Dr. Griffith Electorlytes and Liver Failure

Question 1

first step in assessing hyponatremia

Answer 1

volume status
hypovolemic
eu volemic
hypervolemic

Question 2

hyponatremia - hypovelmic

Answer 2

renal vs. nonrenal

Question 3

hyponatremia - hypovolemic - renal causes

Answer 3

Urine sodium > 20

nephropathies (recovery from ATN)

Question 4

hyponatremia - hypovolemic - non renal causes

Answer 4

Urine sodium <10

vomiting, diarrhea, dehydration

Question 5

hyponatremia - hypervolemic - renal causes

Answer 5

urine sodium > 20

ARF, nephrotic syndrome, CRF

Question 6

hyponatremia - hypervolemic - non renal causes

Answer 6

urine sodium <10

CHF, cirrhosis (ascites)

Question 7

hyponatremia - euvolemic causes

Answer 7

1) SIADH 2) Addison’s 3) drugs (thiazides) 4) hypothyroidism 5) psychogenic polydypsia 6) beer potamnia

Question 8

SIADH diagnosis

Answer 8

one of exclusion

usually BUN <4

Question 9

normal kidneys w/ low serum osmolity

Answer 9

low serum osm <280

urine should maximally dilute 50-100

Question 10

when is 3% NS given?

Answer 10

rarely: coma, seizures

Question 11

Addison’s disease

Answer 11

adrenal insuff
low sodium
high/normal K+

Question 12

hypothyroidism - cause of hyponatremia

Answer 12

osmolality receptor reset

Question 13

beer potamnia

Answer 13

solute poor beer

Question 14

hypernatremia

Answer 14

dehydration or DI

check urine output (low - dehydration, high - DI) necrosis

Question 15

hyperkalemia, think

Answer 15

1) pseudohyperkalemia
2) shifts
3) increased total body K

Question 16

pseudohyperkalemia

Answer 16

lab artifact

• hemolysis
• WBC > 50,000
• platelets > 750,000

Question 17

hyperkalemia - shifts

Answer 17

acidosis
insulin deficiency (DKA)
tissue necrosis

Question 18

increased total body K+

Answer 18

1) increased intake (decreased excretion)

2) limited excretion

Question 19

hyperkalemia - limited excretion

Answer 19

renal failure
type IV RTA
mineralocorticoid deficiency
drugs (ACEI, NSAIDs, heparin, etc)

Question 20

hyperkalemia level

Answer 20

> 6

Question 21

hyperkalemia EKG changes

Answer 21

non urgent - normal EKG
urgent - peaked T waves
emergent - widened QRS, loss of P wave, sine wave pattern

Question 22

“spurious” cause of hyperkalemia

Answer 22

blood taken above IV

Question 23

EKG changes in hyperkalemia per Mr. Sawaya

Answer 23

peaked T waves
prolonged PR
lose P waves
widened QRS
sine wave
v tach/ v fib

Question 24

hyperkalemia treatment

Answer 24

IV calcium
IV dextrose + insulin
IV sodium bicarb
albuterol
kayexelate
dialysis
limit K+ intake and observe
correct underlying disorder

Question 25

IV calcium for hyperkalemia

Answer 25

immediate effect, short duration
stabilize cardiac membranes
given via large vein

Question 26

IV dextrose and insulin for hyperkalemia

Answer 26

slower onset of action, longer duration of effect

shifts K+ into cells

Question 27

IV sodium bicarb for hyperkalemia

Answer 27

gradual onset
shifts k+ into cells
complications of intracellular fluid shifts

Question 28

albuterol for hyperkalemia

Answer 28

COPD exacerbates patient’s low K+ often from overuse of B-agonists

Question 29

Kayexelate for hyperkalemia

Answer 29

exchange resin
slow onset
K+ is exchanged for Na+
removes K+ from body

Question 30

hypercalcemia symptoms!

Answer 30

constipation
groans - PUD
moans - depression, AMS
stones - renal

Question 31

causes of hypercalcemia in elderly invidiuals

Answer 31

malignacy (breast, kidney, lung)
multiple myeloma
primary PTHism
less common - paget’s, drugs (thiazides)

Question 32

causes of hypercalcemia in younger inviduals

Answer 32

sarcoidosis
primary PTHism
less common: familal hypocalciuric hypercalcemia, lithium, vit d intox, milk-alkalia

Question 33

multiple myeloma symptoms

Answer 33

anemia, proteinuria, hypercalcemia

Question 34

chloride/phosphate ratio >35

Answer 34

hyperparathyroidism

Question 35

uremia - acidosis

Answer 35

BUN >40
Cr >4
usually associated with hyperphosphatemia

Question 36

Lactic Acidosis causes

Answer 36

shock, severe anemia/hypoxia, seizures, DKA

Question 37

high albumin

Answer 37

carries calcium

free low calcium

Question 38

low albumin

Answer 38

free calcium high

Question 39

calcium correction

Answer 39

(0.8 * (4 - Pt’s Albumin)) + Serum Ca)