Electrolyte Disorders

Question 1

Hyperkalemia (Causes)

Answer 1

CELL DEATH

Rhabdo
tumor lysis syndrome - start tx for cancer when cells are destroyed, tumor cells release content into bloodstream

Crush injury
Burn
Renal Failure (don’t excrete K+)
Acidosis (DKA, Addison’s Disease)

Question 2

Hyperkalemia EARLY symptoms (5-6 Range)

Answer 2

More K+ moving across the cell walls

Muscular Excitability
N,V,D, irrit

Question 3

Hyperkalemia LATE symptoms (8-9)

Answer 3

SO much K+
Equal amounts on both sides of cell wall - less responsive

Fatigue, Tetany, RD, Ascending paralysis

Question 4

Hyperkalemia - Cardiac Symptoms

Answer 4

Tall peaked T waves

Then the heart begins to relax - elongated PR , absent P wave, enlarged QRS, Sine Wave

Question 5

1st thing you want to tx with hyperkalemia

Answer 5

Stabilize Cardiac Membrane

Question 6

How do you stabilize cardiac membrane

Answer 6

Calcium Chloride (10 - 20 ml)
Calcium Gluconate (10 - 30 ml)

Calcium is cardioprotective

Question 7

2nd thing you want to tx with hyperkalemia

Answer 7

Shift K+ into the cells

Question 8

How do you shift K+ into the cells

Answer 8

Insulin - 10 units IV push
Followed by 100ml of 50% dextrose

High-dose nebulized albuterol (15 - 25 mg)

Question 9

What does insulin carry

Answer 9

K+ back into the cells

Question 10

3rd thing you want to tx with hyperkalemia

Answer 10

Remove K+ from the cells

Question 11

How do you remove K+ from the cells

Answer 11

1. Hemodialysis
2. Normal saline with Lasix
3. Kaexylate (Ion exchange resin)

Question 12

How can Hypokalemia happen?

Answer 12

Loose through GI
Diuretics
K+ shifts (insulin , beta 2 agonists - albuterol)
Alkalosis
Decreased intake/Malnutrition

Question 13

Hypokalemia symptoms

Answer 13

Causes WEAKNESS
U wave can become visible
ST depression (myocardial hypoxia)

Question 14

Tx of hypokalemia

Answer 14

K+ replacement

Question 15

What goes in hand w/ hypokalemia?

Answer 15

Hypomagnesemia

Question 16

Hypermagnesium s/s

Answer 16

Decreased muscular irritability and activity

Question 17

Low magnesium causes

Answer 17

Increased muscular irritability and activity

Question 18

Hypomagnesemia and Hypocalcemia s/s

Answer 18

Chvostek’s Sign

Trousseau’s Sign

Question 19

Tx for hypomagensemia

Answer 19

Oral Magnesium or IV

Beans, Grains, Chocolate, Nuts, Seeds, Avacados, Bananas

Question 20

Tx for hypermagnesemia

Answer 20

Fluid administration
Loop Diuretics
Dialysis
Stop giving magnesium :)

Question 21

What are the inverse relationship?!

Answer 21

Calcium and Phosphate

Question 22

hypocalcemia? hyperphosphatemia

hypercalcemia? hypophosphatemia

Answer 22

Go through them in book

Question 23

Tx for Hypercalcemia

Answer 23

Treat Cause

1. NS Infusion
2. Clucocorticoids (increase renal calcium excretion by decreasing calcium absorption)
3. Calcitonin (opposes the parathyroid)

Question 24

Hypocalcemia tx

Answer 24

1-2 ampules of 10% calcium gluconate with D5W over 10-20 mins

Question 25

Tx for Hypophosphatemia

Answer 25

High phosphate diet Oral K+ phosphate IV sodium phosphate

Question 26

Tx for hyperphosphatemia

Answer 26

1. Diuretics / Fluids 2. Limit phopshate Intake 3. Oral phosphate - binding agents (aluminum hydroxide)

Question 27

Overhydration

Answer 27

HypOOOOatremia

Question 28

Dehydration

Answer 28

HypEEEEEratremia

Question 29

Water always follows...

Answer 29

Sodium

Question 30

What does sodium do?

Answer 30

Helps keep the body fluids in order Helps nerve and muscle function

Question 31

Hypernatremia causes

Answer 31

Dehydration AMS Weakness Diarrhea

Question 32

Hypoatremia Symptoms

Answer 32

Related to water retention Impending doom Seizures Muscle Cramps Confusion

Question 33

Tx for hypoatremia

Answer 33

MILD - Water restriction/Oral Sodium replacement SEVERE - Over the course of 48 - 72 hours use hypertonic 3-5% saline solution

Question 34

Rapid correction of sodium can cause?

Answer 34

Demyelination of the brain - nerves are damaged nerve impulses slow or stop Pontine Myelinolysis Inc of sodium pulls water from the brain cells

Question 35

Hyperatremia tx

Answer 35

IV NS Treat underlying cause Lower Give 0.5 mEq/hr with 1/2 NS