electrolyte imbalance Flashcards
severe hyponatremia
<125
hyponatremia correction rate
<0.5 mEq/L/hr
risk of central pontine myolinolysis
most common type of hyponatremia
hypotonic
tx for hypotonic hypervolemic hyponatremia
fluid restriction
tx for hypotonic hypovolemic hyponatremia
0.9% saline
hypernatremia tx
calculate free water deficit & resuscitate with IVF
free water deficit
0.4 * kg * ((serum Na/140) -1)
calcium and acid base
acidosis - hypercalcemia
alkalosis - hypocalcemia
hyponatremia symptomatology
CNS symptoms!
lethargy
malaise
nausea
seizures
coma
may be chronic and asymptomatic
hypernatremia symptomatology
CNS symptoms
lethargy
irritability
weakness
confusion
delirium
coma
may be chronic and asymptomatic
hypoK symptomatology
most asymptomatic
MS symptoms in severe hypoK
EKG - decreased amp, broad T, prominent U, QT prolong, PVCs, CT
hypoK treatment
KCl
max rate 20/hr IV
10 mEq will generally raise by 0.1
check mag! deficit will impair correction
consider kphos or kbicarb
hyperK symptomatology
weakness
nausea
diarrhea
fatigue
EKG - palpitations, peaked T, heart block, loss of P waves, sine wave, wide QRS
hyperK treatment
many lab errors - recheck
EKG
goal - stabilize cardiac cell membranes!
> 6 or ekg change requires treatment
calcium gluconate/chloride
insulin + D50W (fastest & largest reduction)
bicarb (if accompanying metabolic acidosis)
B2 agonist (albuterol) w insulin
kayexalate (not emergency)
diuretics
HD
calcium ranges
total 8.5-10.2 (bound & unbound, influenced by albumin)
ionized 4.5-5.3
hypocalcemia symptomatology
neuromuscular irritability
chvostek’s - facial nerve tapping ->contraction
trosseau’s - carpopedal spasm w BP cuff inflation
cramps
increased DTRs
irritability
depression
prolonged QTc
t wave changes
hypocalcemia mgmt
may have low mag too - check
PTH
vitamin D
serum albumin - correct if looking at serum
EKG
correct alkalosis
acute - calcium chloride (CVC), calcium gluconate
chr - oral supplements (calcium & vit D)
hypercalcemia symptomatology
bones
stones
abdominal groans
psychic moans
crisis (13-15) - polyuria, dehydration, mental status changes
fractures (chr)
ca
hypercalcemia treatment
check albumin
> 14 probably malignancy
if >14 or symptomatic
NS
diuresis
bisphosphonates
calcitonin
glucocorticoids
HD
chr - prednidone, lasix
magnesium normal range
1.3-2.2
hypoMg symptomatology
muscle weakness
dysarthria
disorientation
chvostek/trosseau’s signs
hyperactive DTRs
seizures
palpitations
nystagmus
torsades de pointes
hypoMg treatment
check K & Ca
EKG
mag sulfate 1g
mag chloride, mag oxide, mag lactate ER
hypermagnesemia symptomatology
weakness, paralysis
lethargy
N/V
hypotension
diminished DTRs
hypermagnesemia treatment
EKG
stop mag intake
HD if >4 or symptomatic
IVF & diuretics
calcium
glucose & insulin
EKG changes - calcium gluconate, lasix & 1/2NS
