic

A

hypophosphatemia

47
Q

possible clinical manifestations of hypophosphatemia

A

tissue hypoxia, neurlogic: confusion, delirium, sz, coma, Pulm/cardiac: respiratory failure, HF, arrythmia

48
Q

how to treat hypophosphatemia

A

no sx: then oral phosphorus

sx? then IV phosphorus over 3-6 hours

49
Q

how to prevent hypophosphatemia

A

supplement IV fluids in pts at risk (malnourished, DKA, alcoholism)

50
Q

hyperphosphatemia causes (2)

A

CKD or hypoparathyroidism

51
Q

sx of hyperphosphatemia

A

asymptomatic, hypocalcemia, EKG changes, paresthesia’s, vascular calcifications

52
Q

what is treatment of hyperphosphatemia

A

calcium carbonate, restrict K+ intake, saline infusion, dialysis, phosphate binders

53
Q

what to expect on EKG with hypocalcemia

A

QT prolongation

54
Q

clinical sx of hypocalcemia

A

neuromuscular: numbness/tingling in fingers/toes, muscle cramps, tetany, wheezing, dysphagia, voice changes
neurologic: irritable, sz, depression, uncontrolled mvmt

acute hypocalcemia –> syncope, CHF, angina

chronic derm manifestations: coarse hair, brittle nails, psoriasis, dry skin, chronic pruritus, poor dentition, cataracts

55
Q

hypercalcemia ekg

A

short QT interval

56
Q

how to treat hypercalcemia

A

IV normal saline and furosemide

mild: hydration with normal saline and observation
mod: basic tx
severe: aggressive inpatient treatment

57
Q

def hypercalcemia

A

serum over 10.5 mg/dL

58
Q

sx of hypercalcemia

A

stones, bones, groans, psychiatric moans

confusion, coma
polyuria, renal fail, dehydration

constipation, N, anorexia, pancreatitis,

syncope, arrhythmia

59
Q

what is a major cause of hypercalcemia

A

malignancy or hyperparathyroidism

60
Q

when do symptoms of hypokalemia show up?

A

when plasma K+ is less than 3.0mEq/L

Clin Med Renal (3 decks)

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