Renal/Acid-Base

Question 0

Treatment if hypercalcemia

Answer 0

Mild-moderate (12-14) with mild Sx: avoid aggravating factors and PO hydration

Acutely rises to 12-14: IVF (NS) + Bisphosphonates

Severe Hypercalcemia (>14): ALWAYS requires Tx - same as above + calcitonin

Question 1

Symptoms of hypercalcemia

Answer 1

12-14: constipation/nausea

>14: lethargy, confusion, coma (likely 2/2 malignancy, such as breast, lung, or MM)

Question 2

Etiologies of hypercalcemia

Answer 2

Hyperparathyroidism (Primary)
Hypercalcemia of malignancy
Thiazide diuretics (HCTZ, chlorthalidone, metolazone)
Sarcoidosis (via ⬆️ calcitriol by activated macrophages)

Question 3

Etiology of hypocalcemia

Answer 3

Hypoalbuminemia (vol overload, malnutrition, nephrosis)
Acid-Base changes (acidity ⬇️Ca-albumin binding)
Hypoparathyroidism (⬇️PTH) usually post surgical
Vit D deficiency (⬆️️PTH)
Loop diuretics (FurBuTE)
Pancreatitis, osteobl mets, hyperphos
Alcoholism, malabsorption, cisplatin
Hypomagnesemia

Question 4

Symptoms if hypocalcemia

Answer 4

Tetany (perioral numbness, paresthesias, muscle cramps➡️carpal pedal spasm, laryngospasm, seizures)
SOB
Cardiac arrhythmias, prolonged QT

Question 5

Treatment of hypocalcemia

Answer 5

If low Mg, fix that FIRST
Mild sx (paresthesias) or NO Sx: PO calcium

Severe Sx (spasm, sz, ⬆️QT): IV calcium

Acute drop to <7.5 +- Sx: IV calcium

Question 6

Symptoms of hyperkalemia

Answer 6

Muscle weakness/paralysis

cardiac conducting abnormalities/arrhythmias

Question 7

Most common cause of hyperkalemia (generally)

Answer 7

Most commonly due to decreased renal excretion.
-K+ usually excreted via secretion by principal cells at the cortical collecting ducts…excretion req: adequate Aldo response to Aldo and distal sodium and water delivery

Question 8

Etiologies of decreased urinary excretion of potassium (causing hyperkalemia)

Answer 8

⬇️aldo: NSAIDs, ACE-inhibitors, heparin, calcineurin inhibitors

⬇️response to aldo: K+ sparing diuretics (SEAT)
⬇️volume (depletion)
AKI/CKD

Question 9

Causes of increased potassium released from cells

Answer 9

Pseudo hyperkalemia
Metabolic acidosis 
Insulin deficiency, Hyperglycemia, Hyperosmolality
Increased tissue catabolism
Beta blockers (beta-2 activity drives potassium into cells)
Digitalis overdose

Question 10

Treatment for hyperkalemia

Answer 10

IV calcium gluconate ➡️Beta agonist + insulin & glucose + sodium bicarbonate/kayexalate

C BIG K