(2) Common problems in acute care Flashcards

1
Q

Hyponatremia - evaluation

A

Most common electrolyte abnormality

Urine sodium - normal 10-20
Serum osmolality - normal 275-285
Clinical status

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2
Q

Urine sodium > 20

A

suggests kidney issue

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3
Q

Urine sodium < 10

A

suggests problem outside of kidney

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4
Q

Isotonic Hyponatremia - s/s and treatment

A

Pseudohyponatremia
- occurs with extreme HLD, high protein leves
s/s - asymptomatic - usually found on labs

Treatment - cut down on fat

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5
Q

Hypotonic Hyponatremia - assessment

A

Serum osmo < 280
Are they hyper/hypovolemic?
If Hypervolemic - assess for extrarenal salt loss or renal salt wasting?

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6
Q

Any time in acute care you see diarrhea, what should you test for?

A

C-difficile

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7
Q

Hypovolemic Hypotonic Hypernatremia
w/ urine sodium < 10
Causes (3)

A

Dehydration
Diarrhea
Vomiting or prolonged NGT suctioning

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8
Q

Hypovolemic Hypotonic Hypernatremia
w/ urine sodium > 20
Causes (3)

A

Low volume - kidneys cannot conserve NA

    • Diuretics**
    • ACE inhibitors
    • Mineralocorticoid deficiency
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9
Q

Hypervolemic Hypotonic Hypernatremia
MOST COMMON
Causes (3)

Treatment

A
Any Edematous states
-- CHF
-- Liver disease
-- Advanced renal failure
Treatment - restrict fluids
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10
Q

Hypertonic Hyponatremia
serum osmo is?
Most common cause?

A

Serum osmo > 290

Hyperglycemia - usually HHNK

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11
Q

Hyponatremia management?

A
Treatment based on cause
Hypervolemic - fluid restriction 
Hypovolemic - give IVF - normal saline
Symptomatic - give NS with loop diuretic
CNS symptoms - consider 3% and lasix
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12
Q

What rate do you administer 3% saline to a hyponatremic patient?

A

slow and calculated

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13
Q

Hypernatremia

Management

A

Usually due to excess water loss

Depends on cause
Hypovolemia – NS followed by half
Euvolemia – D5W
Hypervolemia - D5W and lasix or dialysis

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14
Q

Normal potassium levels

A

3-5.5

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15
Q

Normal sodium levels

A

135-145

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16
Q

Hypokalemia - causes

A

Diuretics
Alkalosis
GI loss
Excess renal loss

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17
Q

Elevated serum epinephrine in trauma patients may contribute to:

A

Hypokalemia

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18
Q

Hypokalemia - s/s (4)

A

Muscular weakness
Fatigue
Muscle cramps - legs hurt early afternoon
Constipation

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19
Q

Severe Hypokalemia s/s (4)

A

Severe < 2.5

    • flaccid paralysis
    • tetany
    • hyporeflexia
    • rhabdomyolosis
20
Q

Hypokalemia - diagnostics

A

Decreased amplitude on ECG
Broad T waves
Prominent U waves
multifocal PVCs, V-tach, V-fib

21
Q

Hypokalemia managemet

A

2.5-4 give PO or 10 mEq/hr IV
< 2.5 or severe s/s may give 40 mEq/hr
– Give magnesium if refractory hypokalemia

22
Q

Hyperkalemia - causes

A
excess intake 
renal failure 
drugs - NSAIDS 
hypoaldosteronism
cell death
acidosis - shifts extracellular
23
Q

At what rate does K increase with drop in pH?

A

0.7 mEq/L for every 0.1 drop in pH

24
Q

If you replace K 3 times in 8 hours and potassium doesn’t move, what is likely the issue?

A

Hypomagnesemia

25
Hyperkalemia - diagnosis
ECG - tall peaked T-waves
26
Hyperkalemia - management
Kayexalate | Insulin 10 U regular with D50
27
How does insulin and d50 reduce K?
It pushes it into the cell.
28
Why is Calcium important?
Important as a mediator of neuromuscular and cardiac function
29
What is normal ionized calcium
4.5-5.5 mg/dl and does not vary with albumin level
30
Hypocalcemia
Pancreatitis Renal failure Severe trauma Blood transfusions
31
Hypocalcemia
Increased DTR Trousseau's sign - Caropopedal spasm Chvostek's - cheek blink
32
Hypercalcemia
Sluggish - - Fatigue - - muscle weakness - - Depression - - Anorexia - - N/V - -Constipation
33
Severe Hypercalcemia
Can cause coma and death | > 12 is considered a medical emergency
34
Hypercalcemia treatment
Calcitonin Dialysis If > 12 NS infusion with loop diuretic
35
HYPOcalcemia management
``` ABG - check pH Acute - Calcium gluconate Chronic - Oral supplements -- Vitamin D -- Aluminum hydroxide ```
36
If a patient has a normal calcium level (8.5-10.5 mg/dl) but a low albumin, what does this suggest?
Hypercalcemia - because 50% of calcium is bound to albumin
37
Corrected calcium formula
total Ca + 0.8 or (4-serum albumin)
38
What is Chvostek's sign?
twitching of the facial muscles in response to tapping over the area of the facial nerve Hypocalcemia
39
What is Trousseau's sign?
Blood pressure cuff around arm for 3 minutes will induce spasm in the forarm and hand Hypocalcemia
40
Acid-base imbalances | Respiratory Acidosis
pH < 7.35
41
pH - 7.28 CO2 - 50 Bicarb - 25
Respiratory acidosis - Lethargic - Overdose Treatment - ventilation, narcan
42
pH 7.50 CO2 - 25 Bicarb 25
Respiratory alkalosis - Hyperventilation Treatment - sedation
43
pH < 7.35 CO2 - 35-45 Bicarb < 22
Metabolic acidosis
44
Anion Gap
{Na + K} - {HCO3 + Cl}
45
Higher the anion gap
The more acutely ill the patient is
46
Acetazolamide - Diamox
Metabolic alkalosis
47
"ROME"
Respiratory opposite | Metabolic equal