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1. Internal Medicine I > 13. Electrolyte disorders > Flashcards

13. Electrolyte disorders Flashcards

1
Q

What are the three main electrolyte disorders?

A

Disorders of potassium metabolism, disorders of sodium metabolism, and disorders of magnesium metabolism.

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2
Q

What is hypokalemia?

A

Hypokalemia is defined as serum potassium levels below 3.5 mmol/L.

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3
Q

What are the clinical manifestations of hypokalemia?

A
  • Hypertension,
  • arrhythmias,
  • sudden cardiac death,
  • weakness,
  • rhabdomyolysis,
  • alterations in acid-base balance (metabolic alkalosis),
  • paralytic ileus.
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4
Q

What are the long-term effects of hypokalemia?

A

Mortality, risks of cardiovascular disease increase, renal cyst formation, and renal fibrosis.

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5
Q

What is pseudohypokalemia?

A

Artificial hypokalemia in blood sample - e.g in acute leukemia (leukocytes take up potassium).

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6
Q

What are the causes of redistribution hypokalemia?

A

Aldosterone increase, β2-adrenergic effects, anabolic state, insulin, and alkalosis.

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7
Q

What are the etiologies of hypokalemia?

A
  • PseudohypoK
  • Redistribubtion (shifts from ECF to ICF)
  • Extrarenal loss
  • Renal loss
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8
Q

What are the causes of renal loss hypokalemia?

A
  • Medications such as thiazide, furosemide,
  • bicarbonaturia, and
  • magnesium deficiency (increased ROMK-mediated secretion).
  • genetic diseases (bartter, gitelman)
  • hormonal diseases (liddle, cushing)
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9
Q

What is the definition of hyperkalemia?

A

Hyperkalemia, if Se K > 5.5 mmol/L.

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10
Q

What are some clinical manifestations of hyperkalemia?

A
  • muscle weakness (diaphragmatic muscle-respiratory failure),
  • metabolic acidosis,
  • ECG changes: peaked T waves, STD, prolonged QRS, ventricular fibrillation, etc.
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11
Q

What are the etiologies of hyperkalemia?

A
  • PseudohyperK
  • Redistribution
  • Excess intake
  • Impaired renal excretion
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12
Q

What are the causes of pseudohyperkalemia?

A

Hemolysis, difficult phlebotomy.

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13
Q

What are the causes of impaired renal excretion hyperkalemia?

A
  • Medication such as ACEi, ARB, spironolactone,
  • obstructive uropathy,
  • aldosterone deficiency/resistance, Addison’s disease, pseudohypoaldosteronism.
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14
Q

What is the treatment for severe hyperkalemia?

A
  • 10% Ca-gluconate 10mL/10min
  • insulin (4 to 10U/h) with 10% dextrose iv,
  • hemodialysis,
  • β2 agonist by nebulizer (albuterol).
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15
Q

What are the methods for potassium removal in hyperkalemia treatment?

A
  • Resin (sodium/calcium polystyren-sulfonate) 15-60g/day (per os or as retention enema),
  • diuretics such as furosemide and thiazide.
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16
Q

What are the treatments for chronic hyperkalemia?

A

Review of medication, dietary restrictions, intermittent resin/Patiromer treatment, fludrocortisone.

17
Q

What is the definition of hyponatremia?

A

Se Na < 135 mmol/L.

18
Q

What are the clinical signs of hyponatremia?

A
  • Headache,
  • yawning, lethargy,
  • nausea,
  • reversible ataxia,
  • psychosis,
  • seizures, cerebral edema, tentorial herniation,
  • respiratory depression.
19
Q

What is the differential diagnosis for hyponatremia?

A
  • Pseudohyponatremia,
  • translocational hyponatremia (movement of water from ICF to ECF)
  • real/hypotonic hyponatremia. (serum Na AND osm decrease)
20
Q

Etiology of hyponatremia

A
  • Hypovolemia : Renal / extrarenal losses
  • Euvolemia : glucocorticoid deficiency, hypothyroidism, SIADH
  • Hypervolemia : Renal loss, water retention
21
Q

What is the diagnostic criteria for SIAD?

A
  • Se Osm ↓,
  • Urinary Osm > 100 mOsm /kgH2O,
  • Hyponatremia
  • euvolemia.
22
Q

What is the treatment for symptomatic hyponatremia?

A

NaCl infusion in 1 hour ±furosemide

23
Q

What is the risk associated with rapid correction of SeNa in the treatment of hyponatremia?

A

Central pontine myelinolysis (CPM) - osmotic demyelination.

24
Q

What is hypernatremia?

A

Hypernatremia is defined as a serum sodium level greater than 145 mmol/L.

25
Q

What are the clinical manifestations of hypernatremia?

A
  • altered mental status, irritability, restlessness
  • lethargy,
  • seizures, muscle twitching, spasticity
  • hyperreflexia,
  • fever,
  • nausea, vomiting,
  • labored breathing.
26
Q

What is the treatment for hypernatremia?

A

The treatment for hypernatremia involves frequent control of serum sodium levels, with a maximum correction of 8 mmol/L per 24 hours. Treatment of too rapid correction involves dextrose IV and desmopressin.

27
Q

What are the risk factors for hypernatremia?

A

The risk factors for hypernatremia include the elderly, infants, hypertonic infusions, tube feeding, mechanical ventilation, uncontrolled diabetes mellitus, and polyuric disorders.

28
Q

What are the causes of hypernatremia?

A
  1. Hypovolemic : extrarenal and renal loss (diuretics, osmotic diuresis -DM)
  2. Euvolemic : diabetes
  3. Hypervolemic : sodium gain - hyperaldosteronism, cushing’s
29
Q

What is the treatment for hypernatremia?

A
  • Hypo / euvolemic : correction of water deficit
  • Removal of Na (furosemide, hemodialysis)
30
Q

What is the maximum speed of correction for hypernatremia?

A

2 mmol/L/hour, 10 mmol/L/day (caution: cerebral edema).

31
Q

What are the causes of hypermagnesemia?

A

Renal failure, Mg supplementation, familial hypocalciuric.

32
Q

What is the normal value of serum magnesium in women?

A

0.75 to 1.0 mmol/L.

33
Q

What are the causes of hypermagnesemia?

A
  • Renal failure,
  • Mg supplementation,
  • familial hypocalciuric hypercalcemia,
  • acromegaly,
  • adrenal insufficiency.
34
Q

What are the symptoms of hypermagnesemia?

A

Deep tendon reflexes decrease, paralysis

35
Q

What is the treatment for hypermagnesemia?

A

Ca-gluconate iv.

36
Q

What are the causes of hypomagnesemia?

A
  • Decreased intake, malabsorption,
  • increased excretion : polyuric disease, prolonged infusion with excessive Na content, primary aldosteronism, Gitelman syndrome
  • medication (aminoglycosides, calcineurin inhibitors, amphotericin, thiazide
  • other (acute pancreatitis, chr. alcoholism, idiopathic).
37
Q

What are the symptoms of hypomagnesemia?

A

Weakness, hyperreflexia, tremor, spasm, ECG: prolonged QT interval, ST depression, risk of arrhythmias ↑.

38
Q

What is the treatment for hypomagnesemia?

A

MgSO4 iv., per os Mg-salts.

1. Internal Medicine I (20 decks)

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