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ADV DIAG > Exam 1 Electrolytes > Flashcards

Exam 1 Electrolytes Flashcards

(64 cards)

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1
Q

Electrolytes effect what

A

the amount of water in your body
, the acidity of your blood (pH),
your muscle function,
and other important processes.

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2
Q

Sodium range

A

135-145 mmol/L

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3
Q

Hyponatremia- what happens to water balance

A

Excess body water compared to total body
– Patient not able to excrete excess water
– Patient looses more salt than water

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4
Q

Hyponatremia causes ***

A

Non-renal:
– Gastrointestinal: Diarrhea or Vomiting
– Transdermal: Heavy sweating
Renal:
– Thiazide diuretics
– Primary adrenal insufficiency
– Cerebral salt wasting
– Kidney disease

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5
Q

Additional hyponatremia causes

A

Third spacing
– Bowel obstruction, pancreatitis, sepsis or
•Muscle trauma
•Syndrome of Inappropriate Antidiuretic (SIADH)
•General anesthesia, nausea, pain, stress and
•medications
•Cancers (small cell carcinoma of the lung)
•Diseases of the lung (pneumonia)
•Central nervous system (subarachnoid hemorrhage)
•High water and low solute intake
– Primary polydipsia including MDMA (ecstasy)
– Anorexia
•Heart failure
•Liver failure
•Nephrotic syndrome

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6
Q

Clinical Manifestations: Acute(< 48 hours)

125-130 mmol/L hyponatremia

A

Nausea

Malaise

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7
Q

Acute clinical manifestations for hyponatremia 115-120 mmol/L

A

-Headache; lethargy; seizures; coma; respiratory arrest

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8
Q

Clinical Manifestations: Chronic (≥ 48 hours)

– 115-130 mmol/L hyponatremia

A

Fatigue, nausea, dizziness, gait disturbances, forgetfulness, confusion, lethargy, and muscle cramps

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9
Q

HYPERNATREMIA
•Clinical Manifestations:
158-180 mmol/L

A

– lethargy, weakness, and irritability, and can

progress to twitching, seizures, and coma

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10
Q

Hypernatremia

Above 180 mmol/L

A

– high mortality rate, particularly in adults

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11
Q

Hypernatremia treatment

A

–Hypertonic IVF
– Determine dietary intake and limit

Treat with dialysis, free water

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12
Q

K range

A

Normal 3.5-5.0 meq/L

  • Oral/IV intake
  • Stored in cells or excreted in urine
  • Normal potassium intake 40-120 meq/day most of which is excreted in the urine.
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13
Q

HYPOKALEMIA

Causes:

A 
•Decreased potassium intake
•Increase entry of potassium into cells
   – Increased extracellular pH
   – Increased availability of insulin
   – Chloroquine intoxication
•GI losses
   – Vomiting
   – Diarrhea
   – Feeding tube drainage/leakage
   – Chronic Laxative use/abuse 
•Increased urinary sodium losses
  – Increased exchange sodium for potassium
•Diuretics causing polyuria
•Amphotericin B
•Increased sweat losses
•Dialysis/plasmaphoresis
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14
Q

HYPOKALEMIA S&S

A 
Muscle weakness
•Muscle cramps Below 2.5 meq/L
•Rhabdomyolysis
•Myoglobinuria
•Cardiac arrhythmias

Fatigue, anorexia, muscle weakness, BP decrease, ileus development, decreased DTR,

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15
Q

Hypokalemia ecg changes

A

Depression ST segment; decrease in amplitude of the T-wave and an increase in the amplitude of the U wave.

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16
Q

HYPERKALEMIA S&S

A

•serum potassium concentration is ≥7.0 meq/L with chronic hyperkalemia or possibly at lower levels with an acute rise in serum potassium

•muscle weakness or paralysis
•cardiac conduction abnormalities and cardiac arrhythmias including :
sinus bradycardia, sinus arrest, slow idioventricular rhythms, ventricular tachycardia, ventricular fibrillation, and asystole

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17
Q

HYPERKALEMIA

•CAUSES:

A

•Reversible causes of renal insufficiency
– hypovolemia
– nonsteroidal anti-inflammatory drugs(NSAIDS)
– urinary tract obstruction (should also consider this in differentials)
– inhibitors of the renin-angiotensin-aldosterone system

•Dietary intake

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18
Q

HYPERKALEMIA TREATMENT

A
  • Loop or thiazide diuretics (As long as the patient is not volume depleted!)
  • IV NaCl (If volume depleted)
  • Dialysis
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19
Q

Bicarbonate is what

A

Co2

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20
Q

BICARBONATE(CO2)

•normal range arterial

A

7.35- 7.45

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21
Q

Bicarbonate serum range

A

22-28 meq/L

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22
Q

•Acid-base balance is maintained by

A

pulmonary and renal excretion of carbon dioxide

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23
Q

METABOLIC ACIDOSIS S&S

A
  • Chest pain, palpitations, headache, altered mental status, decreased visual acuity, nausea, vomiting, abdominal pain, muscle weakness, bone pains, Kussmaul respirations ( Rapid deep breathing)
  • Extreme acidemia leads to neurological and cardiac complications
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24
Q

METABOLIC ALKALOSIS

•CAUSES:

A

Kidney ‘s are unable to excrete the excess bicarbonate, usually because of volume depletion
- the desire to retain sodium prevents the excretion of bicarbonate, which would have to occur as sodium or potassium bicarbonate to maintain electroneutrality

  • Loop diuretic therapy (Lasix, Torsemide, Bumex)
  • Loss of gastric secretions emesis/NG suction
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25
METABOLIC ALKALOSIS S&S
Slowed breathing which can lead to Apnea •Cyanosis •Nausea, vomiting, and diarrhea •Irritability, twitching, confusion, and picking at bedclothes. •Rapid heart rate, irregular heart beats, and a drop in blood pressure •Severe cases can lead to convulsions and coma.
26
MAGNESIUM range
•Normal 1.8-2.5 mg/Dl
27
Magnesium regulated by what
Parathyroid hormone Diet Kidneys
28
Magnesium competes with
Calcium an excess of one can lead to excretion of the other.
29
HYPOMAGNESEMIA | •CAUSES:
•Magnesium intake is less than renal excretion •Alcoholism •Poor nutritional intake or malabsorption disease – Celiac sprue, short bowel syndrome •Diuretics •Magnesium-wasting agents – Amphotericin B, cisplatin, cyclosporin, pentamidine •Chronic diarrhea •Chronic use of omeprazole and other PPI •Uncontrolled Diabetes Mellitus/Hyperglycemia •Increased calcium intake can cause decrease in Mg absorption
30
HYPOMAGNESEMIA S&S
``` Hypocalcemia (40-60% due to diuresis/diarrhea) •Abnormal eye movements •Convulsions/muscle spasms/cramps •Muscle weakness •Anorexia •Refractory Hypokalemia •Cardiac arrest •Coma/death ``` Increased nm activity/ irritability
31
HYPERMAGNESEMIA | •CAUSE:
``` Impaired renal function •Ingestion of magnesium -Epsom salts – accidental poisoning •laxative abuse •Magnesium Citrate / Milk of Magnesia ```
32
HYPERMAGNESEMIA S&S
•Can result in Hyperkalemia • CNS depression, somnolence, bradycardia, increased QRS duration, decreased deep tendon reflexes, paralysis
33
•4.0 mEq/L mg- conduction
hyporeflexia
34
> 5.0 mEq/L mg conduction
prolonged atrioventricular conduction
35
•>10 mEq/L mg conduction
omplete heart block
36
•> 13.0 mEq/L mg conduction
Cardiac arrest
37
PHOSPHORUS | •Normal range
2.4-4.1 mg/dL
38
Ph absorbed through
Small intestine
39
Phosphorus stored in
Bone
40
Phosphorus regulated by
Kidney regulates to keep homeostasis | – Excess excreted in the urine
41
•85% phosphorus is found in
Bone
42
Phosphorus main function
formation of bones and teeth | •
43
Phosphorus assists with
Assists with using protein for growth, maintenance and repair of cells and tissues ``` •Works with B vitamins to support – Kidney function – Muscle contractions – Normal heartbeat – Nerve signaling ```
44
HYPOPHOSPHATEMIA | CAUSES:
``` Decreased net intestinal absorption – Inadequate intake – Medications interfering with absorption (antacids with Mg or Aluminum, niacin) – Steatorrhea or chronic diarrhea – Vitamin D deficiency or resistance ``` Increased urinary phosphate excretion – Primary and secondary hyperparathyroidism – Vitamin D deficiency or resistance – Hereditary hypophosphatemia rickets
45
HYPOPHOSPHATEMIA | ?
Acute movement of extracellular phosphate into the cells Refeeding Syndrome: increased insulin secretion, particularly during refeeding after starvation anorexia Acute respiratory alkalosis Hungry bone syndrome
46
HYPOPHOSPHATEMIA S&S
* Loss of appetite * Anemia * Muscle weakness * Bone pain * Rickets in children/Osteomalacia in adults * Increased susceptibility to infection * Numbness and tingling in extremities * Difficulty walking
47
HYPERPHOSPHATEMIA | •CAUSES:
Phosphate entry into the extracellular fluid exceeds the rate at which it can be excreted •Tumor lysis syndrome •Muscle necrosis (rhabdomyolysis) •Lactic acidosis •Diabetic ketoacidosis (or severe hyperglycemia alone) •Ingestion of a large amount of phosphate containing laxative Most commonly seen with pts with CKD, also seen with hyperparathyroidism, also associated with hypocalcemia, DKA, injuries that cause muscle damage, high levels of vit D
48
HYPERPHOSPHATEMIA S&S
* Muscle cramps * Tetany * Perioral numbness or tingling * Bone and joint pain * Pruritus * Rash
49
Normal total calcium
8.5-10.5 mg/dL
50
•Normal ionized calcium
4.65-5.25 mg/dL
51
•Factors that influence the calcium concentration
– Parathyroid hormone – Vitamin D - Calcium ion – Phosphate
52
CORRECTED SERUM CALCIUM
Ca = Serum Ca + 0.8 * (Normal Albumin – Patient Albumin) •Example: Serum Ca = 10mg/dL; Albumin 2.0 g/dL Normal Albumin = 4 g/dL Corrected Ca = 10 + ( 0.8 (4-2))= 10 + 1.6 = 11.6 mg/dL
53
If Ca abnormal,
look at albumin levels If albumin low, do a corrected Ca level Half ca bound by protein, half unbound so after being corrected, you may have normal ca
54
Calcium has inverse relationship to
Phosphorus
55
HYPOCALCEMIA | •CAUSES:
•Hypoparathyroidism– Ineffective action in the kidney, bone and intestine to normalize the calcium - Post surgical (parathyroid glands or thyroid gland) •Hyperparathyroidism (secondary)– PTH is increased in response to low serum calcium concentrations, in an attempt to mobilize calcium from kidney and bone and to increase 1,25-dihydroxyvitamin D production. •Chronic hypocalcemia occurs when these actions are inadequate to restore the serum calcium to normal.
56
HYPOCALCEMIA | •CAUSES:
``` Vitamin D deficiency – Poor intake or malabsorption – Reduced exposure to UV light •Hyperphosphatemia •Acute kidney injury with increased phosphorous intake (oral/enema) •Rhabdomyolysis or tumor lysis ```
57
HYPOCALCEMIA S&S
``` •Neuromuscular irritability •Cardiac – Prolonged QT interval – Hypotension – Heart failure – Arrhythmia ```
58
HYPOCALCEMIA S&S | Chronic
``` – Ectopic calcifications – Extrapyramidal signs – Parkinsonism – Dementia – Subscapular cataract – Abnormal dentition – Dry skin ```
59
HYPOCALCEMIA TREATMENT
* Normalize magnesium * Correct PTH * Normalize phosphorous
60
HYPERCALCEMIA | •CAUSES:
* Accelerated bone reabsorption * Excessive gastrointestinal absorption * Decreased renal excretion of calcium ~ primary hyperparathyroidism and malignancy are the most common, accounting for greater than 90% of cases
61
~calcium Values above 13 mg/dL are most likely what
Malignancy
62
HYPERCALCEMIA S&S | •<12 mg/dl
– asymptomatic, – nonspecific symptoms such as constipation, fatigue, and depression.
63
Hypercalcemia s/s
12 to 14 mg/dL – may be well-tolerated chronically – acute rise to these concentrations may cause marked symptoms, including polyuria, polydipsia, dehydration, anorexia, nausea, muscle weakness, and changes in sensation •>14 mg/dL – progression of the above symptoms
64
HYPERCALCEMIA TREATMENT
•12-14 mg/dl asymptomatic or mildly symptomatic (eg, Constipation)– does not require immediate treatment. •> 14 mg/dL– Requires treatment regardless of symptoms

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