Electrolyte Disorder

Question 1

What are the treatment of hyponatremia ?

Answer 1

1. Fluid restriction
2. Hypertonic solution/ Normal saline
3. Demeclocycline - irreversible (rarely used)
4. Vaptans/ Coni Vaptans - reversible

Question 2

MOA of vaptans?

Answer 2

Vasopressin receptor antagonist

Question 3

Cause of hyponatremia

Answer 3

Increase ADH

Question 4

Effect of hyponatremia to brain

Answer 4

Brain swelling

Question 5

Cause of hypernatremia

Answer 5

Low ADH

Question 6

Effect of hypernatremia to brain

Answer 6

Brain shrinkage

Question 7

Treatment of hypernatremia ?

Answer 7

1. Drink water
2. Glucose 5%

Question 8

What are the causes of hypokalemia associated with renal loss (kidney secrete excess amount of K+) ?

Answer 8

1. Diuretics (thiazide & loop diuretics)
2. High aldosterone level (Aldosterone reabsorp water and Na+, so excrete more K+)
3. Hypomagnesimia

Question 9

What are the causes of hypokalemia associated with GI loss?

Answer 9

vomitting and diarrhea

Question 10

How does beta-2 agonist cause hypokalemia?

Answer 10

decrease serum potassium levels via an inward shift of potassium into the cells due to an effect on the membrane-bound Na/K-ATPase

Question 11

Why does insulin cause Hypokalemia?

Answer 11

promotes the entry of K+ into skeletal muscles and hepatic cells by increasing the activity of the Na+-K+-ATPase

Question 12

What are the causes of hypokalemia ?

Answer 12

1. Renal loss
2. GI loss
3. B2 stimulation
4. Insulin

Question 13

What are the effect of hypokalemia to CDV/heart?

Answer 13

Arrythmia & Tachycardia

Question 14

What are the causes of hyperkalemia associated with renal loss?

Answer 14

1. Chronic kidney disease
2. Diuretics - K+ sparring
3. Reduced aldosterone
4. B. Blocker - any type of BB -> hyperkalemia

Question 15

What are the effect of hyperkalemia to CDV/heart?

Answer 15

Bradycardia

Question 16

Normal K+ : 3.5-5 mmol/L

Answer 16

6.0-6.5 = heart beat very slow
7= cardiac arrest
>7= death

Question 17

Effect of hypokalemia on skeletal muscle?

Answer 17

muscle cramps, rhabdomyolysis, and resultant myoglobinuria

Question 18

Effect of hyperkalemia on skeletal muscle?

Answer 18

Muscle weakness / paralysis (Cells have trouble responding to nerve impulses with too much potassium)

Question 19

Effect of hypokalemia on kidney?

Answer 19

Alkalosis

Question 20

Effect of hyperkalemia on kidney?

Answer 20

Acidosis

Question 21

Treatment for hypokalemia ?

Answer 21

1. Mild- oral treatment with banana
2. If <2.5 give K+ IV
3. Give Mg ion (lack of magnesium can lead to low calcium and potassium levels)

Question 22

Treatment for hyperkalemia ?

Answer 22

1. Mild- Oral polysterene resine (it release Na+ and binds to K+ ->excrete)
2. Moderate/severe- Use Calcium chloride / Calcium gluconate (increase HR-> treat Bradycardia)
3. B2 antagonist
4. Insulin
5. Insulin if >7

Question 23

K+ is stored in?

Answer 23

Intracellular. eg mast cell/ cardiac cell

Question 24

Normal range of calcium?

Answer 24

2.2-2.7 mmol/L

Question 25

Ca2+ is stored in?

Answer 25

1. Extracellular fluid (free ionized)
2. 40% albumin protein

Question 26

Cause of hypocalcemia?

Answer 26

1. hypoparathyroidism
2. hypomagnesemia

Question 27

Cause of hypercalcemia?

Answer 27

1. hyperthyroidism - Too much PTH causes calcium levels in your blood to rise too high

Question 28

Treatment for hypocalcemia?

Answer 28

1. IV : Ca gluconate / Ca Chloride
2. Mg
3. Oral Calcium supplement -due to post-surgery, chronic hypoCa2+, thyroid surgery

Question 29

Treatment for hypercalcemia ?

Answer 29

1. Rehydration
2. Biphosphonates
3. LOOP diuretics