McCarthy: K+, Ca+, Mg Flashcards by Jacqui Joseph

Albumin is __ grams in reference to calculating the corrected calcium

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normal lab value: total Ca+, ionized Ca+

total: 8.5 – 10.5 mg/dl
ionized: 4.6-5.1 mg/dl

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normal lab value: phosphorous

2.5-4.5 mg/dl.

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what kind of Ca is biologically active?

only free (ionized) is biologically active

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effect on/from Ca and/or K balance? D50

aka glucose(dextrose + H2O)

used to txt hyperKalemia, can cause hypoKalemia
increase blood sugar (given with insulin)- if hyperkalemia is bad enough, very acidodic
give w/out insulin, the body would produce insulin and drive K+ into cells

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effect on/from Ca and/or K balance? insulin

txt hyperKalemia

- helps drive K+ into cells

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effect on/from Ca and/or K balance? Kayexelate

used to txt hyperKalemia
-binds K+ in GI and excretes it in feces
Removal of K+ takes time, so short term tx strategies involve temporary shifts of K+ from extracellular to intracellular compartment
(kayexalate = cation exchange resin)

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effect on/from Ca and/or K balance? albuterol

used to txt hyperKalemia
-drives K+ into the cells
(via increasing activity of Na/K-ATPase pump)
( B2 agonist )

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effect on/from Ca and/or K balance? calcitonin

txt hyperCalcemia by inhibiting bone resorption

osteoclast inhibitor

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effect on/from Ca and/or K balance? bicarbonate

txts hyperKalemia
(when caused by acidosis)
-Acidosis: H+ in ECF, it enters cell to buffer, K+ leaves cell to balance. there is then DECREASED driving force for K+ secretion = hyperkalemia
*can cause slight alkalosis

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effect on/from Ca and/or K balance? CCBs

if you see on test, this is a WRONG answer

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effect on/from Ca and/or K balance? ARBs

txt hypoKalemia

-raises blood potassium

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effect on/from Ca and/or K balance? ACE-Is (lisinopril)

txt hypoKalemia

-raises blood potassium

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effect on/from Ca and/or K balance? prednisone

increases urinary losses of potassium (hypokalemia)

-manifests in people with too much cortisol (cushing’s- causes hypokalemia)

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effect on/from Ca and/or K balance? Digoxin

worry about increased digoxin toxicity with hypoKalemia (when on diuretic and digoxin- can get hypoKalemia and a fatal arrhythmia)
-WONT drive K in or out of cell specifically. it inhibits the Na/K atpase pump- inhibiting K from going into the extracellular space
(not used much anymore)

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effect on/from Ca and/or K balance? TZD (hydrochlorothiazide)

can CAUSE hypokalemia
-acts on the early distal tubule cells (upstream of principle cells) = increase Na+ delivery to principle cells= more Na+ reabs. here and more K+ secreted.

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effect on/from Ca and/or K balance? K+-sparing diuretics

spironolactone/triamterene

can CAUSE hyperkalemia
Acts on early distal tubule cells and collecting duct principal cells.
Should be avoided in renal dysfunction patients.

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effect on/from Ca and/or K balance? loop diuretics (lasix/furosemide)

can CAUSE hypokalemia

- Acts on thick ascending loop of Henle

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effect on/from Ca and/or K balance? loop diuretics (lasix/furosemide)

can CAUSE hypokalemia

- Acts on thick ascending loop of Henle

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normal lab values: Mg

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1.8 – 2.7 mg/dl

overall: increased Na+ delivery to principle cells causes what effect on K+?

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increased K+ excretion

*With the exception of metolozone, thiazide diuretics are not effective in what pts?

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pt w/ renal insufficiency (GFR < 30)

what disorders can cause increased PTH?

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primary hyperparathyroidism
pseudohypo-parathyroidism
chronic renal failure
vit D deficiency

what disorders can cause decreased PTH?

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surgical hypo-parathyroidism

- humoral hypercalcemia of malignancy

what disorders can cause increased serum Ca+ ?

- primary hyperparathyroidism | - humoral hypercalcemia or malignancy

what disorders can cause increased serum Ca+, and decreased serum phosphate ?

- primary hyperparathyroidism | - humoral hypercalcemia or malignancy

what disorders can cause decreased serum Ca+, and increased serum phosphate?

- surgical hypo-parathyroidism - pseudohypo-parathyroidism - chronic renal failure

how can you tell the difference between chronic renal failure and vit D deficiency?

BOTH: increased PTH, low Ca+ chronic renal failure: high phosphate vit D def.: low phosphate

what disorders have increased urine cAMP?

- primary hyperparathyroidism - humoral hypercalcemia or malignancy (same as those with increased Ca+ and decreased phosphate)

what disorders have decreased urine cAMP?

- surgical hypo-parathyroidism - pseudohypo-parathyroidism (same as those with decreased Ca+ and increased phosphate - except renal failure)

what is primary hyperparathyroidism?

is a disorder of one or more of the parathyroid glands - The parathyroid gland(s) becomes overactive and secretes excess amounts of parathyroid hormone (PTH). = blood Ca+ rises to a level that is higher than normal (called hypercalcemia).

what is surgical hypoparathyroidism? symptoms?

symptoms post-neck surgery: check symtpoms of hypoparathyroidism (may be sign of destruction of parathyroid) -neural irritability : tingling, numbness, parasthesias (b/c easier to depolarize).

hyperventilation (maybe weeds) | -how does it effect Ca+ and PTH

blowing off CO2 = alkalotic … leads to tingling, numbness, parasthesias (from decr. ionized Ca+) when pH normal- there is competition between neg. charges, H+ and Ca+. but if you dec. H+ ion conc, theres a greater chance for Ca+ to bind vacant albumin- then you DO have decr. ionized Ca+ (serum) —> but PTH should respond and correct this.

txt for decreased ionized Ca+ from hyperventilation (if PTH doesn't respond and correct it) ?

TXT with Calcium and active form of vit D (1,25 dihydroxycholecalciferol)

what is pseudohypoparathyroidism?

parathyroid is normal looks like surgical hypoparathyroid except PTH also high receptors on the bones and kidney in target tissue. -you have normal/high PTH but its not working on the receptors of target tissue

what is humoral hypercalcemia of malignancy?

humoral hypercalcemia of malignancy- most common kind of hypercalcemia- lung cancer (squamous cell carcinoma) tumor acts just like PTH - activates receptors in bone and kidney - hyperCa and decr. phos increased urine cAMP

chronic renal failure

decrease GFR = incr. serum phosphorous ( and inverse relationship with calcium so you get hypocalcemia) -naturally stimulate PTH

txt for primary hyperparathyroidism

txt with surgery (remove parathyroid glands) medical txt: txt underlying disease. hyperCa+ makes them volumed depleted so txt with saline to restore volume, txt with lasix (block Na+ reabs so you dont get Ca+ reabs. = calcium diuersis to lower Ca+)- once they are hydrated, then give IV bisphosphonates. goal to prevent initial hyperphosphatemia- give calcium carbonate (binder) - so complex is not absorbed.

txt for surgical hypoparathyroidism

calcium and activated form vitamin D (1,25)

txt for humoral hypercalcemia of malignancy

hyperCa+ makes them volumed depleted so... - txt with saline to restore volume - txt with lasix (block Na+ reabs so you dont get Ca+ reabs. = calcium diuersis to lower Ca+) - once hydrated, txt w/ IV bisphosphonates.

txt chronic renal failure

goal: prevent initial hyperphosphatemia | - give calcium carbonate (binder) - so complex is not absorbed.

Urinary potassium excretion, is primarily determined by secretion where?

in the principal cells in the cortical collecting tubule

how does aldosterone effect K+ excretion?

increases K + excretion

metabolic acidosis (and hyperosmolarity) cause of K+ shifts into or out of cells?

shifts K OUT of cell, causing hyperkalemia

alkalosis and (hypo-osmolarity) both cause K+ to go into or out of the cell?

shifts K+ INTO cell , causing hypokalemia

insulin deficiency causes what change to K+?

hyperkalemia (b/c can't be driven into cells)

decrease in GFR causes what change in K+? how does this happen? what are two causes of this?

hyperkalemia - b/c diminished Na+ and H2O delivery to distal tubule (principal cells) (decrease GFR causes- renal failure or severe CHF - w/ volume depletions)

low aldosterone (hypoaldosteronism) has what effect on K+? what drugs may cause this?

hyperkalemia (NSAIDs, ACEs, spironolactone, etc.) - also primary adrenal insufficiency

McCarthy: K+, Ca+, Mg Flashcards

(48 cards)