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Electrolytes & Shock Flashcards

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1
Q

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

A

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

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2
Q

Ascities management

A

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

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3
Q

Anion gap

A

Na - (HCO3- + Cl-)

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4
Q

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

A

MUDPILES - anion gap acidosis

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5
Q

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

A

Cramping, weakness, carpopedal spasm,

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6
Q

HypoCa, elevated phosphorous

A

HypoPT - d/t surgery or auto-immune

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7
Q

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

A

VitD deficiency, CKD

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8
Q

Hyperreflexia electrolyte abnormality

A

HypoCa or hypoMag –> low PTH

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9
Q

Grand-mal seizures, prolonged QT electrolyte abnormality

A

HypoCa

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10
Q

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

A

CKD –> secondary HPT

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11
Q

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

A

End organ resistance - Gs defect

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12
Q

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

A

HypoCa

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13
Q

Low Ca, Low PTH, High Phos

A

Hypoparathyroidism = surgical removal, auto-immune

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14
Q

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

A

Hyperdynamic circulation

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15
Q

Hypothyroidism mechanism of diastolic HTN

A

Inc systemic vasc resistance

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16
Q

Most common causes of hyperCa

A

Malignancy, primary HPT (adenoma 90%)

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17
Q

Malignancy vs. PHPT hyperCa

A

Malignancy >13, low PTH = IL-6

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18
Q

High Ca, high PTH, dec Phos, Sestamibi scan

A

Hyperparathyroid –> resect but can –> hypoCa

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19
Q

High Ca, High PTH levels

A

Primary hyperparathyroidism or Familial (low urine), Lithium

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20
Q

High Ca, Low PTH

A

Malignancy, Vit D, HTCZ, Theophylline, milk alkali

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21
Q

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

A

Granulomatous - Sarcoid or lymphoma

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22
Q

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

A

Familial hypocalciuric hyperCa –> Abn Ca-sensing receptors

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23
Q

Tx for hyperCa

A

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

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24
Q

Saline non-responsive metabolic alkalosis

A

Cushing, Primary hyperaldosteronism, hypoK <2

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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

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