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Clin Med III > electrolyte disorders > Flashcards

electrolyte disorders Flashcards

1
Q

what are the major electrolytes

A
  • Na
  • K
  • Ca
  • Mg
  • HPO4 (phosphorus)
  • Cl
  • HCO3
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2
Q

ways to assess for fluid and electrolyte disturbances

A
  • assess total body water- H&P
  • serum electrolyte concentrations
  • urine electrolyte concentrations
  • serum osmolality
  • can include oncotic pressures- albumin lev
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3
Q

what is the 60-40-20 rule?

A
  • 60% body weight is water
  • 40% of total body weight is intracellular
  • 205 of total body weight is extracellular
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4
Q

how do you assess volume status

A
  • BP and pulse
  • jugular venous distention
  • central venous pressure
  • pulmonary capillary wedge pressure
  • IVC diameter on US
  • R atrial pressure on echo
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5
Q

what is the minimum amount of water intake needed per day

A
  • 1500 ml/day
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6
Q

what is the minimum urine output per day

A
  • 500 ml

- or 30 cc/hour

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7
Q

ADH

A
  • anti-diuretic hormone
  • released from posterior pituitary
  • signals kidneys to hold onto water and Na
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8
Q

third spacing

A
  • lg volume of fluid from intravascular compartment shifts into interstitial space
  • trauma, burns, sepsis
  • vascular damage
  • ascites
  • hypoalbuminemia
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9
Q

osmolality

A
  • aka tonicity

- reflects concentration of solutes/ electrolytes per L of water

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10
Q

what is the role of aldosterone

A
  • reabsorb Na

- excrete K

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11
Q

what is the major extracellular cation

A
  • sodium
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12
Q

what is the major intracellular cation

A
  • potassium
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13
Q

what is the most common electrolyte abnormality in hospitalized pts

A
  • sodium abnormalities
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14
Q

dx of dysnatremias

A
  • det volume status and serum osmolality
  • hyponatremia usually reflects excess water retention
  • iatrogenic- hypotonic fluids
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15
Q

what are normal Na levels

A
  • 135-145 meq/L
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16
Q

what is the most common type of hyponatremia?

A
  • hypo-osmolality with hypovolemia
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17
Q

sx of hyponatremia

A
  • nausea
  • malaise
  • HA
  • lethargy/ obtunded
  • pulmonary edema/ arrest
  • seizures
  • coma
  • death
  • acute onset= greater risk of complications **
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18
Q

acute hyponatremia

A
  • < 48 hours
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19
Q

chronic hyponatremia

A
  • > 48 hours
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20
Q

when do sx of hyponatremia usually dev?

A
  • around 125 meq/L
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21
Q

labs to monitor for Na levels

A
  • serum electrolytes
  • creatinine
  • serum osmolality
  • urine Na
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22
Q

goals of hyponatremia tx

A
  • prevent further decline in serum Na
  • decrease intracranial pressure in pts at risk for dev brain herniation
  • relieve sx
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23
Q

hypovolemic hypotonic hyponatremia

A
  • if urine Na is low it is due to extrarenal salt loss with hypotonic fluid replacement- dehydration, n/v
  • if urine Na is high it is due to renal salt loss with hypotonic fluid replacement- diuretics, ACEI, nephropathies
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24
Q

causes of euvolemic hypotonic hyponatremia

A
  • SIADH
  • post op hyponatremia
  • hypothyroidism
  • psychogenic plydipsia
  • adrenocortigotropin def
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25
Q

causes of hypervolemic hypotonic hyponatremia

A
  • generally due to edematous states
  • CHF
  • liver disease
  • advanced kidney disease
  • nephrotic syndrome
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26
Q

management of hyponatremia

A
  • hypovolemic- IVF resuscitation
  • hypervolemic- loop diuretics or dialysis or both
  • euvolemic- free water restriction
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27
Q

how much do you want to elevate the serum Na when treating hyponatremia

A
  • 4-6 meq/L in 24 hours

- max rate of 8 meq/L in 24 hours

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28
Q

complications of hyponatremia treatment

A
  • iatrogenic cerebral osmotic demyelination
  • due to rapidly correcting Na
  • can occur days after N correction or initial neuro recovery
  • hypoxic episodes may contribute
  • neuro effects are irreversible and catastrophic
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29
Q

hypernatremia

A
  • Na > 145 meq/L

- usually pts are hyperosmolar and hypovolemic

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30
Q

what is the main defense against hypernatremia

A
  • sense of thirst
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31
Q

diabetes insipitus

A
  • passage of large volumes of dilute urine

- causes hypovolemic hypernatremia

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32
Q

primary hyperadolsteronism

A
  • excess production of aldosterone

- causes Na and water reabsorption, K excretion

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33
Q

si/sx of hypernatremia

A
  • dehydration sx may be delayed
  • lethargy/ weakness
  • irritability
  • hyperthermia
  • delirium
  • seizure
  • coma
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34
Q

labs for hypernatermia

A
  • urine osmolality > 400 means it is not renal cause- due to fluid losses
  • urine osomolality < 250 means it is central diabetes insipidus or nephrogenic diabetes insipidus
35
Q

treatment for hypernatremia

A
  • correct cause of fluid loss
  • lower serum Na by 1-2 meq/L per hour in < 24 hours
  • hypovolemia- NS IVF
  • euvolemia- PO water
  • hypervolemia- dextrose PO
36
Q

treatment for diabetes insipidus

A
  • desmopressin- ADH analog
37
Q

causes of hypokalemia

A
  • insufficient intake
  • diuretics
  • D/V
  • meds- insulin, albuterol, terbutaline
  • renal loss
38
Q

si/sx of hypokalemia

A
  • muscle weakness/ cramping
  • palpitations
  • constipation or ileus
  • hyporeflexia, tetany
  • rhabdo
  • may consider if HTN, nephrogenic diabetes insipidus, interstitial nephritis
39
Q

EKG findings for hypokalemia

A
  • flattened t wave
  • ST segment depression
  • U waves
40
Q

treatment for hypokalemia

A
  • mild- PO KCl
  • severe/symptomatic- IV replacement
  • continuous telemetry
  • if Mg is also low replace Mg FIRST
41
Q

hyperkalemia risk factors

A
  • impaired urinary excretion
  • advanced renal disease or insufficiency
  • Addison’s disease
  • urinary tract obstruction
  • acidosis causes intracellular K to shift extracellularly
42
Q

medicines that cause hyperkalemia

A
  • ACEI/ARB

- k sparing diuretics- aldosterone

43
Q

si/sx of hyperkalemia

A
  • muscle weakness/ paralysis
  • ileus
  • paresthesias
  • cardiac conduction abnormalities
44
Q

EKG findings for hyperkalemia

A
  • often dont have any
  • tall or peaked T waves
  • bradycardia
  • widened QRS
  • PR interval prolongation
  • flattened P wave
45
Q

treatment for hyperkalemia

A
  • IV calcium gluconate or chloride first- cardioprotective
  • IV hypertonic glucose with regular insulin
  • IV loop/thiazide diuretics
  • bicarb to counteract acidosis
  • albuterol- K reuptake
  • PO kayexalate- binds K and excreted in stool
  • hemodialysis last line
46
Q

factors that influence calcium concentration

A
  • PTH
  • vitamin D
  • calcium ion
  • phosphate
  • bone
47
Q

where are Ca sensing receptors found

A
  • parathyroid gland

- kidneys

48
Q

hypocalcemia

A
  • often mistaken for neuro disorder

- decreased serum PTH, vit D or Mg levels

49
Q

causes of hypocalcemia

A
  • parathryoid/ thyroid disease/ -ectomy
  • chronic renal failure
  • vit D deficiency
50
Q

what is calcium normally bound to in serum

A
  • albumin

- hypoalbuminemia -> pseudohypocalcemia

51
Q

how do you determine true calcium levels

A
  • need to correct for albumin levels
52
Q

sx of hypocalcemia

A
  • paresthesia
  • hyperreflexia
  • tetany/ neuromusclar irritability
  • muscle spasms/ cramps
  • seizures
  • coma
  • chvostek sign
  • trousseau’s sign
53
Q

chvostek sign

A
  • facial spasm after percussion of facial nerve

- finding for hypocalcemia

54
Q

trousseau’s sign

A
  • spasm of hand by inflation of BP cuff

- finding for hypocalcemia

55
Q

EKG findings for hypocalcemia

A
  • prolonged QT interval
56
Q

hypercalcemia causes

A
  • hyperparathyroidism
  • bone malignancy
  • multiple myeloma
  • overuse of antacids
57
Q

sx of hypercalcemia

A
  • bone pain
  • muscle weakness
  • kidney stones
  • lethargy
  • confusion
  • constipation
  • fatigue
  • depression
  • nausea
  • “stones, bones, moans, groans”
58
Q

diagnostics of hypercalcemia

A
  • labs are complicated

- chest xray to r/o malignancy or granulomatous disease

59
Q

EKG findings for hypercalcemia

A
  • shortened QT interval
60
Q

treatment for hypercalcemia

A
  • renal excretion promoted through aggressive hydration
  • salmon calcitonin with bisphosphonate
  • zoledronic acid
61
Q

hypomagnesemia causes

A
  • alcohol abuse from poor dietary intake
  • reduce intestinal absorption
  • increase renal excretion
  • excessive GI loss
  • starvation
  • refeeding syndrome
62
Q

what does hypomagnesemia impair the release of

A
  • PTH
63
Q

sx of hypomagnesemia

A
  • confusion, lethargy
  • tremors
  • convulsions
  • hyperreflexia
  • paresthesia’s
  • cardiac arrhythmias/ widened QRS
  • conduction prolongation
  • ST depression
64
Q

treatment for hypomagnesemia

A
  • oral replacement of asymptomatic (may cause osmotic diarrhea)
  • IV replacement if severe or symptomatic def
65
Q

hypermagnesemia causes

A
  • renal failure
  • supratherapeutic replacement
  • antacid/ laxative abuse
  • much less common than hypomg
66
Q

sx of hypermagnesemia

A
  • decreased DTR
  • bradycardia
  • hypotension
  • flaccid paralysis
  • cardiac arrest
  • nausea, HA
  • hypocalcemia
67
Q

EKG findings for hypermagnesemia

A
  • tall T
  • widened QRS
  • irregular conduction
  • escape beats
68
Q

treatment for hypermagnesemia

A
  • dietary restriction
  • elim Mg containing meds
  • saline and loop diuretics
  • hemodialysis
69
Q

what causes intestinal absorption of phosphate

A
  • active Vit D
70
Q

what increases urine phosphate excretion

A
  • PTH

- FGF 23

71
Q

primary causes of hypophosphatemia

A
  • alcoholism
  • v/d
  • poor PO intake
  • COPD/ asthma
72
Q

sx of hypophosphatemia

A
  • rhabdo
  • paresthesias
  • encephalopathy
  • respiratory failure
  • arrhythmias/ heart failure
  • acute hemolytic anemia*
  • impaired chemotaxis of leukocytes -> GN sepsis
73
Q

diagnostics for hypophosphatemia

A
  • urine HPO4 excretion

- plasma PTH or PTHrP

74
Q

treatment for hypophosphatemia

A
  • include HPO4 in repletion and maint fluids
  • PO phosphate to prevent hypocalcemia
  • for severe give infusion
  • correct Mg deficiencies
75
Q

hyperphosphatemia

A
  • most common cause= CKD with decreased urinary excretion
  • sx related to underlying cause
  • treat underlying cause
76
Q

colloid IV fluids

A
  • albumin solutions, hyperoncotic starch, dextran, gelatin
  • dont cross cell membrane
  • expand intravascular volume
  • draw fluid from extravascular space
77
Q

crystalloid IV fluids

A
  • contain small molecules that easily pass through cell membrane
  • increase fluid volume in interstitial and intravascular space
78
Q

isotonic IV fluids

A
  • same concentration of solutes in blood
  • NS most common
  • lactated ringers
  • D5W- will hemolyze blood products
79
Q

hypotonic IV fluids

A
  • lower concentration of solutes

- solutions move into cells and causes them to swell

80
Q

hypertonic IV fluids-

A
  • higher concentration of solutes

- pulls fluids from cells -> shrink

81
Q

what is the only IV fluid that can be given with blood products

A
  • normal saline
82
Q

lactated ringers

A
  • most closely mimic blood and plasma concentrations
  • often given in metabolic acidosis
  • not given in lactic acidosis
  • dont give to pt in liver disease- cant metab lactate
  • contains K- caution in renal impairment
  • dont give if pH > 7.5
83
Q

ringers solution

A
  • similar to lactated ringers but does not contain lactate

Clin Med III (26 decks)

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