Dr. Griffith Electorlytes and Liver Failure Flashcards

1
Q

first step in assessing hyponatremia

A

volume status
hypovolemic
eu volemic
hypervolemic

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2
Q

hyponatremia - hypovelmic

A

renal vs. nonrenal

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3
Q

hyponatremia - hypovolemic - renal causes

A

Urine sodium > 20

nephropathies (recovery from ATN)

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4
Q

hyponatremia - hypovolemic - non renal causes

A

Urine sodium <10

vomiting, diarrhea, dehydration

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5
Q

hyponatremia - hypervolemic - renal causes

A

urine sodium > 20

ARF, nephrotic syndrome, CRF

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6
Q

hyponatremia - hypervolemic - non renal causes

A

urine sodium <10

CHF, cirrhosis (ascites)

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7
Q

hyponatremia - euvolemic causes

A

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

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8
Q

SIADH diagnosis

A

one of exclusion

usually BUN <4

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9
Q

normal kidneys w/ low serum osmolity

A

low serum osm <280

urine should maximally dilute 50-100

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10
Q

when is 3% NS given?

A

rarely: coma, seizures

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11
Q

Addison’s disease

A

adrenal insuff
low sodium
high/normal K+

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12
Q

hypothyroidism - cause of hyponatremia

A

osmolality receptor reset

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13
Q

beer potamnia

A

solute poor beer

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14
Q

hypernatremia

A

dehydration or DI

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

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15
Q

hyperkalemia, think

A

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

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16
Q

pseudohyperkalemia

A

lab artifact

  • hemolysis
  • WBC > 50,000
  • platelets > 750,000
17
Q

hyperkalemia - shifts

A
acidosis
insulin deficiency (DKA)
tissue necrosis
18
Q

increased total body K+

A

1) increased intake (decreased excretion)

2) limited excretion

19
Q

hyperkalemia - limited excretion

A

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

20
Q

hyperkalemia level

21
Q

hyperkalemia EKG changes

A

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

22
Q

“spurious” cause of hyperkalemia

A

blood taken above IV

23
Q

EKG changes in hyperkalemia per Mr. Sawaya

A
peaked T waves
prolonged PR
lose P waves
widened QRS
sine wave
v tach/ v fib
24
Q

hyperkalemia treatment

A
IV calcium
IV dextrose + insulin
IV sodium bicarb
albuterol
kayexelate
dialysis
limit K+ intake and observe
correct underlying disorder
25
IV calcium for hyperkalemia
immediate effect, short duration stabilize cardiac membranes given via large vein
26
IV dextrose and insulin for hyperkalemia
slower onset of action, longer duration of effect | shifts K+ into cells
27
IV sodium bicarb for hyperkalemia
gradual onset shifts k+ into cells complications of intracellular fluid shifts
28
albuterol for hyperkalemia
COPD exacerbates patient's low K+ often from overuse of B-agonists
29
Kayexelate for hyperkalemia
exchange resin slow onset K+ is exchanged for Na+ removes K+ from body
30
hypercalcemia symptoms!
constipation groans - PUD moans - depression, AMS stones - renal
31
causes of hypercalcemia in elderly invidiuals
malignacy (breast, kidney, lung) multiple myeloma primary PTHism less common - paget's, drugs (thiazides)
32
causes of hypercalcemia in younger inviduals
sarcoidosis primary PTHism less common: familal hypocalciuric hypercalcemia, lithium, vit d intox, milk-alkalia
33
multiple myeloma symptoms
anemia, proteinuria, hypercalcemia
34
chloride/phosphate ratio >35
hyperparathyroidism
35
uremia - acidosis
BUN >40 Cr >4 usually associated with hyperphosphatemia
36
Lactic Acidosis causes
shock, severe anemia/hypoxia, seizures, DKA
37
high albumin
carries calcium | free low calcium
38
low albumin
free calcium high
39
calcium correction
(0.8 * (4 - Pt's Albumin)) + Serum Ca)