Electrolyte Disorders Flashcards

1
Q

Hyponatremia is a Serum sodium concentration less than what?

A

135 mEq/L

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2
Q

What is the most common electrolyte abnormality in hospitalized patients? what causes this?

A

Hyponatremia

often caused by hypotonic fluids

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3
Q

Evaluation for hyponatremia starts with a careful history for what?

A

1) New medications,
2) Changes in fluid intake (polydipsia, anorexia, intravenous fluid rates and composition),
3) Fluid output (nausea and vomiting, diarrhea, ostomy output, polyuria, oliguria, insensible losses)

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4
Q

Mismanagement of what issue can result in neurologic catastrophes from cerebral osmotic demyelination

A

Hyponatremia

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5
Q

Mild hyponatremia is what range?

is this symptomatic?

A

sodium concentrations of 130-135 mEq/L
is usually
asymptomatic

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6
Q
Hyponatremia
Mild / Moderate / severe 
S/S
1) Nausea
2) Malaise
A

Mild

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7
Q
Hyponatremia
Mild / Moderate / severe 
S/S
1) Respiratory arrest
2) Seizure
3) Coma
4) Permanent brain damage,
5) Brainstem herniation
6) Death
A

Severe

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8
Q
Hyponatremia
Mild / Moderate / severe 
S/S
1) Headache
2) Lethargy
3) Disorientation
A

Moderate

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9
Q

Treatment for Hyponatremia

A

(a) Restriction of free water and hypotonic fluid intake is the initial step in hyponatremia management.
(b) Free water intake should generally be less than 1-1.5 L/day,
- —More severe free water restriction may be necessary in patients with minimal free water clearance
- —Hypertonic saline may be necessary in patients with negative free water clearance.

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10
Q

Tru/False
Iatrogenic cerebral osmotic demyelination from overly rapid sodium correction is minor and reversible with hypotonic saline therapy

A

False

Generally catastrophic and irreversible

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11
Q

Definition of what issue?

(a) Sodium concentration greater than 145 mEq/L.
(b) Typically, hypovolemic due to free water losses
(c) Rarely, excessive sodium intake may cause hypernatremia

A

Hypernatremia

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12
Q

Intact thirst mechanism and access to water are the primary defense against what issue?

A

hypernatremia

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13
Q

Signs and symptoms of what issue?

(a) Dehydration patient
- -Orthostatic hypotension
- - Oliguria
(b) Early signs
- - Lethargy
- - Irritability
- -Weakness
(c) Severe signs (usually Na > 158mEq/L)
- -Hyperthermia
- -Delirium
- -Seizures
- -Coma

A

Hypernatremia

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14
Q

Hypernatremia is what value?

A

Sodium concentration greater than 145 mEq/L

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15
Q

Tx for Hypernatremia

A

(a) Correcting the cause of the fluid loss
(b) Replacing water
(c) Replacing electrolytes (as needed)
(d) Fluids should be administered over a 48-hour period,
- –Aiming for serum sodium correction of approximately 1 mEq/L/h (1 mmol/L/h)

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16
Q

TX for Hypernatremia
Fluids should be administered over how long?
What is the rate of sodium correction?

A
  • 48-hour period,

- sodium correction of approximately 1 mEq/L/h

17
Q

Disposition

Patients with symptomatic hypernatremia

A

hospitalization for evaluation and treatment.

18
Q

Disposition Hyponatremia

A

Hospitalization for

1) Monitoring of fluid balance and weights,
2) Treatment
3) Frequent sodium checks

19
Q

What is a Serum potassium level less than 3.5 mEq/L (3.5 mmol/L).

A

Hypokalemia

20
Q

Severe hypokalemia may induce what?

A

arrhythmias and rhabdomyolysis.

21
Q

Hypokalemia can result from

A

1) Insufficient dietary potassium intake,

2) Intracellular shifting of potassium from the extracellular space

22
Q

The most common cause of hypokalemia is

A

gastrointestinal loss from infectious diarrhea

23
Q

S/S of what issue?

(a) Mild to moderate symptoms
- -Muscular weakness
- -Fatigue
- -Muscle cramps
(b) Severe
- -Flaccid paralysis
- -Hyporeflexia
- -Hypercapnia
- -Tetany
- -Rhabdomyolysis

A

Hypokalemia

24
Q

Severe Hypokalemia is resulted from what potassium level?

A

less than 2.5mEq/L

25
Q

Electrocardiogram of a Hypokalemia pt may show what?

A

1) Decreased amplitude and broadening of T waves,
2) Premature ventricular contractions,
3) Depressed ST segments

26
Q

What is the safest and easiest treatment for mild to moderate hypokalemia?

A

Oral potassium supplementation

–40-100 mEq/day over a period of days to weeks

27
Q

Complications of hypokalemia

A

(a) Cardiac arrhythmias

(b) Rhabdomyolysis

28
Q

Unexplained hypokalemia, refractory hypokalemia, or suggestive alternative diagnoses should be referred for consultation to where?

A

endocrinology or nephrology

29
Q

Disposition

Patients with symptomatic or severe hypokalemia, especially with cardiac manifestations,

A

Hospitalization

30
Q

What issue

Serum potassium level greater than 5.0 mEq/L (5.0 mmol/L).

A

Hyperkalemia

31
Q

Hyperkalemia may develop in patients taking what medications

A

1) ACE inhibitors,
2) Angiotensin-receptor blockers,
3) Potassium-sparing diuretics

32
Q

True/False

The ECG may be normal despite life- threatening hyperkalemia

A

True

33
Q

Hyperkalemia impairs neuromuscular transmission, causing:

A

1) Muscle weakness
2) Flaccid paralysis
3) Ileus

34
Q

Your patient was clenching her fist during venipuncture from being scared of needles
-serum potassium resulted in a level higher that 5.0 mEq/L

What is your next course of action and why?

A

Repeat laboratory testing to rule out false hyperkalemia
-Fist clenching during venipuncture may raise the potassium concentration by 1-2 mEq/L by causing acidosis and potassium shift from cells.

35
Q

ECG results may indicate what?

1) Bradycardia,
2) PR interval prolongation,
3) Peaked T waves,
4) QRS widening,
5) Conduction disturbances
- -Bundle branch block
- –Atrioventricular block

A

Hyperkalemia

36
Q

Ventricular fibrillation and -cardiac arrest are terminal events. of what issue

A

Hyperkalemia

37
Q

Emergent treatment for hyperkalemia is indicated when

A

1) Cardiac toxicity,
2) Muscle paralysis,
3) Severe hyperkalemia (potassium greater than 6.5 mEq/L) even in the absence of ECG changes

38
Q

Hypernatremia

What may be required to remove potassium in patients with acute or chronic kidney injury

A

Hemodialysis