Fluids and Electrolytes

Question 1

Where is potassium reabsorbed in the nephrons?

Answer 1

The proximal tubule

Question 2

Where is potassium reabsorbed in the nephrons?

Answer 2

The proximal tubule

Question 3

How is potassium eliminated?

Answer 3

90% renally

10% in feces

Question 4

What are 4 medications that can help bring potassium into cells?

Answer 4

Beta-adrenergic agents, insulin, aldosterone, and acid/base.

Question 5

During acidosis would the patient be at risk for hyperkalemia or hypokalemia? Why?

Answer 5

Hyperkalemia because the body will push H+ into cells and exchange it with K+ to increase the pH of the blood.

Question 6

During alkalosis would the patient be at risk for hyperkalemia or hypokalemia? Why?

Answer 6

Hypokalemia because there will be a lack of H+ and the body will push H+ out of the cell exchanging it with K+ and lead to a reduction in blood pH.

Question 7

What is the serum potassium in hypokalemia?

Question 8

If I give someone 10mEq of potassium how much will their serum levels of potassium increase?

Answer 8

0.1mEq/L.

Question 9

How much potassium can be given orally at one time?

Answer 9

40mEq.

Question 10

Can you push potassium IV?

Answer 10

No!

Question 11

How much potassium can you give in a peripheral line?

Answer 11

10mEq/hour

Question 12

How much potassium can you give in a central line?

Answer 12

20mEq/hour

Question 13

What is the serum potassium level during hyperkalemia?

Answer 13

> 5mEq/L

Question 14

What is the serum potassium level during hyperkalemia?

Answer 14

> 5mEq/L

Question 15

How is potassium eliminated?

Answer 15

90% renally

10% in feces

Question 16

What are 4 medications that can help bring potassium into cells?

Answer 16

Beta-adrenergic agents, insulin, aldosterone, and acid/base.

Question 17

During acidosis would the patient be at risk for hyperkalemia or hypokalemia? Why?

Answer 17

Hyperkalemia because the body will push H+ into cells and exchange it with K+ to increase the pH of the blood.

Question 18

During alkalosis would the patient be at risk for hyperkalemia or hypokalemia? Why?

Answer 18

Hypokalemia because there will be a lack of H+ and the body will push H+ out of the cell exchanging it with K+ and lead to a reduction in blood pH.

Question 19

What is the serum potassium in hypokalemia?

Question 20

For severe hyperkalemia, what are the acute temporary tx options?

Answer 20

10 units insulin + dextrose
Beta agonist
Bicarbonate

Question 21

How much potassium can be given orally at one time?

Answer 21

40mEq.

Question 22

Can you push potassium IV?

Answer 22

No!

Question 23

How much potassium can you give in a peripheral line?

Answer 23

10mEq/hour

Question 24

How much potassium can you give in a central line?

Answer 24

20mEq/hour

Question 25

What is the most common form of potassium that we give?

Answer 25

KCl

Question 26

What is the serum potassium level during hyperkalemia?

Answer 26

>5mEq/L

Question 27

What are 4 things that decrease the output of potassium?

Answer 27

Kidney disease Medications Acidosis Diabetes

Question 28

What are 4 things that increase input of potassium?

Answer 28

Over replacement Overuse of K supplements Medications Potassium rich foods (kale)

Question 29

Medications that reduce _______ secretion will cause a lower output of potassium.

Answer 29

Aldosterone

Question 30

What are some symptoms of hyperkalemia?

Answer 30

Peak T waves on the EKG Muscle cramping Arrhythmias

Question 31

When is hyperkalemia severe?

Answer 31

Potassium>7 or EKG changes

Question 32

How do you treat severe hyperkalemia?

Answer 32

Stabilize the myocardium with Calcium IV. Then you use acute tx.

Question 33

For severe hyperkalemia, what are the acute temporary tx options?

Answer 33

10 units insulin + dextrose Beta agonist Bicarbonate

Question 34

Where is magnesium absorbed in the nephrons?

Answer 34

Loop of Henle

Question 35

Where is magnesium found?

Answer 35

Bone and muscle

Question 36

What is the serum level for hypomagnesemia?

Question 37

What is the serum level for hypermagnesemia?

Answer 37

>2.3mg/dL

Question 38

What are the 4 big things that can lead to hypokalemia?

Answer 38

Diuretics, diarrhea, decreased absorption, and low magnesium

Question 39

What are 4 causes of low magnesium?

Answer 39

Alcoholism, diarrhea, low calcium, and low magnesium.

Question 40

What are symptoms of hypomagnesium?

Answer 40

Muscle cramping, disruption in nerve conduction (seizures, coma, etc.), sometimes asymptomatic, and QT prolongation (Torsades de Pointes)

Question 41

How do you treat low magnesium?

Answer 41

You want to give magnesium through IV at a slow rate (usually MgSulfate). If you must use oral magnesium use MgOxide b/c of the high Mg percentage.

Question 42

What are some causes of hypermagnesium?

Answer 42

Kidney failure or disease, over consumption of antacids, and over correction of hypomagnesium.

Question 43

How do you treat hypermagnesium?

Answer 43

Avoid magnesium, diuretics, can use calcium chloride if they have an arrhythmia.

Question 44

Where is phosphorus found?

Answer 44

Bone and intracellular fluid

Question 45

Where is phosphorus reabsorbed in the nephrons?

Answer 45

The proximal tubule.

Question 46

What is the serum level of hypophosphatemia?

Question 47

What are some symptoms of hypophosphatemia?

Answer 47

Issues breathing, respiratory failure, body can't use oxygen as efficiently, muscle cramping, rigid red blood cells, compromised immune system.

Question 48

How do you treat hypophosphatemia?

Answer 48

You want to give PO over IV. You can give IV when the patient has diarrhea, which prevents absorption.

Question 49

What are the serum levels for hyperphosphatemia?

Answer 49

> 4.5 mEq/L

Question 50

What are some causes of hyperphosphatemia?

Answer 50

Renal failure, red blood cell lysis, a decrease in calcium, carbonated beverages.

Question 51

What are some symptoms of hyperphosphatemia?

Answer 51

Usually asymptomatic Muscle cramping Calcium phosphate precipitation (can lead to obstructive nephrpathy)

Question 52

How do you treat hyperphosphatemia?

Answer 52

Use binders to decrease the absorption of phosphorus (can be calcium acetate or aluminum, but you can't use aluminum in patients with renal failure)

Question 53

What are the serum levels in hypocalcemia?

Question 54

What are some causes of hypocalcemia?

Answer 54

Hypomagnesemia, hypoparathyroidism, medications, not enough intake, not enough vitamin D.

Question 55

What are the serum levels in hypercalcemia?

Answer 55

> 10.5 mg/dL

Question 56

What are some causes of hypercalcemia?

Answer 56

Lithium, no excretion, too much bone resorption, lack of water

Question 57

What are some symptoms of hypercalcemia?

Answer 57

Kidney stones, GI symptoms, short QT, and severe pain.

Question 58

How do you treat hypercalcemia?

Answer 58

Rehydration, diuretics, sometimes calcitonin

Question 59

What is the first line treatment for hypercalcemia in patients with cancer?

Answer 59

Bisphosphonates. Might use corticosteroids may be used in cases of multiple myeloma or other malignancies where steroids are part of usual treatment

Question 60

How do you treat hypercalcemia in patients with kidney disease?

Answer 60

Avoid diuretics | May need diuresis

Question 61

What is normal osmolarity?

Answer 61

275-290 mOsm/kg

Question 62

What do we give when a patient is severely hyponatremic?

Answer 62

100 mL 3% saline every 10 minutes

Question 63

What is the rate at which you should correct hyponatremia if it is not severe?

Answer 63

8-10 mEq/L over 24 hours, or 18 mEq/L over 48 hours

Question 64

When a patient has isotonic hyponatremia what must you rule out?

Answer 64

Pseudohyponatremia

Question 65

What is the most common form of hyponatremia?

Answer 65

Hypotonic

Question 66

How do you treat hypotonic hyponatremia?

Answer 66

Establish a volume status