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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
causes of hypervolemic hypotonic hyponatremia
- generally due to edematous states - CHF - liver disease - advanced kidney disease - nephrotic syndrome
26
management of hyponatremia
- hypovolemic- IVF resuscitation - hypervolemic- loop diuretics or dialysis or both - euvolemic- free water restriction
27
how much do you want to elevate the serum Na when treating hyponatremia
- 4-6 meq/L in 24 hours | - max rate of 8 meq/L in 24 hours
28
complications of hyponatremia treatment
- 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
29
hypernatremia
- Na > 145 meq/L | - usually pts are hyperosmolar and hypovolemic
30
what is the main defense against hypernatremia
- sense of thirst
31
diabetes insipitus
- passage of large volumes of dilute urine | - causes hypovolemic hypernatremia
32
primary hyperadolsteronism
- excess production of aldosterone | - causes Na and water reabsorption, K excretion
33
si/sx of hypernatremia
- dehydration sx may be delayed - lethargy/ weakness - irritability - hyperthermia - delirium - seizure - coma
34
labs for hypernatermia
- 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
treatment for hypernatremia
- 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
treatment for diabetes insipidus
- desmopressin- ADH analog
37
causes of hypokalemia
- insufficient intake - diuretics - D/V - meds- insulin, albuterol, terbutaline - renal loss
38
si/sx of hypokalemia
- muscle weakness/ cramping - palpitations - constipation or ileus - hyporeflexia, tetany - rhabdo - may consider if HTN, nephrogenic diabetes insipidus, interstitial nephritis
39
EKG findings for hypokalemia
- flattened t wave - ST segment depression - U waves
40
treatment for hypokalemia
- mild- PO KCl - severe/symptomatic- IV replacement - continuous telemetry - if Mg is also low replace Mg FIRST
41
hyperkalemia risk factors
- impaired urinary excretion - advanced renal disease or insufficiency - Addison's disease - urinary tract obstruction - acidosis causes intracellular K to shift extracellularly
42
medicines that cause hyperkalemia
- ACEI/ARB | - k sparing diuretics- aldosterone
43
si/sx of hyperkalemia
- muscle weakness/ paralysis - ileus - paresthesias - cardiac conduction abnormalities
44
EKG findings for hyperkalemia
- often dont have any - tall or peaked T waves - bradycardia - widened QRS - PR interval prolongation - flattened P wave
45
treatment for hyperkalemia
- 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
factors that influence calcium concentration
- PTH - vitamin D - calcium ion - phosphate - bone
47
where are Ca sensing receptors found
- parathyroid gland | - kidneys
48
hypocalcemia
- often mistaken for neuro disorder | - decreased serum PTH, vit D or Mg levels
49
causes of hypocalcemia
- parathryoid/ thyroid disease/ -ectomy - chronic renal failure - vit D deficiency
50
what is calcium normally bound to in serum
- albumin | - hypoalbuminemia -> pseudohypocalcemia
51
how do you determine true calcium levels
- need to correct for albumin levels
52
sx of hypocalcemia
- paresthesia - hyperreflexia - tetany/ neuromusclar irritability - muscle spasms/ cramps - seizures - coma - chvostek sign - trousseau's sign
53
chvostek sign
- facial spasm after percussion of facial nerve | - finding for hypocalcemia
54
trousseau's sign
- spasm of hand by inflation of BP cuff | - finding for hypocalcemia
55
EKG findings for hypocalcemia
- prolonged QT interval
56
hypercalcemia causes
- hyperparathyroidism - bone malignancy - multiple myeloma - overuse of antacids
57
sx of hypercalcemia
- bone pain - muscle weakness - kidney stones - lethargy - confusion - constipation - fatigue - depression - nausea - "stones, bones, moans, groans"
58
diagnostics of hypercalcemia
- labs are complicated | - chest xray to r/o malignancy or granulomatous disease
59
EKG findings for hypercalcemia
- shortened QT interval
60
treatment for hypercalcemia
- renal excretion promoted through aggressive hydration - salmon calcitonin with bisphosphonate - zoledronic acid
61
hypomagnesemia causes
- alcohol abuse from poor dietary intake - reduce intestinal absorption - increase renal excretion - excessive GI loss - starvation - refeeding syndrome
62
what does hypomagnesemia impair the release of
- PTH
63
sx of hypomagnesemia
- confusion, lethargy - tremors - convulsions - hyperreflexia - paresthesia's - cardiac arrhythmias/ widened QRS - conduction prolongation - ST depression
64
treatment for hypomagnesemia
- oral replacement of asymptomatic (may cause osmotic diarrhea) - IV replacement if severe or symptomatic def
65
hypermagnesemia causes
- renal failure - supratherapeutic replacement - antacid/ laxative abuse - much less common than hypomg
66
sx of hypermagnesemia
- decreased DTR - bradycardia - hypotension - flaccid paralysis - cardiac arrest - nausea, HA - hypocalcemia
67
EKG findings for hypermagnesemia
- tall T - widened QRS - irregular conduction - escape beats
68
treatment for hypermagnesemia
- dietary restriction - elim Mg containing meds - saline and loop diuretics - hemodialysis
69
what causes intestinal absorption of phosphate
- active Vit D
70
what increases urine phosphate excretion
- PTH | - FGF 23
71
primary causes of hypophosphatemia
- alcoholism - v/d - poor PO intake - COPD/ asthma
72
sx of hypophosphatemia
- rhabdo - paresthesias - encephalopathy - respiratory failure - arrhythmias/ heart failure - acute hemolytic anemia* - impaired chemotaxis of leukocytes -> GN sepsis
73
diagnostics for hypophosphatemia
- urine HPO4 excretion | - plasma PTH or PTHrP
74
treatment for hypophosphatemia
- include HPO4 in repletion and maint fluids - PO phosphate to prevent hypocalcemia - for severe give infusion - correct Mg deficiencies
75
hyperphosphatemia
- most common cause= CKD with decreased urinary excretion - sx related to underlying cause - treat underlying cause
76
colloid IV fluids
- albumin solutions, hyperoncotic starch, dextran, gelatin - dont cross cell membrane - expand intravascular volume - draw fluid from extravascular space
77
crystalloid IV fluids
- contain small molecules that easily pass through cell membrane - increase fluid volume in interstitial and intravascular space
78
isotonic IV fluids
- same concentration of solutes in blood - NS most common - lactated ringers - D5W- will hemolyze blood products
79
hypotonic IV fluids
- lower concentration of solutes | - solutions move into cells and causes them to swell
80
hypertonic IV fluids-
- higher concentration of solutes | - pulls fluids from cells -> shrink
81
what is the only IV fluid that can be given with blood products
- normal saline
82
lactated ringers
- 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
ringers solution
- similar to lactated ringers but does not contain lactate

Clin Med III (26 decks)

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