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Renal > Fluid and Electrolyte Disorders (Part 2) > Flashcards

Fluid and Electrolyte Disorders (Part 2) Flashcards

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1
Q

Which electrolytes are highly regulated by kidneys, need prominent renal reabsorption, and are large intracellular concentrations?

A

K+ and Mg 2+

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2
Q

Which electrolytes have large bony deposits and are regulated by vitamin D and the parathyroid hormone (PTH)?

A

Ca 2+ and Phosphate

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3
Q

Normal serum K+ levels

A

3.5 - 5 mEq/L

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4
Q

Define hypokalemia

A

< 3.5 mEq/L

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5
Q

What are the main causes of hypokalemia?

A
  • Intracellular shifting
  • Total body deficit
  • Hypomagnesemia
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6
Q

In hypokalemia patients, why does intracellular shifting happen?

A
  • Metabolic alkalosis

- Drugs: albuterol, insulin, theophylline

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7
Q

In hypokalemia patients, why does total body deficit happen?

A
  • Poor intake of dietary potassium

- Excessive loss due to renal (diuretics, amphotericin B) or extra-renal (vomiting, diarrhea)

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8
Q

(T/F) - The clinical presentation of hypokalemia can be variable and independent on the degree of hypokalemia

A

FALSE - it’s variable and DEPENDENT on the degree of hypokalemia

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9
Q

What are some symptoms from hypokalemia?

A
  • Muscle cramping/impaired muscle contractions
  • Severe EKG changes: ST segment depression or flattening
  • Cardiac arrhythmias (heart block, ventricular fibrillation)
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10
Q

If patient has hypokalemia, what is the first treatment option?

A

Treat underlying cause

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11
Q

If the patient has mild (3.0 - 3.5 mEq/L) hypokalemia, what is the best treatment?

A

Oral K+ supplements

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12
Q

What is a main adverse effect from oral K+ supplements?

A

GI upset (to reduce, give patient < 20 mEq of K+)

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13
Q

Once hypomagnesemia has been treated in hypokalemia patients and they’re asymptomatic, what should be given for treatment?

A

Oral K+ supplements

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14
Q

Once hypomagnesemia has been treated in hypokalemia patients and they’re symptomatic, what should be given for treatment?

A

IV K+ replacements

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15
Q

What are the types of IV K+ replacements given to hypokalemic patients?

A

Peripheral line

Central line

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16
Q

The maximum dose for a central line K+ replacement in hypokalemic patients is…

A

20 mEq/hr

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17
Q

The maximum dose for a peripheral line K+ replacement in hypokalemic patients is…

A

10 mEq/hr

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18
Q

(T/F) For every 10 mEq given to a patient raises their serum K+ levels ~0.1 mEq/L

A

TRUE

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19
Q

Define hyperkalemia

A

> 5.0 mEq/L

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20
Q

What are the main causes of hyperkalemia?

A
  • Extracellular shifting
  • Increased intake
  • Decreased output
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21
Q

In hyperkalemia patients, why does extracellular shifting happen?

A

Metabolic acidosis

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22
Q

In hyperkalemia patients, why does increased intake happen?

A
  • Exogenous [K+ supplement; salt substitutes (DASH)]

- Endogenous [hemolysis, burns, muscle crush injuries]

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23
Q

In hyperkalemia patients, why does decreased output happen?

A
  • Renal failure (acute or chronic)

- Drugs: TMP/SMX, ACEi/ARBs, NSAIDs, K+ sparring diuretics

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24
Q

(T/F) - Hyperkalemic patients are typically symptomatic

A

False - typically asymptomatic

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25
What are some symptoms from hyperkalemia?
- Palpitations - Skipped heart beats - Weakness - Bradycardia
26
Do life-threatening arrhythmias occur in hyperkalemia? If so, at what serum K+ level?
Yes, > 6.0 mEq/L
27
Before starting pharmacological treatments for hyperkalemic patients, what should be done?
Treat underlying disease
28
If the patient has mild (5.5 - 6.0 mEq/L) hyperkalemia, what pharmacological treatment can be given?
- Sodium polystyrene sulfonate | - Furosemide IV
29
(T/F) - Sodium polystyrene can be given to patients who have constipation
FALSE - contraindicated in constipated patients
30
If the patient has moderate/severe (> 6.0 mEq/L) hyperkalemia who is symptomatic, what pharmacological treatment should be given first?
Patient experiencing severe cardiac arrhythmias - administer calcium gluconate IV
31
After symptoms have been controlled from moderate/severe hyperkalemia, what other pharmacologic treatment can be given?
- Insulin | - Albuterol
32
What are the normal serum Mg 2+ levels?
1.5 - 2.2 mEq/L
33
Define hypomagnesemia
< 1.5 mEq/L
34
What are the causes of hypomagnesemia?
- Diet - GI sources - Renal sources - Hypoparathyroidism - Hyperaldosteronism
35
How does diet affect hypomagnesemia?
Poor nutrition
36
How does GI sources affect hypomagnesemia?
Vomiting, diarrhea, and malabsorption
37
How does renal sources affect hypomagnesemia?
Loop diuretics, amphotericin, aminoglycosides, ATN
38
(T/F) - Hypomagnesemia is typically asymptomatic
TRUE
39
What are some symptoms from hypomagnesemia?
- Twitching - Tetany - Generalized convulsions - Heart palpitations
40
What are some signs from hypomagnesemia?
- Tremors - Cardiac arrhythmias - EKG changes (widened QRS interval with peaked T waves; PR interval prolonged)
41
How is mild (1.0 - 1.4 mEq/L), asymptomatic hypomagnesemia treated (give class of drug)?
Oral magnesium supplementation
42
What is the drug name that is under the class of oral magnesium supplementation?
Magnesium oxide 400 mg PO
43
(T/F) - Diarrhea is a common adverse effect from magnesium oxide 400 mg
TRUE
44
On day 1, how is moderate/severe (< 1.0 mEq/L) symptomatic hypomagnesemia treated?
1st: Magnesium sulfate 2 g IV bolus once 2nd: Magnesium sulfate 6 g IV in 24 hrs
45
On day 2, how is moderate/severe (< 1.0 mEq/L) symptomatic hypomagnesemia treated?
- Magnesium sulfate 4 g IV in 24 hrs
46
How long can it take for moderate/severe hypomagnesemia to return to normal levels?
3 - 5 days
47
If a patient has a disorder of K+ and Mg 2+ levels, what would be treated first?
Abnormal magnesium levels
48
Define hypermagnesemia
> 2.2 mEq/L
49
What are the causes of hypermagnesemia?
- Excess intake - Renal sources - Hypothyroidism - Lithium - Addison's disease
50
When does hypermagnesemia become symptomatic?
> 4.0 mEq/L
51
What are the symptoms of hypermagnesemia?
- Cardiac abnormalities (heart block, QRS prolongation, QT prolongation) - Somnolence - Coma - Respiratory depression - Hyporeflexia
52
(T/F) - Before treating hypermagnesemia with pharmacological treatment, underlying disease needs to be treated first
TRUE
53
If hypermagnesemia is moderate/severe, how is it treated? (pharmacological treatment)
1st: Calcium gluconate IV 2nd: Loop diuretics 3rd: Fluids
54
Would hemodialysis be given to patients who have severe and poor kidney function in patients with hypermagnesemia?
YES
55
What are the normal serum calcium levels?
8.5 - 10.8 mg/dL
56
What are the normal serum phosphorus levels?
2.6 - 4.5 mg/dL
57
Define hypocalcemia
< 8.5 mg/dL
58
Define hyperphosphatemia
> 4.5 mg/dL
59
What are some causes in hyperphosphatemia?
- CKD (secondary - hyperparathyroidism) | - Rhabdomyolysis
60
What are some causes in hypocalcemia?
- CKD (reduced calcium absorption due to decreased active vitamin D production by kidneys) - Surgically induced hypoparathyroidism - Malnutrition
61
What are signs/symptoms of hyperphosphatemia?
- Deposits of calcium-phosphorus crystals in joints, eyes, skin and vasculature
62
What are signs/symptoms of hypocalcemia?
- Tetany - Paresthesia - Confusion - Hypotension - Bradycardia - QT prolongation - Osteoporosis (long-term)
63
(T/F) - Calcium is insignificantly protein bound
FALSE - calcium is SIGNIFICANTLY protein bound
64
(T/F) - Corrected calcium should only be done when patients have hypocalcemia (low in calcium)?
TRUE
65
Equation of corrected calcium
[(4 - albumin) x 0.8] + Ca2+ serum level
66
If the patient is asymptomatic, how would hypocalcemia be treated in a patient?
With oral calcium (calcium carbonate)
67
If the patient has CKD, how would hypocalcemia be treated in a patient?
Ergocalciferol (D2) PO
68
If the patient is symptomatic, how would hypocalcemia be treated in a patient?
1st: Calcium gluconate IV bolus 2nd: Calcium gluconate IV continuous
69
(T/F) - For every 1 gram of calcium gluconate, 90 mg of elemental calcium is given
TRUE
70
If the patient has normal renal function, how would hyperphosphatemia be treated?
- IV fluids - Furosemide * promotes excretion of phosphorus*
71
If the patient has renal failure, how would hyperphosphatemia be treated first?
1st: Restrict on dietary phosphorus
72
Continuation: If the patient has renal failure and a calcium-phosphorus produce < 55, how would hyperphosphatemia be treated next?
- Calcium salts - Renagel - Fosrenol
73
Continuation: If the patient has renal failure and a calcium-phosphorus product > 55, how would hyperphosphatemia be treated next?
- Sevelamar | - Lanthanum
74
Continuation: If the patient has renal failure and are undergoing dialysis, what is the best medication to give for hyperphosphatemia?
Velphoro
75
Define hypercalcemia
> 10.8 mg/dL
76
Define hypophosphatemia
< 2.6 mg/dL
77
What are some causes of hypercalcemia?
- Malignancy (lung, bone, breast) - Hyperparathyroidism - Excess intake - Drugs: calcium supplements, lithium, thiazides, tamoxifen
78
What are some causes of hypophosphatemia?
- Refeeding syndrome - Phosphate binders - Alcoholism
79
What are the symptoms related to malignancy in hypercalcemia?
- N/V - polyuria - polydipsia - Ca2+ > 15 = acute renal failure - Ventricular arrhythmias
80
What are the symptoms related to hyperparathyroidism in hypercalcemia?
- Calcification of organs/skin - Shortening of QT interval - Chronic renal failure
81
If the patient has functioning kidneys, what treatment can be given in patients?
- Zoledronic acid (IV 4 mg over 15 mins) - Normal saline - Furosemide - Ibandronate - Pamidronate - Prednisone (chronic treatment)
82
If the patient has non-functioning kidneys, what treatment can be given in patients?
- Hemodialysis (immediately) - Calcitonin - Prednisone (chronic treatment)
83
What are the symptoms related to CNS in hypophosphatemia?
- Weakness - Tingling - Confusion - Numbness
84
What are chronic symptoms in hypophosphatemia?
- Osteomalacia | - Osteopenia can lead to osteoporosis
85
If the patient is asymptomatic and phosphate > 1 mg/dL, how would you treat hypophosphatemia?
Neutra-phos 250 mg
86
If the patient is symptomatic and phosphate < 1 mg/dL, how would you treat hypophosphatemia?
IV phosphate salts
87
Do you want to correct other electrolyte disorders when a patient has hypophosphatemia?
Yes, to prevent redistribution

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