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nephrology & urology > electrolyte disorders > Flashcards

electrolyte disorders Flashcards

1
Q

causes of hyperkalemia

A

cellular redistribution from the intracellular to the extracellular compartment

K++ retention

impaired K++ excretion

tissue breakdown

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2
Q

Hyperkalemia commonly associated with what

A

renal failure

ACE inh

hyporeninemic hypoaldosteronism

cell death

metabolic acidosis

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3
Q

severe hyperkalemia can result in what

A

dysrhythmias and cardiac arrest

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4
Q

what can cause spurious hyperkalemia

A

thrombocytosis and hemolysis

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5
Q

hypoaldosteroism and metabolic acidosis commonly assoc with what

A

hyperkalemia

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6
Q

earliest ECG manisfestation of hyperkalemia is what

(over 6.5)

A

peaking of T waves

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7
Q

ECG changes in severe hyperkalemia(over 7)

A

P wave flattening, PR interval prolongation, QRS widening

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8
Q

what to give in severe hyperkalemia with heart effects

A

calcium gluconate IV to antagonize effects of heart.

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9
Q

what can you give to drive K++ back into the intracellular compartment;

good/bad

A

sodium bicarb, glucose, insulin;

rapid onset but duration short

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10
Q

what to give to remove K++ from the body

A

kayexalate

last resort: hemodialysis

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11
Q

neurologic symptoms of hyperkalemia

A

numbness, tingling, weakness, flaccid paralysis

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12
Q

labs for hyperkalemia

A

serum K++ over 5

urine K++, Cr, osmolality reveal decreased fractional excretion of K++

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13
Q

EKG when K++ is 8-10

A

sine wave pattern with cardiac arrest

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14
Q

cellular redistribution from the intracellular to the extracellular compartment

K++ retention

impaired K++ excretion

tissue breakdown

A

causes of hyperkalemia

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15
Q

renal failure

ACE inh

hyporeninemic hypoaldosteronism

cell death

metabolic acidosis

A

Hyperkalemia commonly associated with what

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16
Q

P wave flattening, PR interval prolongation, QRS widening

A

ECG changes in severe hyperkalemia(over 7)

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17
Q

numbness, tingling, weakness, flaccid paralysis

A

neurologic symptoms of hyperkalemia

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18
Q

serum K++ over 5

urine K++, Cr, osmolality reveal decreased fractional excretion of K++

A

labs for hyperkalemia

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19
Q

pnemonic for hyperkalemia tx

A

C BIG BK

calcium gluconate

bicarb and/or insulin and glucose to temporarily shift K++ back into cells

B agonists to promote celluar reuptake of K++

Kayexalte to remove K++ from body

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20
Q

causes of hypokalemia

A

shift of K++ into intracellular compartment or from K++ losses of extrarenal or renal origin

most commonly occurs with diuretics, renal tubular acidosis, GI losses, hypomagnesemia, polyuria

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21
Q

vent arrhythmias, MI, ileus, constipation, rhabdomyolysis

A

think hypokalemia

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22
Q

ECG in hypokalemia

A

flattened or inverted T waves, prominent U waves, ST depression, ventricular ectopy

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23
Q

most helpful tests for causal workup of hypokalemia

A

blood acid-base parameters, urinary K++ and Cl levels

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24
Q

how does hypokalemia affect the heart

A

it potentiates the effects of cardiac glycosides on myocardial conduction and may lead to dig intoxication

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25
Q

cardiovascular manisfestations of hypokalemia

A

ventricular arrhythmias, hypoTN, cardiac arrest

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26
Q

neuromuscular manisfestations of hypokalemia

A

malaise, skeletal mm weakness, cramps, smooth mm involvement leading to ileus and constipation

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27
Q

polyuria, nocturia, hyperglycemia, rhabdomyolysis, ileus, cramps or weakness, hyporeflexia, ascending paralysis

A

hypokalemia

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28
Q

how to distinguish renal from GI losses on hypokalemia

A

24 hr or spot urine K++ test

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29
Q

If hypokalemia is not responding to K++ repletion, then what

A

check magnesium levels

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30
Q

shift of K++ into intracellular compartment or from K++ losses of extrarenal or renal origin

most commonly occurs with diuretics, renal tubular acidosis, GI losses, hypomagnesemia, polyuria

A

causes of hypokalemia

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31
Q

flattened or inverted T waves, prominent U waves, ST depression, ventricular ectopy

A

ECG in hypokalemia

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32
Q

it potentiates the effects of cardiac glycosides on myocardial conduction and may lead to dig intoxication

A

how does hypokalemia affect the heart

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33
Q

ventricular arrhythmias, hypoTN, cardiac arrest

A

cardiovascular manisfestations of hypokalemia

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34
Q

malaise, skeletal mm weakness, cramps, smooth mm involvement leading to ileus and constipation

A

neuromuscular manisfestations of hypokalemia

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35
Q

relationship between PTH, Ca, Phosphorus

A

PTH and Ca same, phosphorus different

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36
Q

hospitalized pt with malignancy

A

think hypercalcemia

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37
Q

anorexia, nausea, constipation, polyuria, polydipsia, consciousness level, inravascular volume depletion

A

hypercalcemia

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38
Q

24 hr urine calcium levels mean what

A

elevated: cancer or hyperparathyroidism. decreased: hyperparathyroidism

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39
Q

worst thing hypocalcemia can do

A

complete cardio collapse

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40
Q

psoriasis, dry skin, perioral numbness

CV signs: wheezing, bradycardia, crackles, S3

A

hypocalcemia signs

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41
Q

common causes of disorders of calcium and phosphorus

A

PTH d/o, chronic renal failure, malignancy

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42
Q

vitamin D intoxication, hyperparathyroidism, sarcoidosis

A

other causes of hypercalcemia

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43
Q

which calcium disorder is more common?

found in who?

A

hypocalcemia

critically ill pts

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44
Q

hypercalcemia

s/s

A

anorexia, nausea, constipation, polyuria, polydipsia, consciousness level, inravascular volume depletion

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45
Q

common causes of hypocalcemia

A

chr disease(like CKD) or hypoparathyroidism

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46
Q

what is trosseau’s sign

A

carpel tunnel spasm after BP cuff applied for 3 min. hypocalcemia

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47
Q

what is chvostek’s sign

A

spasm of facial muscle after tapping facial nn. hypocalcemia

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48
Q

severe hypocalcemia results in what

A

complete cardiovascular collapse

severe manisfestations: syncope and angina

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49
Q

brittle nails, pruritis, mm cramps, SOB, n/t in extremities

A

sx of hypocalcemia

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50
Q

hypocalcemia signs

A

psoriasis, dry skin, perioral numbness

CV signs: wheezing, bradycardia, crackles, S3

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51
Q

neuro findings in hypocalcemia

A

trousseau, chvostek, confusion, dementia, seizure, irritability

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52
Q

cramps and tetany after a thyroidectomy

A

hypocalcemia

53
Q

labs for hypocalcemia

A

ionized Ca and PTH

54
Q

corrected calcium formula

A

measured total calcium + [0.8 x (4-albumin)]

55
Q

normal calcium levels

A

8.5 to 10.2

56
Q

tests to order for hypercalcemia

A

corrected Ca

CXR to look for pulm mass

UA for hematuria- RCC

ESR

24 hr urine

57
Q

hypercalcemia tx

A

isotonic saline for volume repletion

loop if hypervolemic after this

bisphosphonates for severe cases

58
Q

vitamin D def, respiratory alkalosis, burns, hyperPTH

A

common causes of hypophosphatemia

59
Q

hyperphosphatemia commonly secondary to what

A

CKD

60
Q

hypophosphatemia commonly secondary to what

A

diminished supply or absorption, increased urinary losses or redistribution

61
Q

severe hypophosphatemia may lead to what

A

rhabdo, paresthesia, encephalopathy

62
Q

phosphate binders

A

calcium carbonate tablets

63
Q

normal phosphate levels

A

2.5 to 4.5

64
Q

normal magnesium levels

A

1.5 to 2.5

65
Q

sx of hypermagnesemia

A

usually asymptomatic except in CKD given Mg products such as laxatives or antacids

decreased DTR, mm weakness, N/V, resp depression, then cardiac arrest follows

66
Q

ECG findings in hypermagnesemia

A

widened QRS complex, prolonged PR interval, prolonged Q-T interval

67
Q

bleeding and clotting times increased

A

think hypermagnesemia

68
Q

tx of hypermagenesemia

A

calcium gluconate, lasix, dialysis

69
Q

hypokalemia, hypocalcemia, hypocalciuria assoc with what

A

hypomag

70
Q

most magnesium is stored where

A

bones and muscles

71
Q

tx of hypomagnesemia

A

oral magnesium oxide for chronic cases

severe symptomatic: mag sulfate sol’n IV 7 days(1 gm then 6 days over 1 L in 24 hrs); or IM 4 doses

72
Q

when does hypomag appear

A

when total body stores are severely depleted; usually from diminished intake and impaired absorption

73
Q

what is hypomag commonly associated with

A

chronic alcoholism

chronic diarrhea

hypoPTH

hyperaldosteronism

diuretic therapy

osmotic diuresis

nutritional deficiencies

long term use of PPI

74
Q

S/S of hypomag

A

tetany, N/V, lethargy, anorexia, weakness, seizures, weakness

75
Q

labs and EKG for hypomag

A

hypokalemia, hypocalcemia, hypocalciuria

EKG: prolonged PR and QT interval or widening of QRS

76
Q

hypokalemia and hyperkalemia levels

A

under 3.5 mEq/L

over 5.0 mEq/L

77
Q

flaccid paralysis and ascending paralysis

A

hyperkalemia

hypokalemia

78
Q

sodium bicarb, glucose, and insulin can do what

A

drive K++ cells intracellularly

79
Q

hyporeflexia can be what

hyperreflexia

A

hyporeflexia: hypokalemia
hyperreflexia: hypernatremia

80
Q

hypoaldosteronism can be what

hyperaldosteronism

A

hyperkalemia

hypomagnesium

81
Q

hyperPTH

hypoPTH

A

Hyper: hypophosphatemia and hypercalcemia

hypo: hypocalcemia and hypomagnesium

82
Q

calcium gluconate for what

A

severe hyperkalemia

hypermagnesium

83
Q

rhabdomysis can appear in what

A

hypokalemia

hypophosphatemia

84
Q

when to get a corrected calcium and an ionized calcium

A

corrected in hypercalcemia

and ionized in hypocalcemia

85
Q

hypernatremia level if what

A

over 145 mEq/L

86
Q

low urine Na and polyuria

A

DI

87
Q

what to worry about in hypernatremia

A

brain cell shrinkage and DI

88
Q

Na greater than 200

A

do dialysis

89
Q

what is the most common electrolyte disorder seen in general hospital population secondary to use of hypotonic fluid administration

A

hyponatremia

90
Q

hypovolemia and cheyne stokes respirations

A

hyponatremia

91
Q

hypernatremia occurs in who

A

elderly and may occur in infants with diarrhea

92
Q

neurologic manifestations of hypernatremia

A

thirst(from hypertonicity), restlessness, irritability, disorientation, lethargy, delirium, convulsions, coma

93
Q

thirst(from hypertonicity), restlessness, irritability, disorientation, lethargy, delirium, convulsions, coma

A

neurologic manifestations of hypernatremia

94
Q

non neurological symptoms of hypernatremia

A

dry mouth, dry mucous membranes, lack of tears, decreased salivation, flushed skin, tachycardia, hypoTN, fever, oliguria, anuria, hyperventilation, lethargy, HYPERREFLEXIA

95
Q

6 hypernatremia causes pnemonic

A

Diuresis

dehydration

DI

docs(iatrogenic)

diarrhea

disease(kidney, sickle cell)

96
Q

dry mouth, dry mucous membranes, lack of tears, decreased salivation, flushed skin, tachycardia, hypoTN, fever, oliguria, anuria, hyperventilation, lethargy, hyperreflexia

A

non neurological symptoms of hypernatremia

97
Q

urine sodium decreased/elevated vs concentrated/diluted

A

decreased if hypernatremia is due to extrarenal losses and elevated if due to renal losses or sodium excess.

Concentrated with extrarenal losses and diluted with DI

98
Q

antidiuretic stimulation and DI

A

it does not increase urine osmolality in nephrogenic DI

99
Q

how to indicate a hyperosmolar coma

A

elevated serum glucose

decreased UO

increased urine osmomality

100
Q

urine osmolality under 100

and 100-300

A

central DI

nephrogenic DI

101
Q

hypernatremia treatment

* preferred route

*unstable vital signs

* hypovolemia present

*dialysis

*caution in what

A

free water orally is preferred, can also do IV or SQ 5% dextrose solution

unstable: do isotonic 0.9% NaCl

treat hypovolemia first(isotonic saline or LR) then the hypernatremia

dialysis if sodium greater than 200 mEg/L

caution because rapid correction can cause pulmonary or cerebral edema, especially in pts with DM

102
Q

hyponatremia levels

A

sodium less than 130-135

103
Q

hyponatremia usually due to what

A

increased ADH

104
Q

hyponatremia with hypervolemia occurs when

A

in the setting of CHF, nephrotic syndrome, renal failure, hepatic cirrhosis

105
Q

hyponatremia with euvolemia occurs when

A

with hypothyroidism, glucocorticoid excess, SIADH

106
Q

SIADH

A

The syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH) is characterized by excessive release of antidiuretic hormone (ADH or vasopressin) from the posterior pituitary gland or another source. The result is HYPOTONIC hyponatremia and sometimes fluid overload.

107
Q

if you suspect SIADH…

A

CT to rule out CNS d/o and CXR to rule out lung pathology

108
Q

demeclocycline for what?

risks?

A
  • for chr hyponatremia unresponsive to fluid restriction; to induce nephrogenic DI.
  • may cause neprotoxicity in pts with cirrhosis
109
Q

ADH from what

A

pituitary hormone

110
Q

tx for neurogenic(central) DI

what to do for mild disease

nephrogenic DM

diet

A
  • parenteral or intranasal desmopressin
  • diuretics, chlorpropamide, carbamazepine
  • HCTZ, amiloride diuretics, indomethacin
  • limited salt and protein
111
Q

SIADH found in what diseases

A

It is usually found in patients diagnosed with small-cell carcinoma of the lung, pneumonia, brain tumors, head trauma, strokes, meningitis, and encephalitis.

112
Q

SIADH

urine osmolality

urine sodium

A

osmolality greater than 100

sodium greater than 40

113
Q

hyponatremia clinical symptoms

A

lethargy, disorientation, muscle cramps, anorexia, hiccups, N/V, seizures

114
Q

signs of hyponatremia

A

HYPOreflexia, orthostatic hypoTN, cheyne stokes respirations, coma, stupor, delirium, agitation

115
Q

lethargy, disorientation, muscle cramps, anorexia, hiccups, N/V, seizures

A

hyponatremia clinical symptoms

116
Q

HYPOreflexia, orthostatic hypoTN, cheyne stokes respirations, coma, stupor, delirium, agitation

A

signs of hyponatremia

117
Q

what can progress to seizures, coma, or brainstem herniation

A

hyponatremia

118
Q

formula for serum osmolality

A

(2 x serum Na) + (BUN/2.8) + (glucose/18)

119
Q

dangers of correcting hyponatremia too rapidly

A

central pontine myelinolysis or osmotic demyeination

120
Q

order what tests if SIADH suspected

A

CT and CXR

121
Q

hyponatremia treatment in

1) hypervolemic & euvolemic
2) hypovolemic

A

1) water restriction +/- diuretics
2) Normal saline

122
Q

chronic hyponatremia tx

1) rate
2) unresponsive to fluid restriction
3) euvolemic or hypervolemic hyponatremia

A

1) over 72 hr duration with <8 mEq/L/day
2) demeclocycline
3) vasopressin antagonists(conivaptan)

123
Q

causes of DI

1) neurogenic
2) nephrogenic
3) acquired

A

Neurogenic: deficient secretion of ADH from pituitary

nephrogenic: kidneys unresponsive to normal vasopressin levels, inherited X linked trait,

acquired from lithium therapy, HYPOkalemia, HYPERcalcemia, or renal disease

124
Q

main symptoms of DI

A

polyuria(50-60 mL/kg/day), nocturia, polydipsia,

maybe seizures

125
Q

how to differentiate neurogenic and nephrogenic DI

A

Water deprivation and desmopresin testing(DDAVP):

NEUROGENIC(central) DI: dec urine output and increased urine osmolality

if little or no change in urine osmolality, it is most likely NEPHROGENIC DI

126
Q

urine osmolality less than 250 mOsm/kg

A

despite hyperkalemia

it is NEPHROgenic DI

127
Q

tx for central DI and nephrogenic DI

A

central: DDAVP
nephrogenic: salt restriction and water intake, thiazide diuretics

128
Q

labs in volume depletion

A

hemocrit and serum albumin increased

urinary sodium decreases

urea increases (secondary to urine stasis in nephron) but little change in serum Cr

nephrology & urology (7 decks)

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