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Critical Care > Electrolyte Disturbances > Flashcards

Electrolyte Disturbances Flashcards

1
Q

what ECG abnormalities are seen with hyperkalemia?

A
  • peaked T wave
  • flat P wave
  • prolonged PR interval
  • Wide QRS
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2
Q

Hypokalemia and hypomagnesemia can occur together d/t what?

A

impaired renal absorption

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3
Q

How is hypermagnesemia treated?

A
  • calcium gluconate for cardiac issues

- dialysis if severe

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4
Q

What are the 3 causes of hypovolemic hyponatremia?

A
  • diuretics
  • cerebral salt wasting
  • Addison’s disease
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5
Q

What medication can be used to reverse the cardiac adverse effects with hyperkalemia?

A
  • calcium gluconate
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6
Q

What are the 3 causes of hypernatremia?

A
  • free water loss
  • loss of water > sodium loss
  • gain of sodium > water
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7
Q

What are the 2 main causes of hypercalcemia?

A
  • hyperparathyroidism

- malignancy

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8
Q

How is hypovolemic hypernatremia treated?

A
  • volume resuscitation with IVF

- replace free water deficit

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9
Q

What is the effect of hyperkalemia on the heart?

A
  • slows impulse transmission in the heart resulting in possible cardiac arrest
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10
Q

How is hypokalemia treated?

A

giving back potassium PO or IV

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11
Q

How is hypervolemic hyponatremia treated?

A
  • fluid restriction + diuretics
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12
Q

What is the most common cause of community acquired hypernatremia?

A

hypovolemic hypernatremia

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13
Q

What is the maximum change of free water deficit that is safe per day?

A

8-12 mEq/L/hr

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14
Q

How is euvolemic hypernatremia diagnosed?

A
  • failure of urine osm to increase after fluid restriction
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15
Q

What is the treatment for hypervolemic hypernatremia?

A
  • remove source + give diuretics

- AND correct free water deficit

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16
Q

What lab findings are diagnostic for euvolemic hyponatremia?

A
  • high urine Osm and high urine Na
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17
Q

What are the 2 causes of hypovolemic hypernatremia?

A
  • excessive diuresis

- sweating, diarrhea, hypodipsia

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18
Q

What are the 3 causes of hypervolemic hyponatremia?

A
  • Heart failure (low urine Na)
  • Cirrhosis (low urine Na)
  • Renal failure (high urine Na)
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19
Q

How is refeeding syndrome treated?

A

electrolyte repletion and careful monitoring

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20
Q

How is euvolemic hypernatremia treated for patients without central DI vs. with central DI?

A
  • no CDI = replace free water deficit

- CDI = replace free water deficit + DDAVP

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21
Q

This is a potentially fatal shift in fluids + electrolytes that may occur in malnourished patients receiving enteral/parenteral feeds.

A

refeeding syndrome

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22
Q

Encephalopathy, headache, nausea, vomiting, seizures are all consistent with what electrolyte disturbance?

A
  • hyponatremia
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23
Q

What medication can be given to temporarily treat hyperkalemia d/t a transcellular shift?

A
  • insulin

- AND dextrose (to prevent hypoglycemia)

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24
Q

How fast should you treat symptomatic severe hypovolemic hyponatremia?

A

4-6 mEq/L in the first 1-2 hours to reach 120 mEq/L

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25
Q

What are the 4 causes of hyperkalemia d/t a transcellular shift?

A
  • acidosis
  • DKA
  • tumor lysis syndrome/rhabdo
  • Drugs (e.g. digitalis)
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26
Q

What is the main cause of euvolemic hyponatremia?

A

SIADH

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27
Q

How is hypocalcemia treated?

A
  • CaCl

- OR calcium gluconate

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28
Q

How do you measure plasma osmolality?

A

= (2 x Na+) + (Glucose/18) + BUN/2.8)

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29
Q

What is the difference between central vs. nephrogenic DI?

A
  • central DI = no ADH release

- Nephrogenic DI = poor renal response to ADH

30
Q

What is the normal range for potassium?

A

3.5-5.0 mEq/L

31
Q

What is the normal range for sodium?

A

135-145

32
Q

What is the main cause of euvolemic hypernatremia?

A
  • diabetes insipidus
33
Q

The majority of potassium is excreted how?

A

through urine

34
Q

Bone pain, kidney stones, constipation, depressed mood are all consistent with what electrolyte abnormality?

A
  • hypercalcemia
35
Q

What medication blocks aldosterone via competitive binding of receptors?

A
  • spironolactone
36
Q

What drugs are known to cause hypomagnesemia?

A
  • diuretics
37
Q

What is the hallmark sign of refeeding syndrome?

A

hypophosphatemia

38
Q

What fluid should be used to correct free water deficit? How fast should this be done?

A
  • pure water via gut OR D5W IV

- no faster than 0.5 mEq/L/hr

39
Q

How is hypomagnesemia treated?

A

2g MgSO4 IV over 2-5 min

40
Q

How is hyperphosphatemia treated?

A
  • phosphate binders in GI tract (e.g. sucralfate)
  • calcium acetate tablets IF hypocalcemia
  • OR dialysis
41
Q

what ECG abnormalities are seen with hypokalemia?

A
  • U waves
  • T wave flattening or TWI
  • QT prolongation
42
Q

What are the 3 causes of hyperkalemia d/t impaired excretion?

A
  • renal failure
  • addison’s disease
  • HTN drugs/ NSAIDs
43
Q

First degree AV block can happen with this electrolyte disturbance.

A
  • Hypermagnesemia
44
Q

If a patient has hypovolemic hyponatremia and is symptomatic ( Na <120) what is the treatment?

A
  • hypertonic saline (3%)

* to reduce cerebral edema

45
Q

What are the 5 causes of hypokalemia d/t a total body loss?

A
  • diuretics
  • hypomagnesemia
  • large NG drainage
  • diarrhea
  • cushing syndrome
46
Q

What hormone stimulates K+ secretion in distal nephron?

A
  • Aldosterone
47
Q

Thirst, AMS, seizures, hyperreflexia, lethargy. These clinical features are consistent with what electrolyte disturbance?

A
  • hypernatremia
48
Q

In what 2 conditions might you see pseudohyperkalemia?

A
  • hemolysis during blood draw
  • severe leukocytosis/thrombocytosis

*repeat lab draw!!

49
Q

What are 4 causes of pseudohyponatremia?

A
  • high triglycerides (>1500 mg/dL)
  • high protein level
  • profound hyperglycemia
  • exogenous osmoles (e.g. mannitol, contrast dye)
50
Q

What are the 5 indications for renal replacement therapy (RRT)?

A
  • acidosis
  • electrolyte imbalances
  • intoxicants (lithium, ASA, etc.)
  • overload (fluid)
  • uremia
51
Q

What % of patients with acute renal failure in ICU will require RRT?

A

70%

52
Q

How is hypercalcemia treated?

A
  • IVF
  • AND glucocorticoids/ bisphosphonates
  • OR dialysis
53
Q

How is hypovolemic hyponatremia treated?

A
  • isotonic fluid administration
  • IF taking diuretics = STOP
  • IF adrenal insufficiency = fludrocortisone
54
Q

What is the risk of correcting the free water deficit too fast?

A
  • brain swelling
55
Q

Blood transfusions and Heparin administration can cause this electrolyte disturbance.

A
  • hypocalcemia
56
Q

What are the 4 causes of hypokalemia d/t a transcellular shift?

A
  • B2 agonism (albuterol)
  • Insulin
  • Alkalosis
  • Hypothermia
57
Q

How is hypophosphatemia treated?

A

give back phosphorus (NaPO4 or KPO4)

58
Q

Chvostek’s and Trousseau’s sign are consistent with this electrolyte disturbance.

A
  • hypocalcemia
59
Q

How is euvolemic hyponatremia treated?

A
  • fluid restriction and treat underlying cause
60
Q

What ECG changes are seen with hypocalcemia?

A
  • prolonged QTc interval via ST prolongation
61
Q

What is the formula to correct hyperosmotic hyponatremia d/t hyperglycemia?

A

increase Na+ by 1.6 mEq for every 100 mg/dL of glucose over 100 mg/dL

62
Q

What is the normal range for total calcium on BMP (ionized + bound)?

A

9-10 mg/dL

63
Q

Muscle weakness, constipation, palpitations, and fatigue are all clinical symptoms of what electrolyte disturbance?

A
  • hypokalemia
64
Q

What is the normal level of magnesium?

A

2.0 mg/dL

65
Q

What is the most common cause of hypophosphatemia?

A
  • intracellular shift d/t refeeding syndrome
66
Q

Respiratory muscle weakness, low cardiac output, and hemolytic anemia is consistent with what electrolyte disturbance?

A
  • hypophosphatemia
67
Q

What are the 3 common causes of hypervolemic hypernatremia?

A
  • Sodium bicarbonate infusions
  • aggressive hypertonic saline for high ICP
  • excessive salt ingestion
68
Q

What drugs can be used to remove excess K+ from the body in the setting of hyperkalemia? (2 options)

A
  • Kayexalate

- Veltassa

69
Q

What is the normal range for phosphorus?

A

2.5-5 mg/dL

70
Q

What ECG abnormalities are seen with hypomagnesemia?

A
  • torsades de pointes
71
Q

What are the 3 goals of hyperkalemia treatment?

A
  • reverse cardiac adverse effects
  • transcellular shift into cells
  • remove excess K+ from body

Critical Care (8 decks)

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