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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
What are the classifications for hypomagnesemia?
Mild: 1 - 1.4 | Moderate - severe: < 1.0
26
What are the causes of hypermagnesemia?
Diet: poor nutrition Excess intake: magnesium supplements Renal sources: acute/chronic kidney failure Others: hypothyroidism, lithium, Addison's disease
27
What is the clinical presentation of hypermagnesemia?
Usually asymptomatic until > 4.0 | Cardiac abnormalities, hyporeflexia, somnolence, coma, respiratory depression
28
What is the treatment of hypermagnesemia?
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
What are the classifications for hypermagnesemia?
Mild/asymptomatic: < 4.0 | Moderate - severe (+ symptoms): > 4.0
30
What is normal calcium range?
8.5 - 10.8
31
What is normal phosphate range?
2.6 - 4.5
32
What are the causes of hyperphosphatemia?
CKD - secondary hyperparathyroidism | Rhabdomyolysis
33
What are the causes of hypocalcemia?
CKD - reduction in calcium absorption d/t decrease in active vitamin D production by kidney Surgically induced hypoparathyroidism Malnutrition
34
What are the clinical presentations for hyperphosphatemia?
Deposition of calcium-phosphorous crystals in joints, eyes, skin and vasculature
35
What are the clinical presentations for hypocalcemia?
``` Tetany Paresthesias Confusion Hypotension Bradycardia QT prolongation Long-term osteoporosis ```
36
What is the corrected calcium equation?
Measured Ca + 0.8[4-albumin]
37
What is the treatment of hypocalcemia when asymptomatic w/o CKD?
Oral calcium
38
What is the treatment of hypocalcemia when asymptomatic w/CKD?
May give ergocalciferol
39
What is the treatment of hypocalcemia when symptomatic?
IV calcium gluconate (Bolus or continuous)
40
How many milligrams of elemental calcium are in 1 gram of IV calcium gluconate?
90 mg
41
What is the treatment of hyperphosphatemia with normal renal function?
IV fluids + furosemide
42
What is the treatment of hyperphosphatemia with renal failure?
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
What are DDIs with calcium carbonate and acetate?
Iron Zinc FQ
44
Which drugs are chewable for phosphatemia?
Sucroferric oxyhydroxide | Lanthanum
45
Which drugs can be used for phsophatemia when calcifications are present?
Sevelamer
46
What are the side effects of calcium carbonate and acetate?
Constipation N/V/D Increased Ca
47
What are the side effects of sevelamer?
Pruritus | N/V/D
48
What are the side effects of lanthanum?
N/V/D
49
What are the side effects of sucroferric oxyhydroxide?
Dark colored feces | N/D
50
What are the DDIs with sucroferric oxyhydroxide?
Vit D analogs and levothyroxine
51
How much elemental iron is in sucroferric oxyhydroxide?
500mg
52
What are the causes of hypercalcemia?
Malignancy: bone, breast, lung Hyperparathyroidism Excessive intake Drugs: thiazide diuretics, lithium, tamoxifen
53
What are the causes of hypophosphatermia?
Phosphate binders Refeeding syndrome Alcoholism
54
What is the clinical presentation of hypercalcemia?
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
What are the treatments for hypercalcemia with functioning kidneys?
``` NS Furosemide Pamidronate Ibandronate Zoledronic acid Prednisone ```
56
What are the treatments for hypercalcemia with non-functioning kidneys?
Hemodialysis Calcitonin Prednisone
57
What is the clinical presentation of hypophosphatemia?
CNS: weakness, numbness, paresthesias, confusion Others: myalgias, bone pain, arrhythmia, acute respiratory failure Chronic: osteopenia and osteomalacia
58
What is the treatment for a patient that is asymptomatic with a PO4 > 1
Neutra-phos
59
What is the treatment for a patient that is symptomatic with PO4 < 1
IV therapy | Phosphate salts

Renal (8 decks)

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