Clin Med Electrolytes and Volume

Question 1

HYPONATREMIA

what is most common type of hyponatremia?

Answer 1

hypervolemia hypo-osmolar

due to fluid overload

Question 2

HYPONATREMIA

what does hyperglycemia do to sodium?

Answer 2

hyperglycemia can cause a

hyperosmolar HYPONATREMIA

Question 3

HYPONATREMIA

how does hyperglycemia cause hyponatremia?

Answer 3

hyperglycemia causes water to shift from the intracellular compartment to extracellular compartment, causing dilution of sodium

Question 4

HYPONATREMIA

what does SIADH do to sodium?

Answer 4

SIADH causes

hypo-osmolar, euvolemic hyponatremia

Question 5

HYPONATREMIA

how does SIADH cause hyponatremia?

Answer 5

SIADH causes increase in circulating ADH (due to hypersecretion from post pit)

increased ADH –> increased water retention –> more dilute fluid

Question 6

HYPONATREMIA

at what serum sodium levels do s/s begin to develop?

Answer 6

125-130 mEq/L

but pt may be asymptomatic until as low as 110 mEq/L

Question 7

HYPONATREMIA

mild hyponatremia treatment?

Answer 7

fluid restriction only

Question 8

HYPONATREMIA

severe hyponatremia treatment?

Answer 8

fluid restriction AND sodium replacement

SLOOOOWLY

Question 9

HYPONATREMIA

sodium level goal of severe hyponatremia treatment?

Answer 9

135 mEq/L

Question 10

HYPONATREMIA

injury that occurs if hyponatremia treatment occurs too quickly?

Answer 10

CPM

central pontine myelinolysis

Question 11

HYPONATREMIA

clinical manifestations of hyponatremia?

Answer 11

CNS dysfunction symptoms:

cerebral edema –> HA, n/v, weakness, lethargy, sz, coma, permanent brain damage

Question 12

HYPERNATREMIA

what sodium level indicates hypernatremia?

Answer 12

> 145 mEq/L

Question 13

HYPERNATREMIA

in what volume conditions do we find hypernatremia?

Answer 13

hypervolemia

or

hypovolemia

Question 14

HYPERNATREMIA

what is the most common cause of hypernatremia?

Answer 14

MC cause = volume depletion

usually seen with insensible losses from fever, sweating, vomiting, diarrhea, primary hypodipsia

Question 15

HYPERNATREMIA

in what two ways does DI cause hypovolemic hypernatremia?

Answer 15

decreased secretion of ADH from post pit

or

increased renal resistance to ADH (with resultant inability to concentrate urine)

Question 16

HYPERNATREMIA

what is a common cause for hypervolemia hypernatremia in the hospital setting?

Answer 16

aggressive IV admin of NS

or

infusion of hypertonic fluids

Question 17

HYPERNATREMIA

what are s/s of increased serum sodium?

Answer 17

AMS, sz, hyperreflexia, spasticity, lethargy

Question 18

HYPERNATREMIA

what is the goal of treatment of hypernatremia?

Answer 18

normalize serum sodium
restore ECF and ECF compartments
with
hypotonic or isotonic fluids

Question 19

HYPERNATREMIA

what happens if elevated serum sodium correction occurs too rapidly?

Answer 19

administer hypotonic or isotonic fluids slowly!

don’t go too fast, or you may see

cerebral edema,
szs,
permanent brain damage,
death (from cerebral herniation)

Question 20

what are the most common causes of dyskalemias?

Answer 20

medication side effects
dietary intake
renal dysfunction

Question 21

HYPOKALEMIA

define hypokalemia

Answer 21

potassium <3.5 mEq/L

Question 22

HYPOKALEMIA

what are the most common causes of hypokalemia?

Answer 22

increased renal excretion
from diuretic use,
from hyperaldosteronism
from hypomagnesemia

Question 23

HYPOKALEMIA

what are some other, less common, causes of hypokalemia?

Answer 23

alkalosis
insulin
beta 2 adrenergic agonists

Question 24

HYPOKALEMIA

s/s of hypokalemia?

Answer 24

muscle weakness
constipation
fatigue
palpitations

Question 25

HYPOKALEMIA EKG s/s of hypokalemia?

Answer 25

flat T waves U wave formation ST segment depression

Question 26

HYPOKALEMIA what is the treatment of mild hypokalemia?

Answer 26

oral replacement using KCl

Question 27

HYPOKALEMIA what is the treatment of severe hypokalemia?

Answer 27

``` IV replacement of potassium (10mEq/hr) WITH TELEMETRY (to watch for arrthymias) ``` (don't rebound into hyperkalemia!)

Question 28

HYPOKALEMIA what other electrolyte must be checked before replacing potassium?

Answer 28

Mg if concomitant hypomagnesemia is present, Mg must be repleted prior to potassium replacement (because of the role of Mg in regulating the sodium-potassium-ATPase pump)

Question 29

HYPERKALEMIA how is hyperkalemia defined?

Answer 29

K+ > 5.0 mEq/L

Question 30

HYPERKALEMIA hyperkalemia is a common complication seen with:

Answer 30

renal insufficiency, acidosis, medication side effects (ACE-I's, ARBs, aldosterone antagonists)

Question 31

HYPERKALEMIA common s/s of hyperkalemia?

Answer 31

muscle stuff - muscle weakness muscle cramping parasthesias

Question 32

HYPERKALEMIA common EKG changes seen in hyperkalemia?

Answer 32

``` tall/peaked T waves widened QRS P wave loss prolonged PR interval ST depression ```

Question 33

HYPERKALEMIA symptomatic hyperkalemia first treatment

Answer 33

IV CALCIUM stabilize cardiac membranes, prevent arrhythmias!!!

Question 34

HYPERKALEMIA after IV calcium, what treatments are given to restore proper potassium levels?

Answer 34

giving oral or rectal resins to bind to potassium and then be pooped out hemodialysis

Question 35

HYPOCALCEMIA define hypocalcemia

Answer 35

Ca+2 <8.5 mg/dL

Question 36

HYPOCALCEMIA common causes of low calcium

Answer 36

thyroid/parathyroid conditions Vit D deficiency chronic renal disease

Question 37

HYPOCALCEMIA s/s of hypocalcemia

Answer 37

``` paresthesias muscle cramping tetany Chvostek sign Trousseau sign ```

Question 38

HYPERCALCEMIA define hypercalcemia

Answer 38

Ca+2 > 10.5 mg/dL

Question 39

HYPERCALCEMIA common causes of hypercalcemia?

Answer 39

hyperparathyroidism malignancy immobilization

Question 40

HYPERCALCEMIA s/s of hypercalcemia?

Answer 40

``` STONES BONES MOANS (lethargy, ab pain/flank pain) PSYCHIC GROANS (depression, confusion) FATIGUE OVERTONES ``` ``` bone pain nephrolithiasis ab pain m. weakness fatigue ```

Question 41

HYPOMAGNESEMIA define hypomagnesemia

Answer 41

Mg+2 < 1.5 mEq/L

Question 42

HYPOMAGNESEMIA what are most common causes of hypomagnesemia?

Answer 42

alcoholism GI loss refeeding syndrome (?)

Question 43

HYPOMAGNESEMIA s/s of hypomagnesemia

Answer 43

lethargy, confusion | hyperreflexia, paresthesias

Question 44

HYPERMAGNESEMIA define hypermagnesemia

Answer 44

Mg+2 >2.5 mEq/L | this is rare

Question 45

HYPERMAGNESEMIA most common causes of hypermagnesemia

Answer 45

renal failure | antacid abuse

Question 46

HYPERMAGNESEMIA s/s of hypermagnesemia

Answer 46

flaccid paralysis bradycardia, hypotension cardiac arrest

Question 47

magnesium's claim to fame

Answer 47

Mg+2 is the 2nd most abundant intracellular cation it's vital for ATP processing macronutrient and energy metabolism neuromuscular transmission

Question 48

which form of calcium is most physiologically significant?

Answer 48

ionized calcium is the most physiologically significant

Question 49

what is calcium bound to in serum?

Answer 49

albumin

Question 50

hypERphosphatemia presents similarly to

Answer 50

hyPOcalcemia | they have an inverse relationship

Question 51

Hypokalemia is associated with (flattened/peaked) _____________T-waves on ECG.

Answer 51

flattened

Question 52

Insulin lowers serum potassium levels by activating (enzyme) __________

Answer 52

Na/K ATPase

Question 53

list four findings of hypervolemia

Answer 53

decreased hct SOB +/- increased RR pulm edema low albumin

Question 54

eight causes of hypervolemia

Answer 54

CHF nephrotic syndrome cirrhosis renal failure corticosteroids/mineralocorticoids nephropathy hyperaldosteronism Kwashiorkor

Question 55

what is the best and easiest to identify sign of fluid increase

Answer 55

sudden weight gain

Question 56

what are four common presentations of hypervolemia?

Answer 56

sudden wt gain edema/ascites pulm edema paroxysmal nocturnal dyspnea/orthopnea

Question 57

what physical exam findings correspond with hypervolemia?

Answer 57

``` crackles upon auscultation bounding pulses moist skin JVD S3 gallop ```

Question 58

what is used for dx of hypervolemia?

Answer 58

decreased hct decreased O2 sat CXR - signs of pulm congestion increased central venous P

Question 59

treatment of hypervolemia?

Answer 59

treat underlying cause - fluid reduction - fluid/salt restriction - diuretics - hemodialysis if palliative care situation, treat w/ nitroglycerine and morphine (vasodilate and improve pulm congestion)

Question 60

another name for hypovolemia

Answer 60

intravascular volume contraction

Question 61

causes for hypovolemia

Answer 61

decreased fluid intake excess fluid or Na+ loss due to v/d, sweat burns/hemorrhage/trauma

Question 62

hypovolemia presentation

Answer 62

``` sudden wt loss tachy hypotensive pale, dry mucous membranes no skin tenting ```

Question 63

hypovolemia dx based on....

Answer 63

increased hct increased hgb increased serum protein increased BUN/creatinine ratio

Question 64

treatment of hypovolemia

Answer 64

allow permissive hypotension in shock pts - -> administer fluids to maintain survivable BP (not a normal BP!) MAP target = 55-60 inpatient - replace fluids

Question 65

stages of hypovolemic shock

Answer 65

Stage 1: <= 15% blood vol loss (750 mL) Stage 2: 15-30% blood vol loss (750-1500 mL) Stage 3: 30-40% blood vol loss (1500-2000mL) Stage 4: >40% blood vol loss (>2000 mL)

Question 66

hypervolemia - hematocrit goes up or down?

Answer 66

down

Question 67

hypervolemia - albumin goes up or down?

Answer 67

down

Question 68

name four main ways hypervolemia presents

Answer 68

low hematocrit SOB +/- increased RR pulm edema low albumin

Question 69

s/s of hypERvolemia (name four)

Answer 69

sudden wt gain edema/ascites pulm edema paroxysmal nocturnal dyspnea/orthopnea

Question 70

three main findings upon PE for hypERvolemia, plus two

Answer 70

crackles in lungs JVD increase central venous P also, lowered Hct low O2 sat

Question 71

if hypERvolemia is treated with diuretics, what is given?

Answer 71

loop diuretics (most effective) thiazides +/- albumin K+ supplementation

Question 72

how is hypERvolemia treated palliatively?

Answer 72

improve pulmonary congestion nitro (vasodilation) and morphine