Electrolyte Disorders

Question 1

Normal K

Answer 1

3.5-5.1

Question 2

Hypokalemia

Answer 2

< 3.5

Mod-sev (sx)
-Cramping, weakness, malaise, myalgias
-ECG, arrhythmias

ASYM: oral
SYM: IV (may be)

Question 3

Hypokalemia & hypomagnesemia together

Answer 3

Correct hypomagnesemia first (Mg needed for K uptake)

Question 4

Hypokalemia Non-Pharm

Answer 4

Increase diet K
-banana, orange, kiwi, mango, greens, avocado, chocolate, nuts and seeds

Question 5

Oral K

Answer 5

Potassium Chloride (most often), also K phosphate and bicarb

AE
-Abd pain/cramp
-Diarrhea, nausea, flatulence
-Hyperkalemia

10 mEq KCl, 10-40 daily to QID (divided to minimize AE)

BEST FOR ASYM PTS

Question 6

IV K

Answer 6

K chloride, acetate, phosphate salts

Diluted before use, as IV, NS or 0.45% always!

-10 mEq/100 ml 1 hr
-20 mEq/50 ml 1 hr (central line only)

Recheck K after 30-40 meq total

FOR SEVERE HYPOK

Question 7

HypoK Monitoring

Answer 7

-K
-ECG
-Renal
-Mg

Question 8

Hyperkalemia

Answer 8

> 5.1 (severe > 6.5)

ASYM, mild = monitor, diet ed, change causing agent

SYM OR ECG changes = URGENT

Question 9

Mild hyperK
Mod hyperK
Severe hyperK

Answer 9

5.2-5.9
-Kayexelate suspension or Furosemide 20-40 IVP

6-6.4
-Insulin 0.1 u/kg, albuterol, Na Bicarb

6.5+
-Ca gluconate or Ca chloride (cacl central line)

ANI goes to KFCC

Question 10

Normal Mg

Answer 10

1.7-2.6

Question 11

Hypomagnesium

Answer 11

< 1.6, < 1.2 is severe

Asym
-neurologic (convulsions), neuromuscular (twitch/tremor/etc), cardio (ECG, HTN, arr)

Question 12

HypoMg TX
-Severe/sym
-Mod/asym

Answer 12

severe < 1.2
-Mg Sulfate 2 g IV over 2 min, then 20 then 2-4 g over 2-4 hr

1.2-1.6 mod
-Mg sulfate 8 g IV over 8 hr (over 4 if mg is 1.2-1.6)

Question 13

Magnesium Oral

Answer 13

Oxide (most common, diarrhea)
-242 ele mg (1-2 tabs BID or TID)

Lactate, Cl, gluconate preferred (less GI SE)

Question 14

Hypermagnesemia

Answer 14

> 2.6

-Rare except kidney disease

-lethargy, confusion, muscle weakness, dysrhythmias

Question 15

HyperMg TX
-Severe
-Mild

Answer 15

• 1-2 g IV Ca gluconate, then furosemide 20-40 IV with 0.45 NS, and limit Mg in diet
• asym: d/c agent, reduce Mg in diet

Question 16

Normal Ca

Answer 16

8.6 – 10.2 mg/dL

Question 17

Hypocalcemia

Answer 17

< 8.6, ionized < 1.1

-neuromuscular (tetany), cardiac (ECG), CNS (dep/anx/conf/hall), derm (dry, brittle, puffy, dermatitis)

Question 18

Hypocalcemia TX

Answer 18

IV
-CaCl: increase vein irritation, central line, more ele
-CaGlu: less irritation, less ele

Oral
-Ca acetate
-Ca carbonate

Question 19

Hypercalcemia

Answer 19

> 10.2
(sev >13)

-fatigue, anorexia, polyuria, polydipsia, nocturia

Question 20

Hypercalcemia TX

Answer 20

ASYM, observe

ASYM >12: saline, loop, calcitonin, GC

Good kidneys: saline, loop, calcitonin, GC, hemodialysis

Bad kidneys: hemodialysis, calcitonin, GC

Question 21

Normal Phosphorus

Answer 21

2.5-4.5

Question 22

Hypophophatemia

Answer 22

< 2.5, < 1.5 is severe

-organ dysfunction, seizure, coma

-confusion, resp failure, cardiac dysfunction, muscle weakness

Question 23

Hypophophatemia TX

Answer 23

Sodium Phos (more often) IV

K Phos (for both low K and phos) IV

mild: increase phos in diet, oral phos, 250 mg tid

Question 24

K-phos neutral vs Neutra-phos-K

Answer 24

KPN: 8 mmol, but 1.1 meq of K (low Na pts)

NPK: 8 mmol, but 14.3 meq of K (for low K pts)

Question 25

Drug induced high Mg

Answer 25

-Lithium
-Mg products (antacids)

Question 26

Drug induced low Mg

Answer 26

-laxatives
-aminoglycosides
-cyclosporine
-tacrolimus
-diuretics, digoxin
-cisplatin
-PPI long term

Megan has to get her TDAP CLC

Question 27

Hypophos drug induced

Answer 27

-Diuretics
-GC
-Na bicarb

Question 28

HypoK Drug Induced

Answer 28

-B2 agonist (albuterol)
-Levothyroxine
-Insulin, verapamil (OD)
-Thiazide, LP
-AG, AB, MC
-Penicillin, cisplatin
-Laxatives
-SPS, PAT, SZ

PS B LIT LA

Question 29

Hyper Ca Drug Induced

Answer 29

-Thiazides
-Vit D, Ca
-Lithium
-Theophylline
-Tamoxifen
-Ganciclovir

cal got TTT an LVG