9-10

Question 1

What is the purpose of the TTKG?

Answer 1

Assess renal K secretion by cortical collecting ducts.

K urine • Osm serum)/(Osm urine • K serum

Question 2

Hyperkalemia is serum K >

Answer 2

5.5 mmol/L

Question 3

Hyporeninemic hypoaldosteronism can cause ___

Answer 3

Hyperkalemia

Question 4

Renal resistance to ___ can cause hyperkalemia

Answer 4

Mineralcorticoids

Question 5

Addisons and Schmidts syndrome can both cause

Answer 5

Hyperkalemia

Question 6

Does hypo or hyperkalemia lead to v fib?

Answer 6

Both can

Question 7

EKG findings with K=
6
7
9
10

Answer 7

6- peaked t waves, flattened p waves, increased PR interval
7- widened QRS
9- deep S waves, merging of S and T waves
>10- v fib, arrest

Question 8

Give Calcium Gluconate IV when ___

Answer 8

K>6
Requires emergency reduction
Abnormal ECG

Question 9

Medications used to redistribute K into cells, to reduce plasma K

Answer 9

• 10 units IV insulin, then 50 ml of 50% dextrose
• albuterol along with insulin and glucose
• IV bicarbonate (only if pt also has metabolic acidosis)

Question 10

Hypokalemia is K<

Answer 10

3.5 mmol/L

Question 11

So what is normal K?

Answer 11

3.5-5.5 mmol/L

Question 12

In hypokalemia, If urine K is high (>15) think ____.

If it is low (<15) think ____.

Answer 12

Renal loss

Extrarenal loss

Question 13

Torsades De Pointes can result from ___

Answer 13

Severe hypokalemia (<2.5)

Question 14

In hyperkalemia think about what cation first? Hypo?

Answer 14

Ca first

Mg first

Question 15

What is the most abundant electrolyte in the human body? Where is it mainly located?

Answer 15

Ca
Bone (inactive) - 99%
Ionized Ca is active elsewhere

Question 16

In response to low Ca levels, the ___ releases ___

Answer 16

Parathyroid gland releases PTH

Question 17

In the kidney, modulation of Ca occurs where?

Answer 17

Distal nephron

Question 18

How do the following affect Ca in the urine?

1. Acidosis
2. Alkalosis
3. Loop diuretics
4. Mannitol diuretics
5. Thiazide diuretics
6. Amiloride diuretics

Answer 18

1. Hypercalciuria
2. Hypo
3. Hyper
4. Hyper
5. Hypo
6. Hypo

Question 19

False vs true hypercalcemia

Answer 19

False: increased total Ca from increased total proteins (does not change ionized, active Ca)
True: increased free plasma Ca

Question 20

Increases in albumin of 1 g/dL increases plasma Ca by ___

Answer 20

0.8-1 mg/dL

Question 21

Cancer-related things that can cause hypercalcemia

Answer 21

Neoplastic disease
Primary adenoma
Primary diffuse hyperplasia
Cancer
Multiple endocrine neoplasia

Question 22

Other things things that can cause hypercalcemia (CHIMPANZEES)

Answer 22

C – Calcium supplementation
H – Hydrochlorothiazide, hyperparathyroidism
I – Iatrogenic, immobilization
M – Multiple myeloma, milk-alkali syndrome, medication (e.g Lithium)
P – Parathyroid hyperplasia or adenoma
A – Alcohol, Acromegaly, Addisons 
N – Neoplasm
Z – Zollinger Ellison syndrome
E – Excessive vitamin D
E – Excessive vitamin A
S – Sarcoidosis

Question 23

PTH acts (quickly/slowly)

Answer 23

Quickly

Moment to moment

Question 24

Treatment of hypercalcemia

Answer 24

Saline
Loop diuretics 
Dialysis
Calcitonin
Steroids
IV bisphosphonates

Question 25

Causes of hypocalcemia

Answer 25

``` Renal failure Vitamin D deficiency Mg deficiency Acute pancreatitis Hypoparathyroidism and pseudo- Infusion of phosphate, citrate, or Ca free albumin ```

Question 26

Causes of hyperphosphatemia

Answer 26

``` Renal failure (stage 4 or 5, when GFR<25) Hypoparathyroidism ```

Question 27

Clinical manifestations of hyperphosphatemia

Answer 27

Formation of Ca-P complexes in soft tissue, joints, and kidneys

Question 28

Hyperphosphatemia treatment

Answer 28

Aluminum salts Ca salts Mg salts *all bind P to reduce absorption

Question 29

Causes of hypophosphatemia

Answer 29

``` Inadequate intake Increased excretion (PTH, genetics) ```

Question 30

Clinical manifestations of hypophosphatemia

Answer 30

Metabolic encephalopathy RBC, leukocyte, and platelet dysfunction Decreased muscle strength

Question 31

What is the second most abundant intracellular cation in the human body? It is an essential cofactor for ____ and regulates ___

Answer 31

Mg ATPase enzymes PTH

Question 32

Causes of hypermagnesemia

Answer 32

Renal insufficiency | Hemolysis

Question 33

Clinical manifestations of hypermagnesemia

Answer 33

Cardiac conduction delays Depressed contractility Vasodilation

Question 34

Treatment of choice for hypermagnesemia

Answer 34

Hemodialysis

Question 35

Causes of Hypomagnesemia

Answer 35

PPIs Diuretics Common in hospitalized pts Likely caused by doc