Nuggets to remember Flashcards
(22 cards)
What causes hypernatremic and hypervalemic states?
What causes hypernatremic and hypovalemic states?
What are common causes of SIADH?
Sodium overload, TUBE FEEDINGS.
GI losses, diuretics, diuresis.
Certain cancers like lung or pancreatic, ADH analogues, SSRI’s, Anti psychotics, Pulmonary infection, CNS disorders.
What causes hyponatremia, hypovalemic, and hypotonic states? Is this often seen with dehydration or edema?
How can you treat hypo, hypo, hypo? At what rate should you never correct faster than?
What causes hyponatremia, hypotonic, and hypervalemic states? Is this often seen with dehydration or edema?
thiazide diuretics, diarrhea, vomiting, etc. Dehydration.
Saline solutions .9% NaCl is gold standard. 6-12 mEq/L, can cause severe hypotonic reaction.
Heart failure, kidney failure, cirrhosis. Edema.
How can you treat hyponatremia, hypotonic, and hypervalemic states?
How can you treat SIADH?
What causes hypernatremia, and hypovalemic state?
Sodium and water restrictions, loop diuretics, occasionally vaptans.
Water restriction, loop diuretics, demeclocycline, vaptans.
Diuretics, osmotic diuresis, GI losses, poor water intake have low sodium and low water, dehydration state.
How to treat hypernatremia and hypovalemic state? What should you not correct quicker than and why?
How do you treat hypernatremia and hypervalemic states?
What causes hypernatremia and euvolemic states?
Free water replacement and Saline solution. Don’t correct quicker than 10-12 mEq per day as this may cause cerebral edema.
Free water replacement and loop diuretics.
Diabetes insipidus. Water gain only.
What are causes of central DI? Commonly seen symptoms?
What are causes of nephrogenic DI? Commonly seen symptoms?
How do you treat Central DI?
How do you treat Nephrogenic DI?
Inadequate ADH secretion, caused by injury to CNS. High urination and lots of water drinking.
Causes are kidney failure, chronic hypokalemia and hyper calcemia, demeclocycline, lithium, hereditary disorders.
Desmopressin, Carbamazepine, Chlorpromazine, Clofibrate.
Thiazide diuretics, salt restriction.
What are the intracellular electrolytes?
What are the extracellular electrolytes?
How is potassium regulated?
Magnesium, potassium, phosphate.
Sodium, Chloride.
GI excretion, urinary excretion, food intake, hormonal by insulin, catacholimines, aldosterone.
What are some common causes of hypokalemia?
What is the nugget to remember about hypokalemia and magnesium?
How to treat hypokalemia? General rule for potassium replacement?
Epinephrine, Beta 2 agonists, caffeine, thyolline, insulin(overdose), diuretics, naficillin, ampicillin, mineralcorticosteroids, amphotericin B, cisplatin, aminoglycosides, laxatives, sodium polystyrene sulfate
Remember to check and replace magnesium when treating hypokalemia!
Potassium! 10 mEq pill = 0.1 mEq in serum, usually target 4 mEq.
Primary potassium ADR? How to reduce?
Concerns with IV potassium? What is the big no no to watch out for?
What is the rate at which you can give IV potassium?
GI upset. Divide dose 2-4 doses separated by 2-4 hours. Give microencapsulated formulation. Give with food.
Can cause phlebitis, cardiac concerns, hyperkalemia, pain at infusion site, Vesicant, arrythmias. NEVER give potassium IV push.
Peripheral line administration 10 mEq/100 mL. Central line administration is 20-40 mEq/mL.
What are some drug causes of hyperkalemia?
What are your treatment options for hyperkalemia?
What to watch out for when giving IV calcium for hyperkalemia?
ACEi’s, ARB’s, aliskiren, spironolactone, triamterene, NSAIDS, beta blockers.
Calcium gluconate, calcium chloride heart protection. Albuterol, Insulin +/- dextrose, Sodium Bicarbonate for intracellular shift. Excrete K is furosemide, sodium polystyrene, patriomer.
Calcium chloride is 3x as potent as calcium chloride, more likely to cause tissue necrosis.
What drugs can cause hypomagnesia?
Hallmark signs of hypomagnesia?
What to know about magnesium replacement? What is the IV infusion rate of magnesium?
aminoglycosides, amphotecerin B, digoxin, foscarnet, PPI’s, cisplatin, tacrolimus.
Trousseau sign(hand), chotvskys sign(face).
Can cause diarrhea, give in spread out doses, sustained release formulations help prevent diarrhea. 1 gram per hour.
What drugs can cause hypermagnesia?
How to treat hypermagnesia?
What are the parameters for body pH? pCO2? HCO3?
Treatment of eclampsia in pregnancy(lots of magnesium), lithium, epsom salts, milk of magnesia.
Reduce intake, IV hydration or loop diuretics, IV calcium if cardiac symptoms present.
7.36-7.44. 36-44. 21-27.
In acid base disorders, what is the acid, what is the base and where are they found?
What are some causes of hypochloremia?
What are some causes of hyperchloremia?
Acid–> pCO2 found in lungs. Base–> HCO3 found in kidneys.
loss of chloride, dilution of chloride, decreased uptake of chloride(loops and thiazides).
Concentration of chloride, loss of bicarbonate.
What is the basic stuff to know for metabolic acidosis?
Metabolic alkalosis?
Respiratory acidosis?
Respiratory alkalosis?
Low pH, low HCO3, low pCO2, increased respiration.
High pH, high HCO3, high pCO2, decreased respiration.
Low pH, High pCO2, high HCO3. Kidneys retain HCO3.
High pH, low pCO2, low HCO3. Kidneys excrete HCO3.
Anion gap equation and range?
Causes of anion gap metabolic acidosis(MUDPILES)?
Causes of non anion gap metabolic acidosis(CaRDS)?
Sodium - (Cl+HCO3). More than 17 is anion gap. 3-11 is normal.
Methanol, Uremia, DKA, Propolyne glycol, Intoxication or infection or isonazoid, Lactic acidosis, Ethylene glycol, Salicylates or Sepsis.
Acetazolamide, Renal tubular acidosis, Diarrhea, Spironolactone or Saline excess.
How to treat metabolic acidosis?
Causes of metabolic alkalosis?
Treatment of metabolic alkalosis(Chlean my ASS)?
Treatment with base or THAM.
Vomiting, diuresis, nasogastric suction, hypokalemia, excess mineralcorticoid activity.
Anything with Chloride, Acetazolamide plus potassium, Spironolactone, IV normal saline.
Causes of respiratory acidosis? How to treat?
Causes of respiratory alkalosis? How to treat?
Respiratory system disorders, lungs can’t excrete CO2. Treat under lying cause, oxygen, mechanical respiration if needed.
Encountered in people who are pregnant and at high altitudes, central nervous stimulation. Treat under lying cause, oxygen, mechanical respiration if needed.
Corrected calcium formula?
Will decreased vitamin D levels increase or decrease parathyroid hormone?
What are hypocalcemia causes?
Calcium +(.8*(4-albumin)).
Increase.
Renal failure, hypoparathyroidism, Vitamin D deficiency, bisphophonates, medications.
What are the vitamin D drugs?
Which oral calcium replacement should be taken with food?
What is the max recommended dose of calcium and why?
anything that ends in rol or iol.
Tums, Calcium citrate doesn’t matter.
500 mg due to absorption.
What are the calcium replenishment IV pearls?
What causes hypercalcemia?
How can you treat hypercalcemia?
Give slowly, give calcium gluconate, will exacerbate hypokalemia symptoms.
Thiazide diuretics, Lithium, abuse of calcium containing antacids, malignancies, hyperparathyroidism.
Normal Saline, Furosemide, Pamidronate, Zoledronic Acid, Calcitonin, Cinacalet.
What causes hypophosphatemia?
Which phosphate replacement has the most potassium?
Which phosphate replacements have no sodium?
Respiratory alkalosis, Medications, Antacid use, anorexia or bulimia or chronic alcohol abuse, hyperparathyroidism, vitamin D deficiency.
Neutra-Phos-K, Phos-Nak Neutra-Phos, KPO4.
Neutra-Phos-K, KPO4.
What rate should you give phosphate IV?
What causes hyperphosphatemia?
What is the most potent phosphate binder?
7.5 mMol/hr to prevent symptomatic hypocalcemia.
Hypoparathyroidism, rhabdomyolsis, lots of vitamin d, phosphate containing laxatives, etc.
Amphojel, Alternagel.
What two phosphate binders have calcium?
What 4 phosphate binders are calcium and aluminum free?
What 2 phosphate binders have iron in them?
Tums, Phoslo.
FosRenol, Renvela, Auryxia, Velphoro.
Auryxia, Velphoro.
