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Fa: Methods 2 > 12. Management of Electrolyte Abnormalities > Flashcards

12. Management of Electrolyte Abnormalities Flashcards

1
Q

highest [Na+] allowed before canx elective surgery

A

150 mEq/L

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2
Q

lowest [Na+] allowed before canx elective surgery

A

130 mEq/L

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3
Q

what happens when Na+ is reabsorbed
(5)

A
  1. H2O reabsorbed
  2. BV incr
  3. Bicarb reabsorbed
  4. Cl- reabsorbed
  5. K+ excreted
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4
Q

what does bicarb reabsorption cause

A

metabolic alkalosis

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5
Q

what is a cause for metabolic alkalosis

A

dehydration

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6
Q

relationship between HCO3- and Cl-

A

inverse
- if one is absorbed, the other is excreted

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7
Q
A

hypochloremia

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8
Q
A

hyperchloremia

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9
Q
A

hypochloremia

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10
Q
A

hyperchloremia

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11
Q

with N/S admin, does Na+ reabsorb with more Cl- or HCO3-?

A

Na+ reabsorbs with more Cl-

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12
Q

acidosis caused by excess N/S admin

A

hyperchloremia metabolic acidosis

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13
Q

loop diuretics cause excretion of what?

A

Na+
Cl-

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14
Q

with loop diuretics, does Na+ excrete more with Cl- or HCO3-

A

Na+ excretes with more Cl-

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15
Q

loop diuretics are associated with

A

hypokalemia
hypochloremia
hyponatremia
metabolic alkalosis

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16
Q

a hypotensive or hypovolemic patient wil secrete ______ to incr BP

A

renin

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17
Q

renin function

A

converts angiotensinogen to ang 1

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18
Q

ACE function

A

converts ang 1 to ang 2

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19
Q

where is ACE enzyme produced

A

in the lungs

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20
Q

ang 2 causes

A

vasoconstriction
incr aldosterone
incr ADH

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21
Q

ADH function

A

water reabsoprtion

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22
Q

aldosterone function

A

Na+ and water reabsorption

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23
Q

what ultimately increases BP

A

ang2 induced vasoconstriction
ADH/aldo incr BV

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24
Q

with increased aldosterone, plasma [Na+] will

A

increase
(Na+ reabs > H2O reabs)

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25
aldo SE
incr plasma [Na+] incr BV incr HCO3- decr plasma [K+]
26
ADH SE
incr BV decr plasma [Na+]
27
central DI causes
inhibition of ADH - lower BV - incr [Na+]
28
synthetic ADH
DDAVP
29
what drug antagonizes ADH
demeclocycline
30
cushing's
hyperactive adrenal cortex incr cortisol and/or incr aldosterone
31
cushing's SE
hyperglycemia incr BV HTN hypernatremia hypokalemia met alkalosis
32
addison's
low cortisol low aldosterone
33
addison's SE
hypovolemia hTN hyponatremia hyperkalemia met acidosis hypoglycemia
34
hyperaldosteronism AKA
primary aldosteronism conn's syndrome
35
conn's
incr aldosterone normal cortisol
36
conn's SE
incr BV possible HTN hypernatremia hypokalemia met alkalosis
37
conn's treatment
potassium sparing diuretics
38
hypoaldosterone
decr aldosterone normal cortisol
39
hypoaldosterone SE
hyponatremia hyperkalemia met acidosis
40
which hormonal disorder is often a result of renal failure
hypoaldosteronism
41
renal failure can cause what electrolyte imbalance
hyperkalemia
42
hypernatremia
> 145 mEq/L
43
when you hear hypernatremia you should think?
water deficit
44
hypernatremia etiologies
Na+ retention > H2O retention H2O loss > Na+ loss (dehydration)
45
can hypernatremia occur with incr BV
yes
46
hypernatremia SE
brain cells shrink HTN hyperreflexia NMB potentiation
47
hypernatremia ECG changes
none
48
hypernatremia MAC reqs
increased MAC reqs
49
central DI
posterior pituitary fails to secrete ADH
50
central DI treatment
hypotonic fluids vasopressin/DDAVP thiazide diuretics
51
nephrogenic DI
kidneys dont respond to ADH
52
central DI leads to
hypernatremia
53
nephrogenic DI leads to
hypernatremia
54
nephrogenic DI treatment
hypotonic fluids thiazide diuretics
55
hyponatremia
< 135 mEq/L
56
most common electrolyte abnormality in hospitalized pts
hyponatremia
57
hyponatremia etiologies
water retention Na+ loss > H2O loss (dehydration) hypothyroidism
58
SIADH
excessive ADH === hyponatremia
59
do SIADH pts present with edema?
no - they are hyponatremic and euvolemic
60
AIDS
adrenal infection w/excessive ADH == hyponatremia
61
hyponatremia makes the intravascular space
hypotonic
62
hyponatremia SE
cerebral edema altered mental states muscle weakness
63
hyponatremia ECG changes
none
64
why is irrigation used during a TURP
to allow visualization
65
what type of fluid required during TURP
hypotonic (electrolyte free) in order to allow for cautery
66
what is the problem with hypotonic fluid during TURP
can be absorbed and lead to volume overload w/hyponatremia
67
TURP syndrome
volume overload hyponatremia
68
what solution can be used with TURP with laser
normal saline
69
which solution is most common for TURP
glycine
70
glycine SE
transient visual impairment myocardial depression
71
distilled water SE
hemolysis shock renal failure
72
isonatremic dehydration
138-145
73
hyponatremic dehydration
< 135
74
hypernatremic dehydration
> 150
75
highest [K+] allowed before canx elective surgery
5.5
76
lowest [K+] allowed before canx elective surgery
2.8
77
insulin drives K+
intracellulary
78
insulin _______ plasma [K+]
decr [K+]
79
beta activation ______ plasma [K+]
decr [K+]
80
beta blockers ______ plasma [K+]
incr [K+]
81
[K+]: acidosis
hyperkalemia
82
[K+]: alkalosis
hypokalemia
83
K+ and H+ relationship
K+ enters H+ exits (inverse)
84
hyperkalemia etiologies (9)
beta blocker acidosis sux RBC transfusion cell lysis renal insufficiency adrenal insufficiency ACE inhibitors rewarming after hypothermia
85
intubation dose of sux raises [K+]
0.5 mEq/L
86
hyperkalemia ECG
peaked T smaller P amplitude incr PR interval widen QRS sine wave ECG
87
hyperkalemia SE
ecg changes muscular weakness
88
hyperkalemia temporary treatment
insulin bicarb hyperventilation calcium
89
hyperkalemia longer lasting treatment
kayexalate diuretics dialysis
90
which meds can induce hypokalemia but are not considered treatments for hyperkalemia?
beta agnonists (albuterol, epi)
91
hyperkalemia treatment: insulin
5g dextrose / 1 unit insulin (1 amp D50 / 5 u insulin)
92
hypokalemia etiologies (9)
insulin diuresis sympathetic stimulation alkalosis RBC transfusions dialysis GI loss/vomiting hypothermia hypomagnesemia
93
GI loss/vomiting hypokalemia mechanisms
decr K+ ions in gastric fluids metabolic alkalosis due to loss of acidic gastric fluid
94
hypothermia and hypokalemia
hypothermia causes sympathetic stimulation which shifts K+ intracellularly
95
hypokalemia ecg
flat/inverted T waves U waves
96
hypokalemia SE
ecg changes muscular weakness NMB potentiation resp distress/arrest
97
hypokalemia treatment
KCl infusion
98
KCl infusion periperhal
8-10 mEq/hr
99
KCl infusion central
20 mEq/hr
100
20 mEq of K+ should incr plasma by
0.25 mEq/L
101
what should you avoid in hypokalemic pts
dextrose solutions
102
which hypokalemic patients should you avoid aggressive treatment?
hypothermia head trauma w/incr ICP
103
bowel obstruction electrolyte imbalance
hyponatremia hypernatremia hypochloremia hypokalemia metabolic alkalosis
104
pyloric stenosis pts electrolyte imbalance
metabolic alkalosis hypochloremia hypokalemia
105
fluid of choice in pyloric stenosis
normal saline
106
pyloric stenosis Cl- goal
> 85 mEq/L
107
pyloric stenosis K+ goal
> 3 mEq/L
108
pyloric stenosis Na+ goal
> 130 mEq/L
109
pyloric stenosis venous CO2 goal
< 30 mEq/L
110
pts with pyloric stenosis are more prone to what in PACU
hypoventilation
111
hypochloremia etiologies
bowel obstruction/NV diuretics sodium bicarb w/o chloride met alkalosis resp acidosis
112
hyperchloremia etiologies
met acidosis resp alkalosis excess normal saline admin
113
PTH SE
decr bone Ca2+ incr plasma Ca2+
114
calcitonin SE
incr bone Ca2+ decr plasma Ca2+
115
hypercalcemia etiologies
hyperparathyroid acidosis late stage cancer
116
hypercalcemia ECG
short QT
117
hypercalcemia SE
muscular weakness hypovolemia NMB potentiation CNS symptoms hypomagenesemia renal stones
118
hypercalcemia treatment
normal saline loop diuretic calcitonin dialysis avoid acidosis
119
hypocalcemia etiologies
hypoparathyroidism hypermag hypomag vit D deficiency renal failure
120
hypocalcemia ecg
prolonged QT
121
hypocalcemia SE
hyperreflexia laryngeal stridor masseter spasm laryngospasm muscle weakness NMB potentiation CNS symptoms
122
hypocalcemia treatment
IV CaCl or CaGlu
123
hypermag etiologies
iatrogenic (rarely renal failure)
124
hypermag ecg
short QT prolong PR inteval T wave abnormalities
125
hypermag ecg may resemble
hyperkalemia
126
hypermag SE
muscle weakness NMB potentiation CNS symptoms hTN
127
hypermag treatment
CaCl loop diuretic volume expansion (Fluids) dialysis
128
hypomag etiologies
decr GI absorption incr renal loss hypercalcemia
129
hypomag ecg
possible prolong QT long PR intervals wide QRS ventricular arrythmia
130
hypomag SE
muscle weakness neuromuscular hyperexcitability NMB potentiation CNS symptoms hypokalemia
131
hypomag treatment
1-2 g mag sulfate over 10 mins
132
surgical stress response
HTN tachycardia incr ADH incr aldosterone incr glucagon hyperglycemia decr insulin inflammation hypercoag decr fibrinolysis

Fa: Methods 2 (16 decks)

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