Electrolyte Calculations Flashcards
What are the two forms of K used in the hospital?
KCL and K3PO4
What are the two routes of administration for KCL and K3PO4?
PO and IV push
What is the maximum amount of potassium that can be administered in 1 hr?
20 mg/hr
What is the maximum amount of KCL or K3PO4 that can be given in 1 hr?
10 mg/hr
ie A patient has a K level of 3.2. What is the deficit and what is required to correct it?
~100 meq K deficit
correct with 1 40(KCL) or 1 60(K3PO4) PO for……………..ADD
What are the dose amounts of KCL and K3PO4 available at the pharmacy?
10 meq
20 meq * Dr. Khan’s choice
40 meq * Dr. Khan’s choice
60 meq
Pill and IV forms
ie A patient has a K level of 2.5. What is the deficit and what is required to correct it?
150 meq deficit
Tx both KCL and K3PO4 both PO & IV
give 40/40mg mix over 4hrs (2x for 8 total hrs)
ie A patient has a K level of 1.0. What is the deficit and what is required to correct it?
200 meq deficit
Tx both KCL and K3PO4 both PO & IV
give 40/40 over 4hrs with 20mg K-rider over 8 hrs
How to treat Magnesium-Mg: with significantly low K?
Give 1 dose PO to prevent hypoglycemia
What are the two options for Mg?
MgO PO only &
MgSO IV only
What are the dose options for MgO at the pharmacy?
200 mg
400mg * Dr Khan’s choice
What is the total amount of Mg that can be given per day in the hospital?
400mg 3x/day (1200mg max)
MgO max in hospital
400 mg PO for 2 days only
(note: always put a time limit for nurses)
What are the dose options for MgSO “Mag-Rider”?
2g over 30 min
4g over 2 hr IV
What is the window of correction for Mg?
2.5-3.5
(slight over correction is ok)
ie A patient has a Mg level of 1.0. What is the deficit and what is required to correct it?
2.5 deficit
Tx 1.5 PO then 2mg Mg-rider……ADD
What are the different types of isotonic IV solutions?
Normal Saline (.9 & NaCl)
Dextrose 5% Water (D5W)
Lactated Ringer’s Solution in 5 % Dextrose
Ringer’s Solution
What is in .9 & NaCl?
Contains
Water
Sodium 154mEq
Chloride 154mEq
308 mOsm/L osmolality
What are the uses for NSS (.9&NaCl)?
- Isotonic solution of choice for expanding ECF volume.
- Infused to correct extracellular fluid volume deficit
- Used with Blood product administration
- Used to replace large sodium losses like burn injuries and trauma.
CI: should NOT be used with HEART FAILURE, PULMONARY EDEMA, AND RENAL IMPAIRMENT.
What is in D5W (Dextrose 5% in water)?
Water
Glucose (50g/L)
252 mOsm/L
What are the uses for D5W?
- Initially isotonic and provides free water when dextrose is metabolized(making it hypotonic)
- Expands the ECF and ICF, used for rehydrating and excretory purposes.
- Used to treat Hypernatremia.
CI: Should NOT be used for fluid rescucitation bc hyperglycemia can ensue. Avoid in patients with risk for INCREASED ICP.
What is in Lactated Ringer’s Solutions in 5% Dextrose?
Water
Sodium 130mEq/L
Potassium 4 mEq/L
Calcium 3 mEq/L
Chloride 109 mEq/L
Lactate 28 mEq
273 mOsm/L
What are the other names for Lactated Ringer’s?
D5LR5
LR
Ringer’s Lactate
Hartmann Solution
What are the uses for LR?
- Used for Dehydration, sodium depletion. and replace GI tract fluid losses.
- Fluid loss from Burns, Fistula Drainage, and Trauma.
- Used in patient s with Metabolic Acidosis bc it’s an alkalizing solution.
CI: DO NOT given to patients who cannot metabolize lactate (ie liver disease, lactic acidosis) USE with CAUTION for patients with Heart Failure and Renal failure.
What’s in Ringer’s Solution?
Similar to LR but no Lactate:
Water
Sodium 130mEq/L
Potassium 4 mEq/L
Calcium 3 mEq/L
Chloride 109 mEq/L
What are the uses for Ringer’s Solution?
Similar indications as LR but w/o the CI for lactate:
1. Used for Dehydration, sodium depletion. and replace GI tract fluid losses.
2. Fluid loss from Burns, Fistula Drainage, and Trauma.
3. Used in patient s with Metabolic Acidosis bc it’s an alkalizing solution.
CI: USE with CAUTION for patients with Heart Failure and Renal failure.
What are the different types of hypertonic IV solutions?
3% saline
5% saline
10/20/50% dextrose
What are the uses for hypertonic solutions?
Hyponatremia, ICU, severe Hypoglycemia (pulls excess fluid from cells causing cells to shrink)
What are the different types of hypotonic IV solutions?
.45% Saline 1/2 NS
.225% Saline 1/4 NS
.33% Saline 1/3 NS
What are the uses for hypotonic solutions?
To provide free water for excretion of body wastes
To treat Dehydration and replace fluid
What are the different types of isotonic IV solutions?
.9% Saline-NS
5% dextrose-D5W
Lactated Ringers-LR
What are the uses for isotonic solutions?
Replace minimal fluid loss,
Routine admin to maintain hydration during surgery.
How do you Dx Hypernatremia?
EKG, ABG, Labs
How do you Tx Hypernatremia
Use 10 units of insulin and 1 ampule of glucose (via D5W IV push) to decrease sodium levels
How to determine if a patient has been vomiting?
Order BMP or CMP
Lab will show
Hypokalemic Metabolic Alkalosis
How to treat Hypokalemic Metabolic Alkalosis?
Tx with Sodium Bicarb
result= hypokalemia
What are the 4 routes of admin used in the hospital setting?
PO, IV, IM, Respiratory
Use all 3 routes of admin for what?
Severe Hyperkalemia
How to Treat severe Hyperkalemia
Tx with:
1. Insulin-10 units IV push
2. Sodium Bicarb-30g or 60g PO
3. Albuterol-causes hypokalemia (nebulizer)
What is the first step to treating Hyperkalemia?
Scroll labs to ensure no pseudo-elevation.
Then Tx with all 3 routes of admin
How to treat Resistant Hyperkalemia?
Tx with Dialysis
How to Tx HYPOKALEMIA?
40/40 MIX (200 mEq deficit)
How to Tx HYPERKALEMIA
Scroll first
Then Tx via all 3 routes of admin
Sodium is related to what 2 major problems?
Aldosterone or Dehydration
What are the 2 types of NG tubes?
Levin tube- smaller and lighter-more aspiration risk
Dubhoff tube- weighted at end- less aspiration risk
How to treat a comatose patient?
Give NG tube 1 glass 250mL water
What is “aspiration precaution”?
Sit patient upright- 3pillows
What are the Emergency number in the hospital?
outside the hospital?
In hospital: 119
outside hospital: 911
How to treat Na level of 125-Hyponatremia?
Give 3% saline IV in 250mL bag via central line (preferred)
Only 10mL over each dose over 24hrs
How to move a patient in the hospital bed?
Use a partner
lower head of bed
lift the bed sheet with patient to slide in a scoop motion on 3.
