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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

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, which electrolyte reabsorbs more?

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. which electrolyte excretes more

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
Q

aldo SE

A

incr plasma [Na+]
incr BV
incr HCO3-
decr plasma [K+]

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26
Q

ADH SE

A

incr BV
decr plasma [Na+]

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27
Q

central DI causes

A

inhibition of ADH
- lower BV
- incr [Na+]

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28
Q

synthetic ADH

A

DDAVP

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29
Q

what drug antagonizes ADH

A

demeclocycline

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30
Q

cushing’s

A

hyperactive adrenal cortex
incr cortisol
and/or incr aldosterone

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31
Q

cushing’s SE

A

hyperglycemia
incr BV
HTN
hypernatremia
hypokalemia
met alkalosis

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32
Q

addison’s

A

low cortisol
low aldosterone

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33
Q

addison’s SE

A

hypovolemia
hTN
hyponatremia
hyperkalemia
met acidosis
hypoglycemia

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34
Q

hyperaldosteronism AKA

A

primary aldosteronism
conn’s syndrome

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35
Q

conn’s

A

incr aldosterone
normal cortisol

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36
Q

conn’s SE

A

incr BV
possible HTN
hypernatremia
hypokalemia
met alkalosis

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37
Q

conn’s treatment

A

potassium sparing diuretics

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38
Q

hypoaldosterone

A

decr aldosterone
normal cortisol

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39
Q

hypoaldosterone SE

A

hyponatremia
hyperkalemia
met acidosis

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40
Q

which hormonal disorder is often a result of renal failure

A

hypoaldosteronism

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41
Q

renal failure can cause what electrolyte imbalance

A

hyperkalemia

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42
Q

hypernatremia

A

> 145 mEq/L

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43
Q

when you hear hypernatremia you should think?

A

water deficit

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44
Q

hypernatremia etiologies

A

Na+ retention > H2O retention
H2O loss > Na+ loss (dehydration)

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45
Q

can hypernatremia occur with incr BV

A

yes

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46
Q

hypernatremia SE

A

brain cells shrink
HTN
hyperreflexia
NMB potentiation

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47
Q

hypernatremia ECG changes

A

none

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48
Q

hypernatremia MAC reqs

A

increased MAC reqs

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49
Q

central DI

A

posterior pituitary fails to secrete ADH

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50
Q

central DI treatment

A

hypotonic fluids
vasopressin/DDAVP
thiazide diuretics

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51
Q

nephrogenic DI

A

kidneys dont respond to ADH

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52
Q

central DI leads to

A

hypernatremia

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53
Q

nephrogenic DI leads to

A

hypernatremia

54
Q

nephrogenic DI treatment

A

hypotonic fluids
thiazide diuretics

55
Q

hyponatremia

A

< 135 mEq/L

56
Q

most common electrolyte abnormality in hospitalized pts

A

hyponatremia

57
Q

hyponatremia etiologies

A

water retention
Na+ loss > H2O loss (dehydration)
hypothyroidism

58
Q

SIADH

A

excessive ADH
=== hyponatremia

59
Q

do SIADH pts present with edema?

A

no - they are hyponatremic and euvolemic

60
Q

AIDS

A

adrenal infection w/excessive ADH
== hyponatremia

61
Q

hyponatremia makes the intravascular space

A

hypotonic

62
Q

hyponatremia SE

A

cerebral edema
altered mental states
muscle weakness

63
Q

hyponatremia ECG changes

A

none

64
Q

why is irrigation used during a TURP

A

to allow visualization

65
Q

what type of fluid required during TURP

A

hypotonic (electrolyte free)
in order to allow for cautery

66
Q

what is the problem with hypotonic fluid during TURP

A

can be absorbed and lead to volume overload w/hyponatremia

67
Q

TURP syndrome

A

volume overload
hyponatremia

68
Q

what solution can be used with TURP with laser

A

normal saline

69
Q

which solution is most common for TURP

A

glycine

70
Q

glycine SE

A

transient visual impairment
myocardial depression

71
Q

distilled water SE

A

hemolysis
shock
renal failure

72
Q

isonatremic dehydration

A

138-145

73
Q

hyponatremic dehydration

A

< 135

74
Q

hypernatremic dehydration

A

> 150

75
Q

highest [K+] allowed before canx elective surgery

A

5.5

76
Q

lowest [K+] allowed before canx elective surgery

A

2.8

77
Q

insulin drives K+

A

intracellulary

78
Q

insulin _______ plasma [K+]

A

decr [K+]

79
Q

beta activation ______ plasma [K+]

A

decr [K+]

80
Q

beta blockers ______ plasma [K+]

A

incr [K+]

81
Q
A

hyperkalemia

82
Q
A

hypokalemia

83
Q

K+ and H+ relationship

A

K+ enters
H+ exits

(inverse)

84
Q

hyperkalemia etiology

A

beta blocker
acidosis
sux
RBC transfusion
cell lysis
renal insufficiency
adrenal insufficiency
ACE inhibitors
rewarming after hypothermia

85
Q

intubation dose of sux raises [K+]

A

0.5 mEq/L

86
Q

hyperkalemia ECG

A

peaked T
smaller P amplitude
incr PR interval
widen QRS
sine wave ECG

87
Q

hyperkalemia SE

A

ecg changes
muscular weakness

88
Q

hyperkalemia temporary treatment

A

insulin
bicarb
hyperventilation
calcium

89
Q

hyperkalemia longer lasting treatment

A

kayexalate
diuretics
dialysis

90
Q

which meds can induce hypokalemia but are not considered treatments for hyperkalemia?

A

beta agnonists
(albuterol, epi)

91
Q

hyperkalemia treatment: insulin

A

5g dextrose / 1 unit insulin

(1 amp D50 / 5 u insulin)

92
Q

hypokalemia etiologies

A

insulin
diuresis
sympathetic stimulation
alkalosis
RBC transfusions
dialysis
GI loss/vomiting
hypothermia
hypomagnesemia

93
Q

GI loss/vomiting hypokalemia mechanisms

A

decr K+ ions in gastric fluids
metabolic alkalosis due to loss of acidic gastric fluid

94
Q

hypothermia and hypokalemia

A

hypothermia causes sympathetic stimulation which shifts K+ intracellularly

95
Q

hypokalemia ecg

A

flat/inverted T waves
U waves

96
Q

hypokalemia SE

A

ecg changes
muscular weakness
NMB potentiation
resp distress/arrest

97
Q

hypokalemia treatment

A

KCl infusion

98
Q

KCl infusion periperhal

A

8-10 mEq/hr

99
Q

KCl infusion central

A

20 mEq/hr

100
Q

20 mEq of K+ should incr plasma by

A

0.25 mEq/L

101
Q

what should you avoid in hypokalemic pts

A

dextrose solutions

102
Q

which hypokalemic patients should you avoid aggressive treatment?

A

hypothermia
head trauma w/incr ICP

103
Q

bowel obstruction electrolyte imbalance

A

hyponatremia
hypernatremia
hypochloremia
hypokalemia
metabolic alkalosis

104
Q

pyloric stenosis pts electrolyte imbalance

A

metabolic alkalosis
hypochloremia
hypokalemia

105
Q

fluid of choice in pyloric stenosis

A

normal saline

106
Q

pyloric stenosis Cl- goal

A

> 85 mEq/L

107
Q

pyloric stenosis K+ goal

A

> 3 mEq/L

108
Q

pyloric stenosis Na+ goal

A

> 130 mEq/L

109
Q

pyloric stenosis venous CO2 goal

A

< 30 mEq/L

110
Q

pts with pyloric stenosis are more prone to what in PACU

A

hypoventilation

111
Q

hypochloremia etiologies

A

bowel obstruction/NV
diuretics
sodium bicarb w/o chloride
met alkalosis
resp acidosis

112
Q

hyperchloremia etiologies

A

met acidosis
resp alkalosis
excess normal saline admin

113
Q

PTH SE

A

decr bone Ca2+
incr plasma Ca2+

114
Q

calcitonin SE

A

incr bone Ca2+
decr plasma Ca2+

115
Q

hypercalcemia etiologies

A

hyperparathyroid
acidosis
late stage cancer

116
Q

hypercalcemia ECG

A

short QT

117
Q

hypercalcemia SE

A

muscular weakness
hypovolemia
NMB potentiation
CNS symptoms
hypomagenesemia
renal stones

118
Q

hypercalcemia treatment

A

normal saline
loop diuretic
calcitonin
dialysis
avoid acidosis

119
Q

hypocalcemia etiologies

A

hypoparathyroidism
hypermag
hypomag
vit D deficiency
renal failure

120
Q

hypocalcemia ecg

A

prolonged QT

121
Q

hypocalcemia SE

A

hyperreflexia
laryngeal stridor
masseter spasm
laryngospasm
muscle weakness
NMB potentiation
CNS symptoms

122
Q

hypocalcemia treatment

A

IV CaCl or CaGlu

123
Q

hypermag etiologies

A

iatrogenic
(rarely renal failure)

124
Q

hypermag ecg

A

short QT
prolong PR inteval
T wave abnormalities

125
Q

hypermag ecg may resemble

A

hyperkalemia

126
Q

hypermag SE

A

muscle weakness
NMB potentiation
CNS symptoms
hTN

127
Q

hypermag treatment

A

CaCl
loop diuretic
volume expansion (Fluids)
dialysis

128
Q

hypomag etiologies

A

decr GI absorption
incr renal loss
hypercalcemia

129
Q

hypomag ecg

A

possible prolong QT
long PR intervals
wide QRS
ventricular arrythmia

130
Q

hypomag SE

A

muscle weakness
neuromuscular hyperexcitability
NMB potentiation
CNS symptoms
hypokalemia

131
Q

hypomag treatment

A

1-2 g mag sulfate over 10 mins

132
Q

surgical stress response

A

HTN
tachycardia
incr ADH
incr aldosterone
incr glucagon
hyperglycemia
decr insulin
inflammation
hypercoag
decr fibrinolysis

Fa: Methods 2 (16 decks)

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