Metabolic Emergencies

Question 1

Osmolarity =

Answer 1

2*NA + glucose/20 + BUN/3

Question 2

In true hyponatremia the osmolality is

Answer 2

decreased

Question 3

hyponatremia with an osmotic pressure >295

Answer 3

Hypertonic hyponatremia

MCC is hyperglycemia

Question 4

hyponatremia with an osmotic pressure 275-295

Answer 4

Isotonic hyponatremia

Question 5

hyponatremia with an osmotic pressure <275

Answer 5

Hypotonic Hyponatremia

Question 6

Causes of hypovolemic hyponatremia

Answer 6

Renal: urinary sodium >20
Extrarental: urinary sodium <20

Question 7

SIADH causes what kind of hyponatremia typically

Answer 7

euvolemic hyponatremia

= hypotonic

Question 8

during treatment of hyponatremia, do not raise the sodium more than ______mEq/L/hr

Answer 8

2

Question 9

What sodium level is hypernatremia

Answer 9

> 150

Question 10

What sodium level is hyponatremia

Answer 10

<135

Question 11

hypervolemic hyponatremia with urinary sodium >20

Answer 11

renal failure

Question 12

MC lyte abnormality

Answer 12

Hypokalemia

Question 13

ECG –T wave flattening or inversion, U waves, ST depression, PVC’s, wide QRS, tachyarrhythmias

Answer 13

Hypokalemia

Question 14

When K is <___ you should use IV replacement

Answer 14

2.5

admit

Question 15

K>2.5 and no ECG findings significant symptoms treatment is

Answer 15

PO K replacement and discharge home

Question 16

MCC of hyperkalemia

Answer 16

factitious

dt hemolysis during phlebotomy

Question 17

Treatment of severe/emergent hyperkalemia

Answer 17

Albuterol
Calcium chloride & gluconate
Sodium bicarb
Insulin & glucose
Furosemid
~Dialysis
Sodium polystyrene sulfonate

Question 18

Cushings disease could be implicated in what lyte abnormality commonly

Answer 18

hypernatremia

Question 19

EKG changes seen with hyperkalemia

Answer 19

prolonged PR
tall peaked T waves
short QT
flat p waves, QRS wide
become sinusoidal pattern

Question 20

hypocalcemia reflexes

Answer 20

hyperreflexia
=Trouseeau’s sign
carpopedal spasm
Chvostek’s sign

Question 21

Chovostek’s sign

Answer 21

contraction of the facial muscles after percussion over the facial nerve
=HYPOcalcemia

Question 22

what EKG changes are seen with hypocalcemia

Answer 22

prolonged QT
sinus brady
heart block
VT/VF

Question 23

acutely symptomatic or severe hypocalcemia treatment

Answer 23

IV calcium gluconated 10ml over 10-15min

Question 24

hypercalcemia usually caused by

Answer 24

malignancy or hyperparathyroidism

Question 25

stones bones moans and groans

Answer 25

hypercalcemia

Question 26

EKG of hypercalcemia

Answer 26

shortened QT widened t waves bradys, BBB, AV blocks

Question 27

Hypocalcemia treatment

Answer 27

``` Volume replacement Mithramycin- decreases levels Pamidronate- inhibits bone resorption Calcitonin Hydrocortisone ~furosemide ~dialysis if severe ```

Question 28

what is seen on EKG with hypomagnesemia

Answer 28

tachys torsades prolonged PR and QT

Question 29

tx for hypermagnesemia

Answer 29

calcium gluconate/chloride (antagonizes) Furosemide + IV NS Dialysis if very high or renal failure

Question 30

pH down HC03- down CO2 down

Answer 30

Metabolic acidosis

Question 31

pH up HCO3 up CO2 up

Answer 31

Metabolic alkalosis

Question 32

pH down HCO3 up CO2 up

Answer 32

Respiratory acidosis

Question 33

pH up HCO3 down CO2 down

Answer 33

Respiratory alkalosis

Question 34

COPD likely to cause what acid base imbalance

Answer 34

respiratory acidosis

Question 35

Asthma likely to cause what acid base imbalance

Answer 35

resp alkalosis

Question 36

salicylate toxicity

Answer 36

likely to cause what acid base imbalance

Question 37

Normal anion gap

Answer 37

10-12

Question 38

causes of anion gap acidosis

Answer 38

``` Alcohol Methanol Uremia Diabetic ketoacidosis Paraldehyde Iron, Isoniazid Lactic acidosis Ethylene glycol Carbon monoxide Aspirin Toluene ```

Question 39

MCC anion gap metabolic acidosis

Answer 39

lactic acidosis dt decreased oxygen to tissues | sepsis, shock

Question 40

diarrhea associated with what acid base imbalance

Answer 40

losing bicarb | =non AG metabolic acidosis

Question 41

osmolar gap

Answer 41

difference between measured and calculated – normal < 10

Question 42

Bicarb is given in metabolic acidosis if

Answer 42

<7.2 | not responding to measures and myocardial irritability

Question 43

if alcoholic and hypoglycemic

Answer 43

give thiamine IV before dextrose to prevent Wernicke-Korsakoff syndrome

Question 44

if pt isn't awake and cant establish IV with hypoglycemia

Answer 44

glucagon IM | effective in 10min

Question 45

tx in sulfonylurea induced hypoglycemia

Answer 45

octreotide SQ

Question 46

DKA labs

Answer 46

can do venous BG (vs ABG) | venous is 0.03 less than arterial

Question 47

order or priorities in treatment of DKA

Answer 47

``` Volume NS, glucose to 250 then D% Potassium correction replace if <5.3 follow q2hrs Insulin drip follow q1hr ```

Question 48

hyperosmolar hyperglycemic state seen in

Answer 48

DMII (most commonly)

Question 49

``` glucose >600 Osmolality >315 bicarb >15 pH >7.3 ketones neg- few ```

Answer 49

hyperosmolar hyperglycemic state

Question 50

thyrotoxicosis is

Answer 50

excess circulating hormone from any cause

Question 51

AMS ophthalmoplegia gait ataxia

Answer 51

Wernicke-Korsakoff syn