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Renal > Fluid and Electrolyte Disorders Part II > Flashcards

Fluid and Electrolyte Disorders Part II Flashcards

1
Q

What are the causes of Hypokalemia?

A

Intracellular shifting
Total body deficit
Hypomagnesemia

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2
Q

How does intracellular shifting cause hypokalemia?

A

Metabolic alkalosis

Drugs: albuterol, theophylline, insulin

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3
Q

What can cause total body deficit of hypokalemia?

A

Poor dietary intake of potassium

Excessive loss: extra-renal (D/V), renal (diuretics, ampho B)

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4
Q

What is the clinical presentation of hypokalemia?

A

Variable, dependent on degree of hypokalemia
Muscle cramping, impaired muscle contraction
EKG changes (severe): ST-segment depression or flattening, cardiac arrhythmias (heart block, ventricular fibrillation)

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5
Q

What are the classifications of hypokalemia?

A

Mild: 3.0 - 3.5

Moderate - Severe: < 3.0

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6
Q

What is the general treatment for hypokalemia?

A

Correct underlying cause

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7
Q

What is the treatment of mild hypokalemia?

A

Oral potassium supplement
-Potassium chloride (KCl) tablets, powders, capsules, liquid
-GI upset with high doses PO KCl
=Limit to 20 mEq per dose to decrease GI upset

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8
Q

What is the treatment of moderate - severe hypokalemia?

A 
Correct hypomagnesemia FIRST
Asymptomatic: oral potassium supplement
Symptomatic: IV potassium replacements
-Limited by rate of infusion
-USE IV IF PATIENT HAS SEVERE N/V/D
-Peripheral line = 10 mEq per hour max
-Central line = 20 mEq per hour max
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9
Q

For every __ mEq of potassium (oral or IV) raises serum potassium ___ mEq/L

A

10

0.1

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10
Q

What are the causes of hyperkalemia?

A

Extracellular shifting
Increased intake
Decreased output

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11
Q

How does extracellular shifting cause hyperkalemia?

A

Metabolic acidosis

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12
Q

How does increased intake cause hyperkalemia?

A

Exogenous: potassium supplements, salt substitutes
Endogenous: hemolysis, burns, muscle crush injuries

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13
Q

How does decreased output cause hyperkalemia?

A 
Renal failure (acute or chronic)
Drugs: ACE/ARBs, NSAIDs, K-sparing diuretics, bactrim
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14
Q

What is the clinical presentation for hyperkalemia?

A

Frequently asymptomatic
Sx: palpitations, skipped heartbeats, weakness, bradycardia
Life threatening arrhythmias develop at > 6.0

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15
Q

What are the classifications of hyperkalemia?

A

Mild: 5.5 - 6.0

Moderate - Severe: > 6.0

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16
Q

What is the general treatment of hyperkalemia?

A

Correct underlying cause

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17
Q

What is the treatment of mild hyperkalemia?

A

Sodium polystyrene sulfonate

Furosemide IV

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18
Q

What is the treatment moderate - severe hyperkalemia?

A

Symptomatic
First - antagonize effects of hyperkalemia (give calcium gluconate IV)
Second - rapid correction of hyperkalemia (insulin, albuterol)

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19
Q

What are the causes of hypomagnesemia?

A

Diet: poor nutrition
GI sources: V/D, malabsorption syndromes
Renal sources: loops, acute tubular acidosis, amphotericin, AG
Others: hypoparathyroidism, hyperaldosteronism

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20
Q

What is the clinical presentation of hypomagnesemia?

A

Typically asymptomatic
Sx: twichting, tetany, generalized convulsions (neuromuscular) and heart palpitations
Signs: Tremor, cardiac arrhythmias (vfib, torsades); EKG changes: widened QRS complex ad peaked T waves (mild); prolonged PR interval

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21
Q

What is the treatment if a patient is asymptomatic and serum Mg is 1.0 - 1.4 (mild)?

A

Oral magnesium supplementation (mag oxide)
SE: diarrhea
50% of mg excreted in urine

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22
Q

What is the treatment if a patient is symptomatic or serum Mg < 1.0 (severe)?

A

IV supplementation

Check Mg Q12h until within normal range

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23
Q

What typically occurs with hypomagnesemia?

A

Hypokalemia

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24
Q

How do you treat hypomagnesemia and hypokalemia?

A

Start magnesium infusion FIRST to prevent redistribution of potassium and further worsening of hypokalemia

25
Q

What are the classifications for hypomagnesemia?

A

Mild: 1 - 1.4

Moderate - severe: < 1.0

26
Q

What are the causes of hypermagnesemia?

A

Diet: poor nutrition
Excess intake: magnesium supplements
Renal sources: acute/chronic kidney failure
Others: hypothyroidism, lithium, Addison’s disease

27
Q

What is the clinical presentation of hypermagnesemia?

A

Usually asymptomatic until > 4.0

Cardiac abnormalities, hyporeflexia, somnolence, coma, respiratory depression

28
Q

What is the treatment of hypermagnesemia?

A

Correct/remove underlying cause
Moderate - severe: Calcium gluconate and loops + fluids; hemodialysis if severe and poor kidney function
-If patient was not dialysis dependent before coming to hte hospital, will try higher dose of loops to try to kick start the kidneys

29
Q

What are the classifications for hypermagnesemia?

A

Mild/asymptomatic: < 4.0

Moderate - severe (+ symptoms): > 4.0

30
Q

What is normal calcium range?

A

8.5 - 10.8

31
Q

What is normal phosphate range?

A

2.6 - 4.5

32
Q

What are the causes of hyperphosphatemia?

A

CKD - secondary hyperparathyroidism

Rhabdomyolysis

33
Q

What are the causes of hypocalcemia?

A

CKD - reduction in calcium absorption d/t decrease in active vitamin D production by kidney
Surgically induced hypoparathyroidism
Malnutrition

34
Q

What are the clinical presentations for hyperphosphatemia?

A

Deposition of calcium-phosphorous crystals in joints, eyes, skin and vasculature

35
Q

What are the clinical presentations for hypocalcemia?

A 
Tetany
Paresthesias
Confusion
Hypotension
Bradycardia
QT prolongation
Long-term osteoporosis
36
Q

What is the corrected calcium equation?

A

Measured Ca + 0.8[4-albumin]

37
Q

What is the treatment of hypocalcemia when asymptomatic w/o CKD?

A

Oral calcium

38
Q

What is the treatment of hypocalcemia when asymptomatic w/CKD?

A

May give ergocalciferol

39
Q

What is the treatment of hypocalcemia when symptomatic?

A

IV calcium gluconate (Bolus or continuous)

40
Q

How many milligrams of elemental calcium are in 1 gram of IV calcium gluconate?

A

90 mg

41
Q

What is the treatment of hyperphosphatemia with normal renal function?

A

IV fluids + furosemide

42
Q

What is the treatment of hyperphosphatemia with renal failure?

A

Dietary phosphorous restrictions
If Ca * PO4 < 55 = calcium salts, sevelamer, or lanthanum
If Ca * PO4 > 55 = Sevelamer or Lanthanum
Velphoro for dialysis patients only

43
Q

What are DDIs with calcium carbonate and acetate?

A

Iron
Zinc
FQ

44
Q

Which drugs are chewable for phosphatemia?

A

Sucroferric oxyhydroxide

Lanthanum

45
Q

Which drugs can be used for phsophatemia when calcifications are present?

A

Sevelamer

46
Q

What are the side effects of calcium carbonate and acetate?

A

Constipation
N/V/D
Increased Ca

47
Q

What are the side effects of sevelamer?

A

Pruritus

N/V/D

48
Q

What are the side effects of lanthanum?

A

N/V/D

49
Q

What are the side effects of sucroferric oxyhydroxide?

A

Dark colored feces

N/D

50
Q

What are the DDIs with sucroferric oxyhydroxide?

A

Vit D analogs and levothyroxine

51
Q

How much elemental iron is in sucroferric oxyhydroxide?

A

500mg

52
Q

What are the causes of hypercalcemia?

A

Malignancy: bone, breast, lung
Hyperparathyroidism
Excessive intake
Drugs: thiazide diuretics, lithium, tamoxifen

53
Q

What are the causes of hypophosphatermia?

A

Phosphate binders
Refeeding syndrome
Alcoholism

54
Q

What is the clinical presentation of hypercalcemia?

A

D/t malignancy: N/V, polyuria, polydipsia, Ca > 15 = acute renal failure, ventricular arrhythmias
D/t hyperparathyroidism: Calcification of organs/skin, chronic renal failure, shortening of the QT interval

55
Q

What are the treatments for hypercalcemia with functioning kidneys?

A 
NS
Furosemide
Pamidronate
Ibandronate
Zoledronic acid
Prednisone
56
Q

What are the treatments for hypercalcemia with non-functioning kidneys?

A

Hemodialysis
Calcitonin
Prednisone

57
Q

What is the clinical presentation of hypophosphatemia?

A

CNS: weakness, numbness, paresthesias, confusion
Others: myalgias, bone pain, arrhythmia, acute respiratory failure
Chronic: osteopenia and osteomalacia

58
Q

What is the treatment for a patient that is asymptomatic with a PO4 > 1

A

Neutra-phos

59
Q

What is the treatment for a patient that is symptomatic with PO4 < 1

A

IV therapy

Phosphate salts

Renal (8 decks)

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