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Nayla Foundations Exam 5 > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

What are the electrolytes

A 
Na
K
Cl
CO2
calcium 
(order Mg and phosphorus separately)
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2
Q

What influences sodium retention

A

thirst
ADH
hyponatremia
( ADH is made in hypothalamus, goes to anterior pituitary, and then released to blood)

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3
Q

What influences NaCl retention

A

RAAS (increases Na/decreases K in blood)
ANP/catecholamines
renal factors (GFR)

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4
Q

What are the MC electrolyte abnormality in hospitalized patients

A

Hyponatremia (danger <125, seizures <120)

the faster Na drops, the more severe the situation

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5
Q

Hyponatremia is MC in

A

very young
very old
associated with pulmonary disease or CNS disorder

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6
Q

What are clinical manifestations of hyponatremia

A 
HA, dizziness
N/V
lethargy
weakness
confusion
HYPOventilation 
seizure, coma
(Sx depend of level of cerebral edema)
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7
Q

What are some types of hyponatremia

A
  • Pseudohyponatremia, redistributive hyponatremia

- Hypo, hyper, or euvolemic hyponatremia

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8
Q

What is pseudohyponatremia

A

falsley low sodium (<135) with normal osmolality
Sx: HLD, hyperproteinemia
(if suspected, talk to lab and get true Na level)

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9
Q

What is redistributive hyponatremia

A

in HYPERosmolar state, solutes in the ECF draw water from cells and dilute serum Na
ex: with high glucose, water follows so you get more water in the blood
(for every 100mg glucose >100mg, add 1.5 to Na)

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10
Q

What is hypovolemic hyponatremia due to

A 
Renal (diuretics, addisons) 
non renal (burns, external or internal GI)
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11
Q

How do you treat hypovolemic hyponatremia

A

replace lost fluid (isotonic .9% NS) and treat underlying cause

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12
Q

What is hypervolemic hyponatremia due to

A

Cirrhosis
CHF
Renal failure

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13
Q

How do you treat hypervolemic hyponatremia

A

Diuretics
Dialysis
fluid restriction

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14
Q

What is Euvolemic hyponatremia due to

A

SIADH
Hypothyroid
adrenal insufficiency

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15
Q

How do you treat Euvolemic hyponatremia

A

Fluid restrict

treat underlying cause

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16
Q

What is SIADH

A

too much ADH is released= water retention, but SAME sodium excretion
leads to concentrated urine w/ low osmolality and euvolemia

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17
Q

What can cause SIADH

A 
CNS disease
small cell lung cancer
meds
surgery
stress
psych d/o
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18
Q

How do you treat SIADH

A

fluid restrict

If refractory: give hypertonic NS, demeclocycline, or lithium (vaptans are new)

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19
Q

How do you evaluate hyponatremia

A

good H&P (meds, underlying d/o, fluid status)
check labs (UA sodium/osmolality, CMP)
TSH, Sr cortisol

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20
Q

What do you do with hyponatremia

A

<125 or symptomatic: hospitalize

chronic: slow cautious correction (can use demeclocycline)
severe: hypertonic solution (3% NS)

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21
Q

What is the rate of correction for hyponatremia

A

Severe: 6-12 mEq in first 24 hr// <18 mEq in 48 hr
Chronic: <8 mEq in first 24 hr (check Na q2 hr)

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22
Q

What is central pontine myelinolysis

A

irreversible demyelination in and around the pons, but Sx dont occur until 1-3 days after the overcorrection of Na
Sx: dysarthria, dysphagia, AMS, hypotension, quadriparesis

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23
Q

What is hypernatremia

A

too little water relative to salt (Na >145)

either due to too little water intake, or too high sodium intake, or excess water loss

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24
Q

What happens to the brain in hypernatremia

A

high Na in the ECF causes the brain to shrink

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25
What are some causes of hypernatremia
``` GI, skin, and renal losses ** diabetes insipidus hypothalamic lesion (decreased thirst) hypertonic Na solution drugs (diuretics, lithium) ```
26
What are clinical features of hypernatremia
Usually asymptomatic thirst, AMS, weakness, seizure, coma, focal neuro deficit Symptoms related to rate of onset (slow onset= less sx)
27
What does hypernatremia work up NEED
Urine osmolality! If urine osmolality is: 600): DI, external water loss (if osm high and Na <25, vomiting/diarrhea) (if osm high and Na >100, salt/hypertonic saline ingestion)
28
What is the normal homeostatic response to hypernatremia
create thirst and increase fluid intake | maximize urine concentration to prevent further water loss
29
What is diabetes insipidus
urine H2O loss with high sodium= dilute urine (oppo of SIADH) water is not reabsorbed, collecting ductules are impermeable
30
What are types of diabetes insipidus
Central: 2/2 decreased ADH secretion in brain Nephro: 2/2 kidneys not responding to ADH when present
31
Nephrogenic diabetes insipidus is
genetic of acquired (chronic renal insufficiency, lithium, amyloidosis)
32
How do you treat Nephrogenic diabetes insipidus
Thiazide (prevent NaCl reabsorption in DCT) Amiloride (K sparing) Chlorpropamide NSAID (indomethacin)
33
What do you do with hypernatremia
Severe: hospitalize replace H2O deficit (drink, NG, hypotonic IVF) acute hypernatremia can be corrected more rapidly than chronic hypernatremia
34
How do you calculate H2O deficit
normal TBW (kg x 0.6) - current TBW (normal srNa x normal TBW)/(measured srNa)
35
Where is K mainly found
intracellularly (2% ECF) it is excreted renally it is regulated in the distal nephron
36
What does aldosterone do
increase Na reabsorption | increase potassium excretion
37
What are symptoms of hypokalemia
weakness, fatigue, muscle cramps, decreased DTR, ascending flaccid paralysis, cardia arrhythmia, hypercanis
38
What are hypokalemic EKG findings
prominent U waves Flat T waves PVC ST depression
39
What is the way to remember Hypokalemia
``` YOUCRAMP hYpOkalemia U waves flat Cramp Respiratory failure/Rhabdo Anorexia, n/v Muscle weakness Paralysis, flaccid ```
40
What causes hypokalemia
Transcellular shift: insulin, caffeine, hyperthyroid, metabolic acidosis (more K goes into cell) Renal loss*: high aldosterone, Cushing's, renal tubular acidosis Extrarenal loss: vomit, diarrhea, low Mag (need mag to be normal to correct K)
41
What do you do with hypokalemia
``` Oral K* (IV if cant eat or emergent- give w/ lidocaine) -DONT push K >20 mEq/hr Telemonitor (arrhythmia) for every 0.1mEq <4 mEq, give 10 mEq K+ Severe: draw mag levels Hypokalemia can cause digoxin toxicity ```
42
What is hyperkalemia
When K >5 (severe >6.5) | rare in the absence of renal failure
43
What are symptoms of hyperkalemia
Asymptomatic usually | Ascending flaccid paralysis, arrhythmia
44
What is a way to remember hyperkalemia
``` AFACT! Arrhythmia Flaccid paralysis Ascending muscle weakness Conduction abnormality T waves peaked ```
45
Pseudohyperkalemia can be due to
Hemolysis | repeat fist clenching with tourniquet in place
46
Causes of hyperkalemia include
``` Impaired renal excretion (renal failure, Addisons, hypoaldosterone) Drugs (ACE, ARB, NSAID, Bactrim, K sparing diuretic) high intake (bananas, oranges) Rhabdo, low insulin, acidosis (K shift from ICF-ECF) (pH drop 0.1= K increase 0.5-1) ```
47
What is urgent hyperkalemia treatment
IV calcium (decrease threshold of myocyte) NaHCO3 IV push (increase pH) Insulin (shift K ECF to ICF) Nebulized albuterol, IV lasix, dialysis
48
What is less urgent treatment for hyperkalemia
Kayexalate (exchange Na for K in gut= massive diarrhea full of potassium) Lasix treat underlying cause
49
What is "total calcium"
Free (ionized) + protein bound | calcium is inverse to phosphate
50
What does calcium help with
evaluating metabolism | monitoring hyperparathyroid, malignancy, renal failure
51
Where is calcium found
99% in bone 0.8-1% ICF 0.1-0.2% ECF (in ECF, 50% free, 40% protein bound, 10% complexed)
52
What are the types of calcium
Ionized: not affected by albumin- cardiac function and clotting Complexed: bound to citrate, sulfate, phosphate Protein bound: if albumin decreases, so does calcium
53
What is calcium physiology
absorbed through GI (with vitamin D), stored in bone, excreted by kidney low serum Ca triggers PTH release= bone resorption (release) an kidney reuptake (saves Ca) high serum Ca triggers calcitonin release= inhibit bone resorption (stays in bone) 1g decrease in albumin= 0.8mg decrease in calcium
54
What is hypercalcemia
calcium >10.1 (common, self limiting)
55
Hypercalcemia symptoms are
"Stones, bones, abdominal moans, and psych groans" renal stones, bone pain, abd pain, n/v, constipation, fatigue, memory loss, psychosis, depression -loss of tone, HTN, SHORT QT
56
What causes hypercalcemia
Malignancy, primary hyperparathyroid** | thiazide, lithium, antacids, accutane
57
What do we evaluate in hypercalcemia
``` If >13, malignancy PTH is decreased in malignancy TSH cortisol plasma electrophoresis ```
58
How do you treat hypercalcemia
Volume expansion (NS)* Calcitonin (takes 2 hr) Pamidronate (decrease Ca in 1-2 d, stop bone resorption) Zoledronic Acid (1st line for malignancy) Prednisone Dialysis (last resort)
59
How does hypocalcemia present
``` Tetany (increased NM excitability) paresthesias increased DTR chvostek, Trousseau prolonged QT, arrhythmia, hypotension ```
60
What tetany is seen with hypocalcemia
carpopedal tetany, lip toe finger paresthesia Chvostek: tap facial nerve= face muscle contraction Trousseau: occlude brachial artery for 3 min- carpal spasm
61
What causes hypocalcemia
``` low albumin large transfusion (citrate binds Ca) low Mag (inhibits PTH) low PTH renal failure low vitamin D intestine malabsorption ```
62
What is phosphate used for
investigating parathyroid and calcium abnormalities (phosphate is inverse of calcium)
63
DDx for hyperphosphatemia
renal failure hypocalcemia rhabdo
64
DDx for hypophosphatemia
``` chronic alcoholism diarrhea insulin refeeding syndrome decreased intestinal absorption ```
65
What is magnesium involved in
NM and cardiac function- binds to ATP and is excreted by kidneys (tied to Ca and K) inhibits PTH= hypocalcemia low mag= kidneys cant save K
66
DDx for hypermagnesemia
large amt. ingested IV (preeclampsia Tx) renal insufficiency
67
DDx for hypomagnesemia
``` malnutrition diarrhea alcoholism hypocalcemia cellular shift ```

Nayla Foundations Exam 5 (7 decks)

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