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Methods of Anesthesia > Electrolyte Abnormality > Flashcards

Electrolyte Abnormality Flashcards

1
Q

Highest sodium concentration that should be allowed before cancelling an elective surgery

A

150 mEq/L

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2
Q

Lowest sodium concentration that should be allowed before cancelling an elective surgery

A

130 mEq/L

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3
Q

3 things that happen when sodium is reabsorbed

A
  1. Water is reabsorbed and blood volume increases
  2. Bicarb and chloride are reabsorbed and can lead to metabolic alkalosis
  3. Potassium is excreted, leading to hypokalemia
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4
Q

Acidosis caused by excess N/S administration

A

Hyperchloremic metabolic acidosis (w/normal anion gap)

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5
Q

What happens in RAAS if a patient becomes hypotensive or hypovolemic (5 steps)

A
  1. Renin is secreted from the kidneys
  2. Renin converts angiotensinogen to angiotensin I
  3. ACE converts angiotensin I to angiotensin II
  4. Angiotensin II increases blood pressure (vasoconstriction and release of aldosterone and ADH)
  5. ADH causes water reabsorption, while aldosterone causes sodium AND water reabsorption
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6
Q

Increases sodium AND water reabsorption

A

Aldosterone

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7
Q

What happens when aldosterone is released? (4 things)

A
  1. Plasma sodium concentration increases
  2. Blood volume increases
  3. HCO3- increases possible metabolic alkalosis
  4. Plasma potassium concentration decreases
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8
Q

What happens when ADH is released?

A
  1. Increases water reabsorption
  2. Blood volume increases
  3. Plasma sodium concentration decreases
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9
Q

What happens with Cushing’s disease?

A
  1. Aldosterone increase
    - increased blood volume/hypertension
    - Hypernatremia
    - Hypokalemia
    - metabolic alkalosis
  2. Steroid/cortisol concentrations increase
    - hyperglycemia
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10
Q

What happens with Addison’s Disease?

A

Adrenal insufficiency

  1. aldosterone decreases
    - hypovolemia/hypotension
    - Hyponatremia
    - Hyperkalemia
    - Metabolic acidosis
  2. Decrease in cortisol
    - hypoglycemia
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11
Q

Occurs when there are increased aldosterone concentrations, but normal cortisol levels

A

Hyperaldosteronism

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12
Q

Clinical manifestations of hyperaldosteronism may include

A
  1. Hypokalemia
  2. Hypernatremia
  3. Increased blood volume and blood pressure
  4. Metabolic alkalosis
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13
Q

Treatment for hyperaldosteronism

A

Potassium sparing diuretics

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14
Q

Occurs when there are decreased aldosterone concentrations, but normal cortisol

A

Hypoaldosteronism

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15
Q

Cause of hypoaldosteronism

A

Renal failure

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16
Q

Clinical manifestations of hypoaldosteronism

A
  1. Hyponatremia and hyperkalemia

2. Metabolic acidosis

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17
Q

Hypernatremia is defined as ____

A

> 145 mEq/dL

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18
Q

Etiologies of hypernatremia

A
  1. Retention of sodium

2. Dehydration where water loss is greater than sodium loss

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19
Q

Symptoms of hypernatremia

A
  1. Brain cell shrinkage
  2. Increased MAC requirements
  3. Hypertension
  4. Hyperreflexia and possible weakness
  5. Potentiation of the effects of muscle relaxants
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20
Q

Treatment of hypernatremia

A
  1. Hypotonic fluid
  2. Loop diuretics
    TREAT SLOWLY
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21
Q

How do you calculate water deficit in hypernatremic patients?

A

Water deficit = normal total body water - present total body water

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22
Q

How do you estimate normal total body water?

A

Patients weight in kg x percentage of body weight that is water = TBW

(Normal TBW)(Normal [Na+]) = (present [Na+])(x)

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23
Q

Water deficit for hypernatremic patients should be replaced over ____

A

48 hours

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24
Q

Occurs when the posterior pituitary fails to secrete ADH

A

Central diabetes insipidus

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25
Q

How is central diabetes insipidus treated?

A
  1. Hypotonic fluids
  2. DDAVP
  3. Thiazide diuretics
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26
Q

Occurs when the kidneys do not respond to ADH

A

Nephrogenic diabetes insipidus

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27
Q

Treatment of nephrogenic diabetes insipidus

A
  1. Hypotonic fluids

2. Thiazide diuretics

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28
Q

Plasma sodium concentration considered hyponatremic

A

<135 mEq/dL

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29
Q

Etiologies of hyponatremia

A
  1. Retention of water

2. Dehydration where sodium loss is greater than water loss

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30
Q

Possible symptoms of hyponatremia

A
  1. Cerebral edema
  2. Altered mental status
  3. Muscle weakness
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31
Q

Examples of hyponatremia from water retention

A
  1. SIADH

2. AIDs

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32
Q

How does the body compensate for hyponatremia in a euvolemic or hypervolemic patient?

A

By suppressing ADH release

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33
Q

Treatment of hyponatremia

A

Give sodium

  1. Find out how many mEq/L the patient is deficient in sodium
  2. Find out how many total mEq the patient is deficient in sodium using TBW
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34
Q

How much sodium is in 0.9% of NS?

A

154 mEq/L

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35
Q

What can happen with rapid hyponatremia treatment?

A
  1. Central pontine myelinolysis
  2. Pulmonary edema
  3. Hypokalemia
  4. Hyperchloremic acidosis
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36
Q

Max daily rate of sodium correction

A

10-12 mEq/L

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37
Q

Why can’t a surgeon use normal saline for irrigation with TURP?

A

Saline disperses the electrocautery current

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38
Q

Advantages to performing TURP with a laser

A
  1. Normal saline can be used as an irrigation solution
  2. Less blood loss
  3. Shorter hospital stay
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39
Q

Disadvantages to TURP with a laser

A
  1. Longer operation times

2. May not effectively remove most or all of BPH tissue

40
Q

Possible irrigation solutions used for TURP

A
  1. Distilled water (rare, extremely hypotonic)
  2. 0.9% normal saline (not used with cautery)
  3. Glycine (can lead to possible transient visual impairment)
41
Q

Most common type of dehydration in children

A

Isonatremic

42
Q

Highest potassium concentration that should be allowed before cancelling an elective surgery

43
Q

Lowest potassium concentration that should be allowed before cancelling an elective surgery

44
Q

What does insulin do to potassium?

A

Drives potassium intracellularly and DECREASES plasma K+ concentration

45
Q

What do beta agonists do to potassium?

A

Decreases plasma K+ concentration

46
Q

Acidosis leads to (hypokalemia/hyperkalemia)

A

Hyperkalemia

47
Q

Hypokalemia can lead to (acidosis/alkalosis)

48
Q

Alkalosis can lead to (hypokalemia/hyperkalemia)

A

Hypokalemia

49
Q

Hyperkalemia can lead to (acidosis/alkalosis)

50
Q

Etiologies of hyperkalemia

A
  1. Acidosis & beta blockers
  2. Succinylcholine
  3. RBC transfusions
  4. Cell lysis
  5. Renal and adrenal insufficiency
  6. ACE inhibitors
  7. Rewarming following hypothermia
51
Q

What is seen on an EKG with hyperkalemia?

A
  1. Peaked T waves
  2. Smaller P amplitude
  3. Increased PR interval
  4. Widened QRS
  5. Eventual sine wave EKG and possible vfib/asystole
52
Q

Symptoms of hyperkalemia

A
  1. EKG changes

2. Muscular weakness

53
Q

Hyperkalemic treatment pneumonic

A

CBIGKD (see big kid)

  1. Calcium
  2. Bicarb
  3. Insulin
  4. Glucose
  5. Kaexylate
  6. Diuretic/dialysis
54
Q

Temporary treatments for hyperkalemia

A
  1. Shifting K+ intracellularly

2. Stabilize myocytes with calcium

55
Q

Insulin rate for treatment of hyperkalemia

A

5g dextrose per 1 unit of insulin (1 amp dextrose per 5 units of insulin)

56
Q

How long does calcium stabilize myocytes?

A

15-30 minutes before requiring redose

57
Q

Permanent treatment for hyperkalemia

A
  1. Kaexylate
  2. Diuretics
  3. Dialysis
58
Q

Hypokalemia etiologies (9)

A
  1. Insulin administration
  2. Diuresis/diuretic therapy
  3. Sympathetic stimulation/increase in circulating catecholamines
  4. Alkalosis
  5. Red blood cell transfusions
  6. Dialysis
  7. GI loss/small bowel obstruction and/or vomiting
  8. Hypothermia
  9. Hypomagnesemia
59
Q

Hypokalemia EKG

A
  1. T wave flattened or inverted

2. U waves appear

60
Q

Symptoms of hypokalemia

A
  1. EKG changes

2. Muscle weakness

61
Q

Hypokalemia treatment

A

100 mL NS bag with 20 mEq potassium infused with infusion pump

62
Q

Amount of potassium to give with peripheral IV access

A

8-10 mEq/hr

63
Q

Amount of potassium to give with central line access

64
Q

How much will 20 mEq of potassium increase the plasma level by?

A

0.25 mEq/L

65
Q

How long will it take to increase the plasma potassium concentration by 1.0 mEq/L

66
Q

What should you be cautious of with the treatment of hypokalemia?

A
  1. Avoid dextrose replacement solutions, as insulin will secrete and lower potassium more
  2. Avoid aggressive treatment in hypothermia and head trauma
67
Q

Etiologies of hyperchloremia

A
  1. Metabolic acidosis

2. Excess normal saline administration

68
Q

Etiologies of hypochloremia

A
  1. Bowel obstruction or N/V
  2. Diuretic therapy
  3. Respiratory acidosis
  4. Administration of sodium without chloride (sodium bicarb)
69
Q

Pediatric patients with pyloric stenosis can present with

A
  1. Vomiting, leading to metabolic alkalosis
  2. Hypochloremia
  3. Hypokalemia
70
Q

Why should LR be avoided in pyloric stenosis?

A

Lactate is metabolized to bicarb and can worsen the alkalosis

71
Q

What fluid is used in pyloric stenosis?

A

Normal saline

72
Q

How is pyloric stenosis managed?

A

Electrolyte disturbances are corrected

73
Q

Why are patients with pyloric stenosis prone to hypoventilation after anesthesia?

A

Hypoventilation is the normal compensatory response to their metabolic alkalosis

74
Q

Effects of PTH

A

Decreases bone calcium and increases plasma calcium concentration

75
Q

Effects of calcitonin

A

Decreases plasma calcium concentration and increases bone calcium

76
Q

Etiologies of hypercalcemia

A
  1. Hyperparathyroidism
  2. Acidosis
  3. Cancer
77
Q

Possible effects of hypercalcemia (7)

A
  1. Shortened QT interval on EKG
  2. Muscular weakness
  3. Osmotic diuresis leading to hypovolemia
  4. Potentiation of muscle relaxants
  5. CNS symptoms
  6. Hypomagnesemia
  7. Renal stones
78
Q

Treatment for hypercalcemia

A
  1. Treat hypovolemia with normal saline
  2. Give loop diuretic
  3. Calcitonin
  4. Dialysis
  5. Avoid acidosis
79
Q

Etiologies of hypocalcemia

A
  1. Hypoparathyroidism
  2. Hypermagnesemia
  3. Vitamin D deficiency
  4. Renal failure
80
Q

Effects of hypocalcemia

A
  1. Prolonged QT interval on the EKG
  2. Hyperreflexia and muscular tetany (laryngeal stridor, masseter spasm, laryngospasm)
  3. Muscle weakness and potentiation of muscle relaxants
  4. CNS symptoms
81
Q

Treatment for hypocalcemia

A

IV calcium chloride or calcium gluconate

82
Q

Etiologies of hypermagnesemia

A

Renal failure (rare, caused by medication or health care provider)

83
Q

Possible effects of hypermagnesemia

A
  1. EKG may resemble hyperkalemia (shortened QT interval, prolonged PR interval, T wave abnormalities)
  2. Muscular hyporeflexia and weakness
  3. Potentiation of nondepolarizing muscle relaxants
  4. Hypocalcemia can occur
  5. CNS symptoms
  6. Hypotension
84
Q

Treatment for hypermagnesemia

A
  1. IV calcium chloride
  2. Loop diuretic
  3. Volume expansion
  4. Potential dialysis
85
Q

Etiologies of hypomagnesemia

A
  1. Decreased GI absorption
  2. Increased renal loss
  3. Hypercalcemia
86
Q

Possible effects of hypomagnesemia

A
  1. EKG findings??
  2. Muscular weakness and potentiation of muscle relaxants
  3. CNS symptoms
  4. Hypokalemia
87
Q

Treatment for hypomagnesemia

A

1-2 g magnesium sulfate over 10 minutes

88
Q

Electrolyte abnormalities that can cause hyperreflexia AND possible weakness

A
  1. Hypernatremia

2. Hypocalcemia

89
Q

Electrolyte abnormalities that cause muscle weakness

A
  1. Hyponatremia
  2. Hyperkalemia
  3. Hypokalemia
  4. Hypercalcemia
  5. Hypomagnesemia
90
Q

Electrolyte abnormalities that cause HYPOreflexia and weakness

A
  1. Hypermagnesemia
91
Q

Electrolyte abnormalities that potentiate muscle relaxants

A
  1. Hypernatremia
  2. Hypokalemia
  3. Hypercalcemia
  4. Hypocalcemia
  5. Hypermagnesemia
  6. Hypomagnesemia
92
Q

Electrolyte abnormalities that cause hypovolemia

A
  1. Hypercalcemia
93
Q

Electrolyte abnormalities that can occur with hypovolemia

A

Hyper and hyponatremia

94
Q

Electrolyte abnormalities that can cause hypotension

A
  1. hyperkalemia
  2. Hypocalcemia
  3. Hypermagnesemia
  4. Hypomagnesemia
95
Q

Electrolyte abnormalities that can cause hypertension

A
  1. Hypercalcemia
96
Q

Electrolyte abnormalities that can cause CNS symptoms

A
  1. Hypernatremia
  2. Hyponatremia
  3. Hypercalcemia
  4. Hypocalcemia
  5. Hypermagnesemia
  6. Hypomagnesemia

Methods of Anesthesia (20 decks)

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