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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
disease that can provoke elevation in phosphate
CKD
26
PTH and phosphate renal absorption
DECREASE renal absorption
27
PTH fxn
increases degradation of hydroxappetite crystals in bone (PO4, Ca release) allows absorption of Ca and prohibits PO4
28
what increases absorption of phosphate from GI
Vitamin D
29
what augments renal absorption of phosphate
growth hormone
30
most ideal way to obtain serum phosphate las?
fasting
31
hypophosphatemia causes hypoxia by:
impairs 2,3 DPG shifts oxyhemoglobin dissociation curve to LEFT impairs RBC ability to deliver O2 to cells
32
source of phosphate
Hypo is rare bc it is so common in DIET processed foods and being absorbed lgrly by passive absorption
33
most LIKELY source of hypophosphatemia
Hyperparathyroidism | starvation/malabsorption as well
34
MC population to suffer from malabsorption disorders?
alcoholism
35
critical LOW phosphate:
<1mg/dL
36
late that develops and maintains bones
Ca most abundant mineral in body NMJ performance and blood coagulation
37
how is Ca excreted
stool
38
normal SERUM Ca
8.5-10.5 decrease albumin by 1 gm = decrease Ca by 1 mg
39
normal ionized Ca
4.6-5.3
40
serum total calcium + affected by
protein bound (50% of Ca) availability of serum proteins
41
ionized Ca
NOT protein bound (45% of Ca) ACTIVE calcium
42
ionized Ca and pH (increase or decrease)
elevated pH = decreased ionized Ca decreased pH = increased ionized Ca
43
mc of TRUE hypocalcemia
disorders of PTH or Vitamin D
44
pseudohypocalcemia
hypoalbuminuria
45
hungry bone syndrome
low phosphorus low calcium low magnesium associated with parathryoidectomy
46
lab good for determine hypercalcemia from hyperparathyroid and malignancy
PTH PTrH malignancy will have DECREASED PTH
47
magnesium and PTH
hypermagnesemia causes PTH depravation and is not responsive to peripheral tissues
48
mc cause of HYPERcalcemia
hyperparathyroidism
49
hypercalcemia and diabetes insipidus
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
electrolyte depletion MC in patients with Albuterol
hypokalemia shifts potassium into cell at +10mg
51
K value and pH increase/decrease
pH rise = hypokalemia (alkalosis) pH loss = hyperkalemia (acidosis)
52
Mg and other electrolytes
"cornerstone electrolyte" if it is low, others will be
53
monitoring in patients with hypoK and hypoMg
continuous cardiac monitoring admit everyone with critical hypoK
54
K IV repletion
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
Loop diuretics and electrolyte derangements
hypomagnesium and hypokalemia
56
EKG finding most classic for hypoK
T wave: decreased amplitude, brand U wave
57
EKG finding most classic for hyper K
peaked T waves
58
causes of pseudohyperkalemia
cellular lysis (via drawing the blood) fist clenching during phlebotomy
59
displaces potassium into cell (moved from ECF to ICF)
insulin bicarbonate albuterol
60
causes potassium excretion from body
loop diuretic sodium polystyrene sulfonate (kay-X) Hemodialysis
61
drug provided cautiously in patins taking digoxin
calcium glutinate chloride STONE heart
62
agent that req. central line prior to administration
chloride 3x potent of Ca Gluconate (caustic to vein)
63
pancreatitis and calcium
causes hypocalcemia combo of necrotic cells and insoluble Ca = fat necrosis
64
hypocalcemia S/S
SPASM QT ``` Spasm Peri0oral numbness Abdominal cramps Stridor Mental status change QT prolongation Tetany ```
65
classical PE signs of hypocalcemia
``` Chovstek sign (tapping of facial n.) Trousseau sign (BP cuff, more reliable) ```
66
IV Ca
SEVERE hypocalcemia must provide Mg as well
67
IV Ca caution in Heart DZ
vasoconstriction and ischemia esp. w/low CO and peripheral vasoconstriction
68
PO Ca
calcium given with vitamin D
69
population of its with hypochloremia
excessive volume depletion excessive diuresis, vomiting, nasogastric tube suction
70
tx of hypochloremia
d/x suctioning (underlying cause) addition of 0.9 NS
71
torsdaes and Mg
1-2 g in dextrose over 15-20 min
72
medication used to antagonize Mg
calcium
73
putting a patient on Lasix, what should you add?
oral potassium chloride to prevent hypokalemia
74
vitamin D deficiency clinical presentation
likely caused by CKD elderly low calcium and phosphate Order: Ca, PTH, Vitamin D
75
milk alkali syndrome
causes Ca depletion and due to taking exogenous Ca/base (tums) elevated Ca + metabolic alkalosis + AKI
76
hypercalcemia and fatigue/weight loss
malignancy Granulomatous disease endocrinopathies at risk for cardiac anomalies
77
bones, stones, groans, moans
bones: osteolysis stones: kidney stones groans: pancreatitis, peptic ulcer dz moans: psychiatric dz
78
tx of hypercalcemia
IV hydration (force diuresis) administer bisphosphonates + calcitonin
79
meds to avoid in hypercalcemia
diuretics - worsens dehydration, potassium, Mg loss
80
vomiting and electrolyte derangement
chloride depletion hypochloremia metabolic alkalosis
81
lab added if pt has dark urine, pain in muscles
Rhabdo-- CK levels
82
low phosphate tx
``` Admission IV hydration (esp CK elevation) ``` replete with oral phosphate
83
parenteral phosphate administration Se
can cause decline in Ca - therefore give oral
84
most ideal way to tx hyperphosphatemia
targeting underlying cause + phosphate binders (phoslo)

FA17 Nephrology (13 decks)

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