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Flashcards in Electrolytes & Shock Deck (74)
1

Hyperthermia, seizures, flushed skin, dilated pupils that react, wide QRS

TCA OD - QRS width = severity --> ventricular arrhythmia --> NaBicarb

2

Ascities management

Na, H2O restrict, spironolactone, furosemide paracentesis 2-4L

3

Anion gap

Na - (HCO3- + Cl-)

4

Methanol, Uremia, DKA, Lactic acidosis, Ethylene glycol, Salicylates

MUDPILES - anion gap acidosis

5

Inc pH --> inc albumin+Ca --> hypoCa (ionized)

Cramping, weakness, carpopedal spasm,

6

HypoCa, elevated phosphorous

HypoPT - d/t surgery or auto-immune

7

HypoCa, fatigue, weakness, depression, normal Mg, 2-HPTH, Low Phos

VitD deficiency, CKD

8

Hyperreflexia electrolyte abnormality

HypoCa or hypoMag --> low PTH

9

Grand-mal seizures, prolonged QT electrolyte abnormality

HypoCa

10

Normal/Low Ca, Low 1,25-OH, High Phos, High PTH

CKD --> secondary HPT

11

Low Ca, Short stature, 4th & 5th digits, High PTH, Phos

End organ resistance - Gs defect

12

S/P thyroidectomy, anxiety, fatigue, poor sleep, depression, prolonged QTc

HypoCa

13

Low Ca, Low PTH, High Phos

Hypoparathyroidism = surgical removal, auto-immune

14

Weight loss, irritable, palp, proptosis --> HTN mechanism?

Hyperdynamic circulation

15

Hypothyroidism mechanism of diastolic HTN

Inc systemic vasc resistance

16

Most common causes of hyperCa

Malignancy, primary HPT (adenoma 90%)

17

Malignancy vs. PHPT hyperCa

Malignancy >13, low PTH = IL-6

18

High Ca, high PTH, dec Phos, Sestamibi scan

Hyperparathyroid --> resect but can --> hypoCa

19

High Ca, High PTH levels

Primary hyperparathyroidism or Familial (low urine), Lithium

20

High Ca, Low PTH

Malignancy, Vit D, HTCZ, Theophylline, milk alkali

21

High Ca, Low PTH, High 1,25-OH

Granulomatous - Sarcoid or lymphoma

22

Mildly high Ca, abnormally high/normal PTH, No sx, urine Ca <0.01

Familial hypocalciuric hyperCa --> Abn Ca-sensing receptors

23

Tx for hyperCa

Only >14 = IVFs + calcitonin, avoid diuretics in all pts + bisphos LT

24

Saline non-responsive metabolic alkalosis

Cushing, Primary hyperaldosteronism, hypoK <2

25

Saline responsive metabolic alkalosis

Urine Cl <20, vomiting, diuretic, laxative, dehydration

26

Urine Cl >20, high renin, aldo, bicarb, lowK, lowNa

Diuretic abuse

27

Urine Cl <10
high renin, aldo, bicarb

lowK, lowNa

Vomiting or facitious diarrhea

28

Urine Cl >40, high renin, aldo, bicarb, lowK, normalNa

Bartter/Gitelman syndrome

29

Urine Cl >40, high aldo, bicarb, Na,

low renin, lowK

Primary hyperaldosteronism

30

Urine Cl >40, high renin, aldo, bicarb, Na

LowK

Renin-tumor

31

U-waves, muscle cramps, weakness electrolyte abnormality, alkalosis

Hypokalemia

32

Asystole, flaccid paralysis electrolyte abnormality, acidosis

HyperK

33

Tx of Sx acute hyperK

Calcium gluconate or insulin w/ glucose

34

Succ use is CI w/ what electrolyte abn?

HyperK -- it leads to inc K release, no crush, burns, GB or tumor-lysis

35

Refractory hyperK

HypoMag

36

HypoK management

10mEq/h

37

Causes of hyperK

RF, crush injury, acidosis

38

HyperK management

50% dextrose + insulin, IV calcium --> hemodialysis

39

Hypovolemic hypoNa causes

Volume depletion, adrenal insufficiency, D/V, Diuretics/renal

40

Euvolemic HypoNa causes

SIADH, psychogenic polydipsia, sec adrenal insufficiency, hypothyroid

41

Hypervolemic hypoNa causes

CHF, cirrhosis, CKD

42

Serum Osm >290

Hyperglycemia, advanced renal failure

43

Serum Osm <100

Primary polydipsia, malnutrition (beer binge)

44

Serum Osm 100, Urine Na <25

Volume depletion, CHF, cirrhosis

45

Serum Osm 100, Urine Na >25

SIADH, adrenal insufficiency, hypothyroidism

46

Tx SIADH

Dec fluids, Na tablets, Loops --> hypERtonic saline until serum Na >120

47

Hypovolemic NyperNa management

IV 0.9% Saline --> 0.45 when vol replaced = no more than 1mEq/L/h dec

48

MILD Hypovolemic NyperNa management

IV 0.45 Saline + 5% Dextrose

49

Euvolemic or hypervolemic hyperNa management

D5W

50

HypoNa from SIADH tx

Water restriction

51

HypoNa, rapid developing, CNS sx, water intoxication tx

3% NS

52

Hypovolemic hypoNa Tx

NS or LR

53

Dec vol, dec pressure, inc HR, acidosis, inc osmolarity type of shock

Hypovolemic shock - diarrhea, heat, DKA

54

Ulcers, colon Ca, uterus, leukemia, red O2 shock type

Hemorrhagic shock

55

Dec SV, CO shock

Cardiogenic shock

56

Blood vessels dilate, blood pooling, dec VR shock

Neurogenic shock

57

Bronchial spasm, blood vessels dilate, histamine --> hives, V/D shock

Anaphylactic shock

58

Profound anion gap acidosis, very low bicarb, disc hyperemia

Methanol or ethylene glycol (kidney damage)

59

Dec preload (RA, PCWP), dec CI, O2 sat, INC AFTERLOAD type of shock

Hypovolemic shock

60

Inc preload (RA, PCWP), afterload, DEC CI, O2sat type of shock

Cardiogenic shock

61

Dec preload (RA, PCWP), afterload, SVR, INC CI, O2 sat

Septic shock

62

Dec CO, PCWP, BP, Inc SVR, HR shock

Hypovolemic shock

63

Flat neck veins, dec H&H, tachycardia type of shock

Hemorrhagic shock

64

JVD + resp distress, absent lung sounds, tracheal deviation

Tension pneumothorax

65

JVD + breathing ok, normal CXR, hypotension

Pericardial tamponade

66

Pink & warm extremities, low CVP type of shock

Vasomotor – sepsis, anaphylaxis, spinal trauma, anesthetics

67

Drugs and mech of hyperK
1. BBs
2. ACE/ARBs
3. K+ sparing (amiloride)
4. Digoxin
5. NSAIDs

1. Inhibit B2 K uptake into cells
2. Inhibit AG-II/AT1 --> dec aldosterone
3. Block ENaC or aldo receptor
4. Inhibit Na/K pump
5. Impairs local PGs --> dec renin and aldo

68

Imaging for free air/perforation

Upright CXR

69

Best initial imaging for osteomyelitis

XR

70

When to get head CT WITH contrast?

Cancer or infection

71

When to get abdominal CT scan?

Pancreas
Appendicitis
Most accurate for diverticulitis, Kidney stone (w/o contrast)

72

When to get chest CT?

Hilar nodes/sarcoidosis
Mass lesions
PE
Cavities

73

When to get endoscopic ultrasound?

Pancreatic head lesions
Gastrinoma

74

When to use gallium or indium scan?

Fever of unknown origin - follows iron metabolism transported on ferritin

Indium better for abdomen - tags WBCs