Dr. Griffith Electorlytes and Liver Failure Flashcards
first step in assessing hyponatremia
volume status
hypovolemic
eu volemic
hypervolemic
hyponatremia - hypovelmic
renal vs. nonrenal
hyponatremia - hypovolemic - renal causes
Urine sodium > 20
nephropathies (recovery from ATN)
hyponatremia - hypovolemic - non renal causes
Urine sodium <10
vomiting, diarrhea, dehydration
hyponatremia - hypervolemic - renal causes
urine sodium > 20
ARF, nephrotic syndrome, CRF
hyponatremia - hypervolemic - non renal causes
urine sodium <10
CHF, cirrhosis (ascites)
hyponatremia - euvolemic causes
1) SIADH 2) Addison’s 3) drugs (thiazides) 4) hypothyroidism 5) psychogenic polydypsia 6) beer potamnia
SIADH diagnosis
one of exclusion
usually BUN <4
normal kidneys w/ low serum osmolity
low serum osm <280
urine should maximally dilute 50-100
when is 3% NS given?
rarely: coma, seizures
Addison’s disease
adrenal insuff
low sodium
high/normal K+
hypothyroidism - cause of hyponatremia
osmolality receptor reset
beer potamnia
solute poor beer
hypernatremia
dehydration or DI
check urine output (low - dehydration, high - DI) necrosis
hyperkalemia, think
1) pseudohyperkalemia
2) shifts
3) increased total body K
pseudohyperkalemia
lab artifact
- hemolysis
- WBC > 50,000
- platelets > 750,000
hyperkalemia - shifts
acidosis insulin deficiency (DKA) tissue necrosis
increased total body K+
1) increased intake (decreased excretion)
2) limited excretion
hyperkalemia - limited excretion
renal failure
type IV RTA
mineralocorticoid deficiency
drugs (ACEI, NSAIDs, heparin, etc)
hyperkalemia level
> 6
hyperkalemia EKG changes
non urgent - normal EKG
urgent - peaked T waves
emergent - widened QRS, loss of P wave, sine wave pattern
“spurious” cause of hyperkalemia
blood taken above IV
EKG changes in hyperkalemia per Mr. Sawaya
peaked T waves prolonged PR lose P waves widened QRS sine wave v tach/ v fib
hyperkalemia treatment
IV calcium IV dextrose + insulin IV sodium bicarb albuterol kayexelate dialysis limit K+ intake and observe correct underlying disorder
IV calcium for hyperkalemia
immediate effect, short duration
stabilize cardiac membranes
given via large vein
IV dextrose and insulin for hyperkalemia
slower onset of action, longer duration of effect
shifts K+ into cells
IV sodium bicarb for hyperkalemia
gradual onset
shifts k+ into cells
complications of intracellular fluid shifts
albuterol for hyperkalemia
COPD exacerbates patient’s low K+ often from overuse of B-agonists
Kayexelate for hyperkalemia
exchange resin
slow onset
K+ is exchanged for Na+
removes K+ from body
hypercalcemia symptoms!
constipation
groans - PUD
moans - depression, AMS
stones - renal
causes of hypercalcemia in elderly invidiuals
malignacy (breast, kidney, lung)
multiple myeloma
primary PTHism
less common - paget’s, drugs (thiazides)
causes of hypercalcemia in younger inviduals
sarcoidosis
primary PTHism
less common: familal hypocalciuric hypercalcemia, lithium, vit d intox, milk-alkalia
multiple myeloma symptoms
anemia, proteinuria, hypercalcemia
chloride/phosphate ratio >35
hyperparathyroidism
uremia - acidosis
BUN >40
Cr >4
usually associated with hyperphosphatemia
Lactic Acidosis causes
shock, severe anemia/hypoxia, seizures, DKA
high albumin
carries calcium
free low calcium
low albumin
free calcium high
calcium correction
(0.8 * (4 - Pt’s Albumin)) + Serum Ca)
