acid base and electrolytes

Question 0

Diuretics cause what acid base disturbance? (except which class?)

Answer 0

Metabolic alkalosis (except CAHs)

Question 1

Aspirin/salicylate OD will cause what metabolic disturbance?

Answer 1

Respiratory alkalosis and metabolic acidosis

Question 2

How can you speed excretion of ASA?

Answer 2

Alkalinize the urine with HCO3

Question 3

Sleep apnea and other chronic lung conditions can cause what kind of heart failure?

Answer 3

right-sided (cor pulmonale)

Question 4

How low does someone’s pH need to get before you give bicarbonate?

Answer 4

7.0

Question 5

What kind of hyponatremia is caused by Addison’s disease/hyperaldosteronism?

Answer 5

hypovolemic

Question 6

What kind of hyponatremia is caused by SIADH?

Answer 6

euvolemic

Question 7

If water restriction fails, what can you use to treat SIADH?

Answer 7

Demeclocycline

Question 8

What does demeclocycline induce?

Answer 8

Nephrogenic diabetes insipidus

Question 9

What happens when hyponatremia is corrected too quickly?

What is the max rate of correction?

Answer 9

Central pontine myelinolysis

0.5-1 mEq/L/hr

Question 10

what three things can cause false hyponatremia?

Answer 10

hyperglycemia with the glucose level greater than 200 MG/DL

Hyperproteinemia

Hyperlipidemia

Question 11

what is the relationship between sodium level and glucose?

Answer 11

for each rise and glucose of 100 MG/DL, sodium decreases by 1.6 mEq/L

Question 12

in adrenal insufficiency what will you see in terms of potassium, sodium, and blood pressure?

Answer 12

Hyponatremia, hyperkalemia, and low blood pressure

Question 13

how can sickle cell disease affects sodium levels (this is rare).

Answer 13

Hypernatremia

Question 14

what metabolic Derangements of potassium and calcium can impair the kidneys concentrating ability, thus causing hypernatremia?

Answer 14

hypokalemia and hypercalcemia

Question 15

what is the classic cause of hyponatremia in pregnant patients about to deliver?

Answer 15

oxytocin

Question 16

what findings will you see on EKG with hypokalemia?

Answer 16

– Loss of the T-wave or to a flattening
– U waves
– Premature ventricular and atrial complexes
– Ventricular and atrial tachyarrhythmias

Question 17

what metabolic Derangement causes hypokalemia?

What metabolic derangement. causes hyperkalemia?

Answer 17

hypokalemia – alkalosis

Hyperkalemia – acidosis

Question 18

what is the max rate of replacement for potassium?

Answer 18

20 mEq/hr

Question 19

what will you see on EKG with hyperkalemia?

Answer 19

– Tell Peaked T waves
– Widened QRS
– Prolonged PR interval
– Loss of P waves
– Sine wave pattern

Question 20

adrenal insufficiency and hypoaldosteronism will cause what problem with potassium?

Answer 20

Hyperkalemia

Question 21

what is the treatment for hyperkalemia <6.5?

Answer 21

– Decreased potassium intake and Kayexalate

Question 22

what is the treatment for hyper kalemia greater than 6.5 or with a parent cardiac toxicity?

Answer 22

– Calcium gluconate thirst, which is cardioprotective but does not change potassium level
– Sodium bicarbonate next, which causes potassium to shift inside cells
– Glucose with insulin, which also forces potassium inside cells
– Beta-2 agonist, which also drive potassium into cells

Question 23

what do you do for a patient with hyperkalemia who has renal failure?

Answer 23

emergent dialysis

Question 24

what is chvostek sign and trousseau sign. and what causes them?

Answer 24

Chvostek sign is when tapping the facial nerve causes contraction of the facial muscles
Trousseau’s sign is when inflation of a blood pressure cuff elicits hand muscle spasms

Question 25

what is the classic EKG findings with hypocalcemia?

Answer 25

QT interval prolongation

Question 26

what is the relationship between calcium and albumin?

Answer 26

Hypoalbuminemia will cause hypocalcemia because the protein-bound fraction of calcium is decreased

Question 27

how do you calculate corrected calcium in hypoalbuminemia?

Answer 27

for every 1g/dL decrease in albumin below 4g/dL, correct the calcium by adding 0.8 mg/dL to the given calcium value

Question 28

how do DiGeorge syndrome, hyperparathyroidism, vitamin D deficiency, renal tubular acidosis, acute pancreatitis, and renal failure affect calcium levels?

Answer 28

they all cause hypocalcemia

Question 29

Low calcium is difficult to correct until what other low electrolytes is corrected?

Answer 29

magnesium

Question 30

what is the classic EKG finding in the hypercalcemia?

Answer 30

QT interval shortening

Question 31

what is the most common cause of hypercalcemia in outpatients?
what is the most common cause of hypercalcemia in inpatients?

Answer 31

outpatients – hyperparathyroidism

Inpatients – malignancy

Question 32

how does vitamin a or D intoxication, sarcoidosis, thiazide diuretics, immobilization affect calcium levels?

Answer 32

they all cause hypercalcemia

Question 33

how do you treat hypercalcemia?

Answer 33

– First give IV fluids
– After patient is well hydrated, give furosemide to cause calcium diuresis
– Other treatments include phosphorus, calcitonin, plicamycin

Question 34

what are the specific treatments for hypercalcemia in Paget disease and malignancy induced hypercalcemia?

Answer 34

– paget disease: bisphosphonates

– Malignancy induced: prednisone

Question 35

what is the classic EKG sign of hypomagnesemia?

Answer 35

A prolonged QT interval

Question 36

what drug can be given to cause magnesium diuresis in hypermagnesemia?

Answer 36

furosemide

Question 37

what is the maintenance food of choice in patients who are not eating?

Answer 37

D5 1/2 with 10 to 20 mEq per day of potassium chloride