EXAM 2 - ELECTROLYTES

Question 1

What is an electrolyte?

Answer 1

substance that is electrically charged when in solution
Ca, K, Cl, Na, Mg

Question 2

Which electrolytes are extracellular?

Answer 2

Na, proteins, Cl, bicarbonate

Question 3

Which electrolytes are intracellular?

Answer 3

K, Mg, sulfate, proteins, phosphorus

Question 4

What is sodium?

Answer 4

main ECF cation, governs osmolality and H2O distribution, water follows sodium, aids in acid-base balance, activates muscle & nerve cells, action potentials need Na in order to fire

Question 5

What is hyponatremia?

Answer 5

-more water than sodium, sodium level in blood is too low
-when Na is below normal: 135
- osmolality of extracellular fluid is low = diluted
- rapid changes and drops in Na is more symptomatic than slow decline

Question 6

What is beer potomania?

Answer 6

ETOH intake chronically lowers sodium due to low solute delivery to the kidneys

Question 7

How does water intoxication relate to hyponatremia?

Answer 7

replacing losses with just water rather than electrolytes on a hot day when you are sweating

Question 8

What are the two types of hyponatremia?

Answer 8

dilution hyponatremia
depletional hyponatremia

Question 9

What is dilution hyponatremia?

Answer 9

total body sodium near normal, but total body water is increased
can be hypervolemic (edema) or euvolemic (no edema)

Question 10

What is depletional hyponatremia?

Answer 10

hypovelmic, sodium lost, total body water reduced

Question 11

What is the treatment for hyponatremia?

Answer 11

treat the underlying problem
fluid restriction if vol. overload, sodium replacement

Question 12

What is the treatment for SEVERE hyponatremia?

Answer 12

ICU, bolus of 3% saline to start, telemetry monitoring, neuro checks Q 2-4 hrs

Question 13

What is osmotic demyelination syndrome?

Answer 13

destruction of myelin sheath in brain stem and pons
cause: correcting hyponatremia too fast

Question 14

What can osmotic demyelination syndrome result in?

Answer 14

central pontine myelinolysis
acute paralysis, dysphagia, dysarthria
NO KNOWN CURE

Question 15

What is hypernatremia?

Answer 15

body fluids with more sodium than water
osmolality of extracellular fluid is high
Na level is upper limit of normal: 145

Question 16

What can cause hypernatremia?

Answer 16

excess sodium: salt loading, medications, too much sodium admin (sodium bicarb, zosyn)
water losses, diarrhea, impaired thirst, uncontrolled DM, water deprivation, diuresis, tube feeding without free water

Question 17

What are the clinical manifestations of hypernatremia?

Answer 17

thirst, dry mucous membranes, oliguria, confusion, lethargy, seizures, coma

Question 18

What is the treatment for hypernatremia?

Answer 18

correction of water deficit, replace half in first 24 hours with D5W or free water

Question 19

What is potassium?

Answer 19

main intracellular ion, regulates excitability of cells/cell electrical status, helps control intracellular osmolality

Question 20

What causes hypokalemia?

Answer 20

decreased PO intake, stool output, normal loss or diuresis

Question 21

What are clinical manifestations of hypokalemia?

Answer 21

A SIC WALT
alkalosis, shallow respirations, irritability, confusion/drowsiness, weakness/fatigue, arrhythmias, lethargy, thready pulse, decreased intestinal motility, N/V, ileum

Question 22

What is the treatment for hypokalemia?

Answer 22

oral potassium chloride (KCL) - liquid, tabs, or powder but causes GI upset/bleeding so dilute with lots of water
IV- must be given slowly and diluted
Central Line 20 MEq/1 hr, IV 10 MEq

Question 23

What is the treatment for hyperkalemia (sub-acute)?

Answer 23

stop supplemental K
limit K rich foods
cation exchange resin: sodium polystyrene sulfonate (oral/enema)

Question 24

What is the treatment for hyperkalemia (emergency)?

Answer 24

push K into cells
glucose and insulin
NaHCO3 - temporary treatment
Dialysis

Question 25

What is magnesium?

Answer 25

an intracellular cation stored in muscle and bone

Question 26

What does magnesium help to maintain?

Answer 26

muscle and nerve function, cardiac rhythm, health and immune system, bone strength, blood pressure, electrolyte (K) and glucose levels

Question 27

What are the causes of hypomagnesemia?

Answer 27

decreased intake (malnutrition, alcohol abuse), decreased absorption (Celiac disease, Crohn's), increased need (pregnancy), increased losses

Question 28

What are the clinical manifestations of hypomagnesemia?

Answer 28

serum level <1.7 tremors, weakness, apathy, delirium, coma, prolonged QT, widening of QRS, dysrhythimas, hypokalemia, abnormalities of calcium metabolism

Question 29

What is the treatment for hypomagnesemia?

Answer 29

oral or IV mylanta, magnesium sulfate tables, IV magnesium sulfate

Question 30

What are the causes and treatments for hypermagnesemia?

Answer 30

impaired kidney function - dialysis excess mylanta use- eliminate use

Question 31

What are clinical manifestations of hypermagnesemia?

Answer 31

N/V, neurological impairment (confusion/lethargy), hypotension, dysrhythmias, flushing, headaches

Question 32

Where is calcium found?

Answer 32

found in bones and teeth small amount ionized in blood, unbound and used for physiologic processes

Question 33

What are causes of hypocalcemia?

Answer 33

decreased intake, hypoalbuminemia (calcium binds to albumin), increased loss

Question 34

What are some clinical manifestations of hypocalcemia?

Answer 34

increased cell membrane excitability, trousseau signs, Chvostek sign

Question 35

What is Trousseau sign?

Answer 35

use BP cuff to occlude blood flow, over 3 minutes see carpal spasm

Question 36

What is Chvostek sign?

Answer 36

tap the facial nerve in front of of ear, elicit spasm or contraction: corner of mouth, nose, eye, and cheek muscles

Question 37

What is the treatment for hypocalcemia?

Answer 37

oral replacement, vitamin D, IV replacement

Question 38

What are the causes of hypercalcemia?

Answer 38

increased intake and reabsorption from bones, decreased loss of calcium

Question 39

What are the symptoms of hyperparathyroidism?

Answer 39

nephrolithiasis (kidney stones), HTN, shorted QT, dehydration, somnolence, skeletal muscle weakness

Question 40

What is the treatment of hypercalcemia?

Answer 40

treat underlying cause, symptom management, oral phosphate or calcitonin, increased mobility, IVF and diuretic

Question 41

Where is phosphorus found in body?

Answer 41

bones and blood, inverse relationship with calcium

Question 42

What is phosphorus for?

Answer 42

bone and teeth mineralization, cellular metabolism, acid base balance, cell membrane, helping muscles contract and recover, using and storing energy

Question 43

What are the causes of hypophosphatemia?

Answer 43

excess loss, renal failure, hyperparathyroidism, decreased intake, cellular exchange in acid-base abnormality

Question 44

What are the clinical manifestations of hypophosphatemia?

Answer 44

fatigue, muscle weakness, bone pain, bone fractures

Question 45

What are the causes of hyperphosphatemia?

Answer 45

decreased excretion, hypoparathyroidism, increased intake, cellular exchange in acid-base abnormalities

Question 46

What are the clinical manifestations of hyperphosphatemia?

Answer 46

muscle cramps, tetany (spasms), periorbital numbness or tingling

Question 47

What is the treatment for hyperphosphatemia?

Answer 47

treat underlying cause, dialysis, aluminum hydroxide and aluminum carbonate (binds to phosphorus and increase excretion)

Question 48

What does chloride do?

Answer 48

an extracellular ion that maintains acid base balance, works with sodium to maintain osmotic pressure/water balance

Question 49

What can cause hyperchloremia?

Answer 49

dehydration, hypernatremia. diabetes insipidus (ADH), large infusion of sodium chloride

Question 50

What are the symptoms of hyperchloremia?

Answer 50

muscle weakness, thirst, weakness, fatigue, dehydration TREAT CAUSES