Electrolytes pt 3

Question 1

Hypermagnesia is magnsium above?

Answer 1

2.5

Question 2

Oral ingestion of laxatives, enemas, infusion, and renal insufficiency can all cause?

Answer 2

Hypermagnesia

Question 3

What is the most common clinical feature of hypermagnesium?

Answer 3

Neuromuscular toxicity

Question 4

Nausea, flushing, headahce, lethargy, drowsiness, and decreased DTRs occur at what level of magensium?

Answer 4

4-6

Question 5

Somnolence, hypocalcemia, absent DTRs, hypotension, bradycardia, and EKG changes occur at what level of magnesium?

Answer 5

6-10

Question 6

Muscle paralysis –> flaccid quadriplegia, apnea, respiratory failure, complete heart block and cardiac arrest occur at what magnesium levels?

Answer 6

>10

Question 7

How do you diagnose hypermagnesia?

Answer 7

Magnesium level

BMP

EKG

Question 8

What EKG changes will there be with hypermagnesia?

Answer 8

Diminished conduction

Widened QRS

Prolonged PQ

Question 9

How do you treat hypermagnesia?

Answer 9

Stop offending agent, add diuretic maybe

Calcium gluconate is given IV - to help stabilize cardiac membrane

Hemodialysis if severe + renal impairment

Question 10

Hypomagnesia occurs below?

Answer 10

1.8

Question 11

What is the most common causes of hypomagnesia?

Answer 11

Chronic diuretic therapy (loop and thiazide)

Chronic alcoholism

Chronic diarrhea

Chronic PPI usage.

Question 12

Tetany - positive Trousseau and chovstek sign, muscle spasm, seizures, involuntary movements are neurologic findings of what?

Answer 12

Hypomagnesia

Question 13

What EKG findings are associated with hypomagnesia?

Answer 13

Widening of QRS, peaked T waves

Prolonged PR interval, QRS widening and diminished T wave (more severe)

Frequent PACs and PVCs - ventricular arrythmias.

Question 14

Patients with hypomagnesia usually have concurrent?

Answer 14

Hypokalemia and hypocalcemia.

Question 15

Can’t determine where your hypomagnesia is coming from. What test should you do?

Answer 15

24 hour urine magneisum excretion or fraction excretion of magnesium to help differentiate between GI and renal losses.

Question 16

Treatment of severe symptoms like tetany, arrythmias, or seizures due to hypomagnesium should be treated with what?

Answer 16

IV magnesium sulfate

Continuous cardiac monitoring

Question 17

Treatment of asymptomatic or minimal symptoms of hypomagneisum should be treated with?

Answer 17

Oral replacement - magnesium chloride or magnesium oxide - diarrhea major effect.

Question 18

Malignancy such as ectopic secretion of PTH by tumor, multiple myeloma, and bone mets can cause what?

Answer 18

Hypercalcemia

Question 19

Hyperparathyroidism, MEN, hyperthyroidism, pheochromocytoma, and adrenal insufficiency can cause?

Answer 19

Hypercalcemia

Question 20

Granulomatous disease such as sarcoidosis, TB, histoplasmosis, Berylliosis and coccidiomycosis can cause what?

Answer 20

Hypercalcemia

Question 21

Drugs such as Vitamins A and D, thiazide diuretics, estrogens, Milk-alkali syndrome, lithium can cause what?

Answer 21

Hypercalcemia.

Question 22

Dehydration, prolonged immobilization, iatrogenic, rhabdo, familial, and lab error can cause?

Answer 22

Hypercalcemia.

Question 23

Two most important causes of hypercalcemia?

Answer 23

Malignancy

Hyperparathyroidism.

Question 25

Hypercalcemia symptoms?

Answer 25

Vague- nonspecific Stones, groans, bones, and psychiatric overtones.

Question 26

Severe hypercalcemia can present as?

Answer 26

Lethargy, altered mental status, seizures, coma Cardiac conduction abnormalities - bradyarrhythmias, sinus arrests, av blocks, af, vt, lbbb, rbbb

Question 27

What are EKG findings associated with severe hypercalcemia?

Answer 27

bradyarrythmias, sinus arrests, AV blocks, AF, VT, LBBB, RBB ST segment elevation, **"short QT interval - classic finding"**

Question 28

How do you diagnose hypercalcemia?

Answer 28

Ionized calcium versus total calcium Serum total calcium represents both bound and unbound calcium ionized needs albumin

Question 29

A patient with hypercalcemia might have normal caclcium if what protein is low?

Answer 29

Albumin

Question 30

Corrected calcium equation?

Answer 30

CC = measured total calcium x [0.8 (4-albumin)]

Question 31

After you confirm hypercalcemia what next test should you run?

Answer 31

Serum PTH

Question 32

If Serum PTH is high, dx? Low?

Answer 32

High - primary hyperparathyroidism low - check vit d levels and PTHrp

Question 33

How do you treat hypercalcemia?

Answer 33

Usually dehydrated **- NS open wide.** ## Footnote **Bisphosphonates, calcitonin, glucocorticoids.**

Question 34

Short QT = Prolonged QT

Answer 34

Short QT = hypercalcemia Prolonged = hypocalcemia.

Question 35

What are the major causes of hypocalcemia?

Answer 35

Hypoparathyroid Drugs Hypomagnesia

Question 36

Carpal tunnel spasm after BP cuff is applied for 3 minutes

Answer 36

Trousseau sign

Question 37

Spasm of facial muscle after tapping facial nerve in front of ear

Answer 37

Chovstek sign.

Question 38

Acute and severely symptomatic hypocalcemia should be treated with?

Answer 38

IV calcium gluconate

Question 39

Mild hypocalcemia should be treated with?

Answer 39

Oral calcium and vit D

Question 40

What are acute causes of hyperphosphatemia?

Answer 40

Acute renal failure Tumor lysis syndrome Hypoparathyroidism.

Question 41

What are chronic causes of hyperphosphatemia?

Answer 41

**CKD** Hypoparathyroidism.

Question 42

Although most asymptomatic from hyperphosphatemia, some can have accompanying symptoms from hypocalcemia like?

Answer 42

Tetany, muscle cramps, perioral numbness, tingling Trousseau or chovstek sign.

Question 43

Hyperphosphatemia may cause uremia signs which include?

Answer 43

Fatigue, n/v, pruritus, SOB, sleep disturbances

Question 44

How do you diagnose hyperphosphatemia?

Answer 44

Serum phosphorus, PTH, and serum calcium Vit D levels Renal ultrasound.?

Question 45

Actue hyperphosphatemia and normal renal function can be treated with?

Answer 45

Saline and loop diuretics

Question 46

AKI is treated with phosphate binders in hyperphosphatemia when levels are above? What type of binders?

Answer 46

\>6 Depends on calcium levels too Use calcium based bindings if calcium is low Use noncalcium if calcium is high - sevelamer, aluminum hydroxide.

Question 47

CKD patients should above what foods that are high in phosphates?

Answer 47

Dark colas, oysters, cheese, milk, organ meats, ice cream, chocolate, nuts/seeds

Question 48

Treat hypophosphatemia if 1.0-1.9 with? Below 1?

Answer 48

Oral phosphate Iv phosphate. - switch above 1.5

Question 49

Dipyridmadole can help treat what?

Answer 49

Phosphate wasting in the urine.