Chapter 12: Management of life Threatening Electrolyte and Metabolic Disturbances Flashcards
What value constitutes hypo k
<3.5
Manifestations oh Hypo K
Dysrhythmias (ventricular and supra ventricular conduction delays, sinus Brady), U waves, QT prolongation, flat or inverted t waves, muscular weakness or paresthesia, ileum, abdominal cramps, nausea, and vomiting
Besides K what might need to be corrected in hypo k
Mg and alkalosis or acidosis
Do you correct pH or potassium first in hypo k
K since potassium will shift inter cellularly as pH rises
4 broad catagories that cause hypo k
transcellular shift, renal loss, extra renal loss, decreased intake
Hyper K most common cause and cutoff
renal dysfunction, >5.5
Causes of pseudo hyper k
WBC >100,000 or platelets count >600,000
causes of hyper k
Renal dysfunction academia hypoaldosteronism meds- Aldosterone inhibitors, acei, succinylcholine,NSAIDS, TMP-SMX cell death excessive intake
Manifestations of hyper k
diffuse peaked t ears, pr prolongation, QRS widening, diminished p waves, sine waves, muscle weakness, paralysis, paresthesia. HYPOactive reflexes
In hyper K if significant EKG abnormalities are present give
IV calcium chloride 5-10ml 10% solution over 5-10 minutes. can use calcium gluconate 10-20ml 10% solution.
how long do the effects of calcium last in hyper k
30-60min so you will need another agent
For redistribution of k (3 options)
Insulin and glucose
Sodium Bicarb
Inhaled B2 agonist
For removal of potassium from the body 3 things (don’t always need to do all 3)
loop diuretic and isotonic fluids
sodium polystyrene
dialysis
Euvolemic hyponatremia is almost always secondary to ___
elevated ADH
how to calculate serum osmolarity
[(2X serum sodium) + glucose/18 + BUN/2.8)
Signs of osmotic demyelination syndrome
focal motor deficits, respiratory insufficiency, progressive loss of consciousness
RF for osmotic demyelination syndrome
Malnutrition Female hypo k OH abuse elderly
[Na+} in 3% NaCl, .9NaCl, and LR
513, 154, 130
cutoff for hypo Na
<135
What receptor does vasopressin work on
V2
Contraindications to vasopressin
severe neuro sx, do not co administer with hypertonic saline
Hyper Na clinical manifestations
AMS, Lethargy, seizure, coma, weakness
Polyuria with Hyper Na indicates ___ or ____
DI or excess salt intake
Water deficit formula
.6 X weight(kg) [measured Na/normal Na)-1]
Hyper Na cutoff
> 145
What is calcium often bound to
albumin
for 1g/dl change in albumin how do you adjust calcium
.8mg/dl- less reliable in critically ill Patients
hypocalcemia cutoff
<8.5
hypercalcemia cutoff
11.5
manifestations of hyper calcemia
HTN, cardiac ischemia, arrhythmias,, bradykardiam conduction abnormalities, dig toxicity, dehydration, hypotension, weakness, depressed mentation, coma, seizure, sudden death
manifestations of hypocalcemnia
hypotension, bradycardia, arrhythmias, heart failure, cardiac arrest, digitalis insensitivity, qt and st prolongation, weakness, muscle spas,, larygospasm, hyperreflexia, e=seizures, tenant, paresthesias
hypo phos cutoff
<2.5
hypophos clinical manifestations
muscle weakness, respiratory failure, rhabdo, paresthesias, lethargy, disorientation, obtundation, coma, seizure
hypophos is uncommon except in critically ill patients with
renal failure
hypo mg cutoff
<1.8
does hypotension in the setting of acute adrenal insufficiency respond to fluids
no
lab findings acute adrenal insufficiency
eiosinophillia, hypoNa, Hyper K, acidosis, hypoglycemia
what is the main ketone responsible for acidosis in DKA
Alpha hydroxybuterate
what does hyper Na in DKA suggest
DKA
Initial things to get for DKA workup
fluid status mental status elctrolytes renal function glucose serum ketones blood gas EKG cultures if infection suspected UA
Patients with renal dysfunction require ___ rates if insulin infusion
slower
how fast to raise Na in hypo NA
6-8 in 24 hours
