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FA17 Nephrology > Electrolyte Apps > Flashcards

Electrolyte Apps Flashcards

1
Q

Lab measure most useful in determining “renal handling”

A

Urine (24 hr) or fractional excretion of electrolyte (Fex)

fractional is faster

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2
Q

labs you order in vitamin D deficiency

A

PTH
Phosphorus
Calcium
Vitamin D

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3
Q

HIGH urine concentration means

A

renal wasting

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4
Q

LOQ urine concentration means

A

extrarenal loss of lyte

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5
Q

K is predominantly excreted

A

via Kidneys

also in sweat, stool

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6
Q

aldosterone effect on k

A

stimulates K excretion in kidney

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7
Q

hyperaldosterone and [K]

A

low potassium as a product of normal renin function

increasing sodium reabsorption and potassium excretion

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8
Q

hypoaldosterone and [K]

A

potassium excess thru sodium and potassium exchange and sodium wasting

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9
Q

heparin and K

A

inhibits aldosterone production in adrenal glands

THEREFORE: hyperkalemia

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10
Q

MC cause of hypokalemia in developing world

A

GI losses from infectious diarrhea

concentration in intestinal secretion 10x higher than gastric section

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11
Q

meds known to cause hypokalemia (4)

A

TZD
loops
Beta agonists
insulin

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12
Q

MC cause of HYPERkalemia

A

Lab: psedudohyperkalemia

TRUE DZ: Kidney Disease

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13
Q

meds known to cause hyperkalemia

A 
ACE/ARB
KCL supplements
Spironolactone
B Blockers 
Bactrim, Cyclosporine, Tacrolimus
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14
Q

Hypokalemia lab value

A

<3.5

CRITICAL: <2.5

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15
Q

hyperkalemia lab value

A

> 5.5

CRITICAL: >6.5

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16
Q

how to distinguish between renal and non-renal loss

A

TTKG “Spot potassium excretion”

TTKG > 4 suggest renal loss of potassium

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17
Q

calculation of TTKG

A

(K urine x OSMserum)/ (OSMurine x Kserum)

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18
Q

safest and easiest mean to provide tx of hypo K

A

oral potassium

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19
Q

dosing of potassium rise

A

10mEq of oral K to raise serum by 0.1

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20
Q

how much of human body is made of water? where?

A

60%

ICF space

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21
Q

pt population most prone to hyperkalemia

A

renal insufficiency/kidney disease patients

failure to excrete potassium

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22
Q

most salient SE of IV administration of K?

A

burning sensation in vein

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23
Q

functions of Phosphate (5)

A

energy metabolism

cell signaling

regulation or protein synthesis

skeletal development

bone integrity

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24
Q

where does phosphate mostly exist?

A

essential mineral that exists mainly as HYDROXYAPPETITE (bone) or INTRACELLULAR constituent

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25
Q

disease that can provoke elevation in phosphate

A

CKD

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26
Q

PTH and phosphate renal absorption

A

DECREASE renal absorption

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27
Q

PTH fxn

A

increases degradation of hydroxappetite crystals in bone (PO4, Ca release)

allows absorption of Ca and prohibits PO4

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28
Q

what increases absorption of phosphate from GI

A

Vitamin D

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29
Q

what augments renal absorption of phosphate

A

growth hormone

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30
Q

most ideal way to obtain serum phosphate las?

A

fasting

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31
Q

hypophosphatemia causes hypoxia by:

A

impairs 2,3 DPG

shifts oxyhemoglobin dissociation curve to LEFT

impairs RBC ability to deliver O2 to cells

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32
Q

source of phosphate

A

Hypo is rare bc it is so common in DIET

processed foods and being absorbed lgrly by passive absorption

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33
Q

most LIKELY source of hypophosphatemia

A

Hyperparathyroidism

starvation/malabsorption as well

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34
Q

MC population to suffer from malabsorption disorders?

A

alcoholism

35
Q

critical LOW phosphate:

A

<1mg/dL

36
Q

late that develops and maintains bones

A

Ca

most abundant mineral in body

NMJ performance and blood coagulation

37
Q

how is Ca excreted

A

stool

38
Q

normal SERUM Ca

A

8.5-10.5

decrease albumin by 1 gm = decrease Ca by 1 mg

39
Q

normal ionized Ca

A

4.6-5.3

40
Q

serum total calcium + affected by

A

protein bound (50% of Ca)

availability of serum proteins

41
Q

ionized Ca

A

NOT protein bound (45% of Ca)

ACTIVE calcium

42
Q

ionized Ca and pH (increase or decrease)

A

elevated pH = decreased ionized Ca

decreased pH = increased ionized Ca

43
Q

mc of TRUE hypocalcemia

A

disorders of PTH or Vitamin D

44
Q

pseudohypocalcemia

A

hypoalbuminuria

45
Q

hungry bone syndrome

A

low phosphorus

low calcium

low magnesium

associated with parathryoidectomy

46
Q

lab good for determine hypercalcemia from hyperparathyroid and malignancy

A

PTH
PTrH

malignancy will have DECREASED PTH

47
Q

magnesium and PTH

A

hypermagnesemia causes PTH depravation and is not responsive to peripheral tissues

48
Q

mc cause of HYPERcalcemia

A

hyperparathyroidism

49
Q

hypercalcemia and diabetes insipidus

A

activation of Ca sensing receptors in collecting ducts reduces ADH-induced water permeability

volume depletion worsens hypercalcemia (high water loss increases [Ca])

also causes K loss

50
Q

electrolyte depletion MC in patients with Albuterol

A

hypokalemia

shifts potassium into cell at +10mg

51
Q

K value and pH increase/decrease

A

pH rise = hypokalemia (alkalosis)

pH loss = hyperkalemia (acidosis)

52
Q

Mg and other electrolytes

A

“cornerstone electrolyte”

if it is low, others will be

53
Q

monitoring in patients with hypoK and hypoMg

A

continuous cardiac monitoring

admit everyone with critical hypoK

54
Q

K IV repletion

A

10 mEq to raise serum by 0.1

IV can’t go more than 10 mEQ/hr, central = 20/hr

if you go faster you may cause death due to arrhythmia)

55
Q

Loop diuretics and electrolyte derangements

A

hypomagnesium and hypokalemia

56
Q

EKG finding most classic for hypoK

A

T wave: decreased amplitude, brand

U wave

57
Q

EKG finding most classic for hyper K

A

peaked T waves

58
Q

causes of pseudohyperkalemia

A

cellular lysis (via drawing the blood)

fist clenching during phlebotomy

59
Q

displaces potassium into cell (moved from ECF to ICF)

A

insulin
bicarbonate
albuterol

60
Q

causes potassium excretion from body

A

loop diuretic
sodium polystyrene
sulfonate (kay-X)
Hemodialysis

61
Q

drug provided cautiously in patins taking digoxin

A

calcium glutinate
chloride

STONE heart

62
Q

agent that req. central line prior to administration

A

chloride

3x potent of Ca Gluconate (caustic to vein)

63
Q

pancreatitis and calcium

A

causes hypocalcemia

combo of necrotic cells and insoluble Ca = fat necrosis

64
Q

hypocalcemia S/S

A

SPASM QT

Spasm 
Peri0oral numbness 
Abdominal cramps
Stridor
Mental status change 
QT prolongation
Tetany
65
Q

classical PE signs of hypocalcemia

A 
Chovstek sign (tapping of facial n.) 
Trousseau sign (BP cuff, more reliable)
66
Q

IV Ca

A

SEVERE hypocalcemia

must provide Mg as well

67
Q

IV Ca caution in Heart DZ

A

vasoconstriction and ischemia

esp. w/low CO and peripheral vasoconstriction

68
Q

PO Ca

A

calcium given with vitamin D

69
Q

population of its with hypochloremia

A

excessive volume depletion

excessive diuresis, vomiting, nasogastric tube suction

70
Q

tx of hypochloremia

A

d/x suctioning (underlying cause)

addition of 0.9 NS

71
Q

torsdaes and Mg

A

1-2 g in dextrose over 15-20 min

72
Q

medication used to antagonize Mg

A

calcium

73
Q

putting a patient on Lasix, what should you add?

A

oral potassium chloride

to prevent hypokalemia

74
Q

vitamin D deficiency clinical presentation

A

likely caused by CKD

elderly

low calcium and phosphate

Order: Ca, PTH, Vitamin D

75
Q

milk alkali syndrome

A

causes Ca depletion and due to taking exogenous Ca/base (tums)

elevated Ca + metabolic alkalosis + AKI

76
Q

hypercalcemia and fatigue/weight loss

A

malignancy
Granulomatous disease
endocrinopathies

at risk for cardiac anomalies

77
Q

bones, stones, groans, moans

A

bones: osteolysis
stones: kidney stones
groans: pancreatitis, peptic ulcer dz
moans: psychiatric dz

78
Q

tx of hypercalcemia

A

IV hydration (force diuresis)

administer bisphosphonates + calcitonin

79
Q

meds to avoid in hypercalcemia

A

diuretics - worsens dehydration, potassium, Mg loss

80
Q

vomiting and electrolyte derangement

A

chloride depletion

hypochloremia metabolic alkalosis

81
Q

lab added if pt has dark urine, pain in muscles

A

Rhabdo– CK levels

82
Q

low phosphate tx

A 
Admission 
IV hydration (esp CK elevation)

replete with oral phosphate

83
Q

parenteral phosphate administration Se

A

can cause decline in Ca - therefore give oral

84
Q

most ideal way to tx hyperphosphatemia

A

targeting underlying cause + phosphate binders (phoslo)

FA17 Nephrology (13 decks)

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