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inpatient medicine > nephrology/fluid/electrolyte/acid/base > Flashcards

nephrology/fluid/electrolyte/acid/base Flashcards

1
Q

what are the etiologies of HYPOcalcemia c/ dec PTH

A

MC hypoparathyroidism 2/2 parathyroid destruction, autoimmune or post surg

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2
Q

what are the etiologies of HYPOcalcemia c/ inc PTH

A

chronic renal dz, liver,dz, vit D def (osteomalacia & rickets)
hypomagnesemia, inc phos, hypoalbumenemia

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3
Q

what are the clinical manifestations of HYPOcalcemia

A

dec excitation threshold for heart, nerves & muscle
neuromuscular: cramp, spasm, syncope, seizure, FINGER/CIRCUMORAL PARESTHESIA, CHVOSTEK, TROUSSEAU, INC DTR, dry skin, D/abd pain/cramp

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4
Q

what are the lab findings ass c/ HYPOcalcemia

A

dec ionized Ca and tot serum Ca

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5
Q

what will HYPOcalcemia do to ECG

A

prolong QT interval

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6
Q

how do you manage HYPOcalcemia

A

severe- IV Ca gluconate; mild PO Ca + vit D (ergocalciferol, calcitriol), K, Mg repletion

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7
Q

what is Chvostek sign

A

facial spasm c/ tappin of facial N

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8
Q

what is Trousseau sign

A

inflate BP cuff above systolic causes carpal spasm

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9
Q

what are the eti of HYPERcalcemia

A

90% 2/2 primary hyperparathyroidism or malignancy

inc intact PTH, dec phosphate; thiazides can do this independant of PTH

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10
Q

what are the clinical manifestations of HYPERcalcemia

A

inc excitation threshold for heart, nerves, muscle - = dec DTR- most pt asymptomatic +/- arrhythmia

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11
Q

what does stones, bones, groans, and psychiatric overtones have to do with HYPERcalcemia

A

kidney stones- (Ca oxylate & phosphate), nephrogenic diabetes insipidus; bones- painful, fractures 2/2 remodeling; groans- abdominal- ileus, constipation, N/V; psych- weak, fatigue, depressed

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12
Q

what does HYPERcalcemia do to ECG

A

shortens the QT interval-leads II, V5/6- T looks wider, prolongs the PR and QRS widening

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13
Q

what are the tx for HYPERcalcemia

A

IV saline/ furosemide (lasix) loop diuretic enhances renal Ca excretion if severe/malignancy + bisphosphonates, calcitonin; avoid HCTZ

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14
Q

what are the eti of HYPOphosphatemia

A

primary hyperparathyroidism, excessive IV glucose (insulin shifts phosphate into cells); refeeding syn in ETOHics; resp alkalosis, vit D def

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15
Q

clinical manifestations of HYPOphosphatemia

A

diffuse m. weakness, flaccid paralysis( 2/2 dec ATP), rhabdomyolosis

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16
Q

what are the mgmt of HYPOphosphatemia

A

phosphate repletion- K-phos, Na-phos

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17
Q

what are the eti of HYPERphosphatemia

A

renal failure, pri hypoparathyroid, vit D intox

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18
Q

what are the clin manifest of HYPERphos

A

soft tiss calcifications- most asx, heart block

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19
Q

what are the mgmt of HYPERphos

A

renal failure: phosphate binders (Ca acetate, carbonate, sevelamer(renagel)), dec dietary phos (dairy, dark cola, hydration), acetazolamide

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20
Q

what are the eti of HYPOnatremia

A

impaired kidney free water excretion (inc ADH) can’t make dilute urine; inc water intake

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21
Q

what are clin manifest of HYPOnatremia

A

CNS dysfunction 2/2 cerebral edema- hypotonic shift H2O into cells, alt mental stat, fatigue, HA, N/V m. cramps, seizure

22
Q

what lab w/u for HYPO-Na

A

serum Na

23
Q

What is the mgmt for hypotonic HYPO-na

A

ISOvol-H2O restrict

24
Q

what is the mgmt for hypertonic HYPO-na

A

NS until HD stable then switch to 1/2NS

25
Q

what is the tx for severe ISO or HYPER vol HYPO-na

A

hypertonic saline c/ furosemide

26
Q

what are ADE of correcting NA >0.5mEq/L/h

A

demyelination, cerebral edema

27
Q

what are the eti of HYPER-Na

A

net H2O loss, inadequate H2O intake, or hypertonic Na gain; impaired thirst mech, infant/elderly

28
Q

what are clin manifest of HYPER-Na

A

CNS dysfxn (brain cells shrink) hypertonicity shifts H2O out of cells, confusion, lethargy, coma, M. weak, seizure

29
Q

what are lab find in HYPER-Na

A

serum Na>145 also order Uosm, UNa

30
Q

what is mgmt of HYPER-Na

A

hypotonic fluids-replace H2o deficit, PO preferred (pure H2O, D5W, 0.45%NS, 0.2%NS; AVOID 0.9%NS except in frank circulatory compromise

31
Q

what are the eti of HYPO-magnesemia

A

GI loss: malabsorption ETOHics, ciliac, bowel sx, D/V, laxitives
RENAL loss: diuretics (thiazide, loop), DM, MEDS (PPI, amphoteracin, cisplatin..)

32
Q

what are clin manifest of HYPO-mag

A

neurovasc: AMS, lethargy, weak, m. cramp, inc DTR, tetany, impaired PTH secretion, hypocalcemia, arrhythmia

33
Q

what lab findings are ass c/ HYPOmag

A

HYPOkalemia, HYPOcalcemia

34
Q

what can HYPO-mag do to ECG

A

prolong PR, QTint, R on T & torsades

35
Q

what is mgmt of HYPO-mag

A

IV mag sulfate

mild- oral mag- HYPO-Ca and HYPO-K usually refractory until mag repleated

36
Q

what are eti of HYPER-mag

A

rare MC renal insufficiency/fail, over correction of HYPO

37
Q

what are clin manifest of HYPER-mag

A

dec DTR/HYPOreflexive, N/V skin flush, weak, AMS, bradyarrhythmias

38
Q

what are ECG find of HYPER-mag

A

BRADYarhythmias, prolonged PRI/QTI, wide QRS

39
Q

what is mgmt of HYPER-mag

A

mild-IV fluid + furosemide

severe- Calcium Gluconate- antag mag and stab cardiac membrane

40
Q

what are the eti of HYPOkalemia

A

inc urinary/GI loss MC V/D, diuretics, metabolic acidosis

41
Q

what are clin manifest of HYPO-kal

A

severe M. weakness (inc resp), rhabdo, nephrogenic DI, polyuria, dec DTR, palpitations, arrhythmia

42
Q

what should you rule out c/ labs in HYPO-kal

A

HYPO-mag

43
Q

what ECG find of HYPO-kal

A

T-wave flattening, prominent U wave

44
Q

what is the mgmt of HYPO-kal

A

oral KCL IV if severe, K sparing diuretics (spironolactone, amiloride) tx HYPO-mag, use non dex IV

45
Q

what is one of the major risks of HYPO-kal

A

digitalis toxicity

46
Q

what are the eti of HYPER-kal

A

dec renal excrete/renal fail, dec aldosterone, adrenal insuff, MEDS (diuretics, ACEI/ARB, digoxin, BB, NSAIDs, cyclosporin), cell lysis, metab acidosis

47
Q

what are clin manifest of HYPER-kal

A

progressive ascending neuromuscular weakness, fatigue, paresthesia; CV: palpitations, arrhythmias; GI: abd distention, diarrhea

48
Q

what lab findings would you expect to find in HYPER-kal

A

BMP (K>5.0, glucose, bicarb abnorm 2/2 acidosis), CBC-hemolysis, CK -rhabdo

49
Q

what ECG find ass c/ HYPER-kal

A

tall, peaked T waves, short QTI, wide QRS, flat P wave

50
Q

mgmt HYPER-kal

A

IV calcium gluconate , insulin c/ glucose (shifts K intracell), B2 agonist, kayexalate (enhances GI K excretion, lowers tot body K), bicarb, loop diuretic

inpatient medicine (2 decks)

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