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Clinical 2.0 winter > Electrolyte Imbalance > Flashcards

Electrolyte Imbalance Flashcards

1
Q

normal intracellular K level

A

3.5-5 mmol/L

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2
Q

elimination of potassium

A

secretion from distal tubules

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3
Q

homeostasis of potassium levels affected by

A

hormones
acid base status
hyperosmolality

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4
Q

how insulin affects potassium levels

A

stimulates NA K ATPase pump to transport K+ intracellularly

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5
Q

how catecholamines affect potassium levels

A

betat receptor stimulation activates the pump to drive K intracellular
causes break down of glycogen which increases glucose and releases insulin driving potassium intracellularly

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6
Q

how does aldosterone affect potassium levels

A

acts at distal tubule, increases the urinary potassium excretion

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7
Q

decreased pH affect of K

A

moves H into cells and K out

.1 decrease in pH = .7 increase in serum K

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8
Q

why is the increase K when blood pH decreases called false hyperkalemia

A

not actually increasing the total amount just shifting K into serum

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9
Q

increased blood pH effect on K

A

moves H out of cells and K in
.1 unit increse in PH = .6 decrease in serum K
false hypokalemia

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10
Q

hyperosmolality effect on K

A

K shits to extracellular fluid

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11
Q

mild hypokalemia

A

3.1 - 3.5

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12
Q

mod hypokalemia

A

2.5-3

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13
Q

severe hypokalemia

A

<2.5

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14
Q

effects of hypokalemia

A

mod - cramps, weakness, myalgia

sev - EKG, arrhythmia, increased dig toxicity

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15
Q

causes of hypokalemia

A

GI loss
metabolic alkalosis
hypomagnesemia increases renal excretion of K

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16
Q

100mmol of oral replacement increase serum K by

A

1mmol/L

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17
Q

oral K replacement products

A

potassium chloride liquid
potassium citrate 25meq tablets
slow k 8 meq

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18
Q

dosing of oral K replacement

A

more nore than 24meq per dose to avoid GI irritation or 50meq of liquid and wait 2hrs between doses

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19
Q

slow k dosing in chronic K deficiency

A

8-16meq daily

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20
Q

use IV K replacement if

A

severe hypokalemia

vomiting

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21
Q

monitoring in acute setting correcting severe hypokalemia

A

monitor serum levels numerous times daily

EKG with high rate infusions

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22
Q

monitoring inpatient in mild-mod acute K deficiency

A

replace and check serum levels daily to every 3 days

23
Q

if K replacement is not correcting serum levels check…

A

magnesium levels

24
Q

ambulatory setting K supplement monitorin

A

check serum level and renal function every 1-2 months once stable

25
Q

mild hyperkalemia

A

5.1-5.9

26
Q

moderate hyperkalemia

A

6-7

27
Q

severe hyperkalemia

A

> 7

28
Q

problems with hyperkalemia

A

usually asymptomatic when mild

more severe EKG changes, arrhythmias, mortality

29
Q

4 main causes of hyperkalemia

A

increase K intake
decreased K excretion
decreased effect of aldosterone
extracellular movement of total body potassium (pseudo)

30
Q

foods with high potassium

A 
potatoe
prunes
carrots
yogurt
milk 
orange juice
bananas 
KCL salt substitutes
31
Q

increased intake of K usually only a problem in …

A

severe renal impairment or dialysis

32
Q

causes of impaired K excretion

A 
renal failure
ACEIs
ARBs
K sparing diuretic
NSAID
minor: digoxin, tmpsmx, heparin
33
Q

what is blood sample hemolysis

A

if sample sits too long intracellular K can spill from RBC

falsely elevated serum K

34
Q

first step in severe hyperkalemia treatmemt

A

stabilize the cardiac membrane with IV calcium
doesnt change K levels
calcium gluconate 1g IV

35
Q

ways to drive K intracellular in severe hyperkalemia

A

regular insulin 10units IV* x 1 + dextrose
or

beta 2 agonists salbutamol 10mg nebule inhaled x 1

36
Q

if not hyperglycemic and giving insulin have to give**

A

dextrose 25g IV

37
Q

if severe hyperkalemia from metabolic acidosis

A

sodium bicarc 100mg to moves K back into cells

38
Q

who wouldnt we treat severe hypokalemia with a beta blocker

A

ppl on beta blockers

39
Q

why dont we give insulin SC for hyperkalemia

A

longer duration of effect than dextrose and patient becomes hypoglycemic

40
Q

kayexalate MOA and use

A

exchanges K for Na in the intestine
mild hyperkalemia
15g

41
Q

problems with kayexalate

A

may take hours for full effect
CI in bowel dysfunction
risk of colonic necrosis
ay bind other meds space by 6hr

42
Q

treatment options for mild hyperkalemia

A

furosemide 40mg IV x 1

onset within minutes

43
Q

monitoring of hyperkalemia

also see chart slide 28

A

K levels every 2 hr until <5

44
Q

sodium bicarb not appropriate in

A

ESRD

45
Q

normal sodium serum levels

A

135-147

46
Q

rapid swings in sodium levels assiciated with

A

significant morbidity and mortality

47
Q

hypovolemic hypotonic hyponatremia common with

A

thiazides

48
Q

euvolemic hyponatremia associated with

A

SIADH
syndrome of inappropriate secretion of antidiuretic hormones
ADH retains water but losses sdoium

49
Q

hypervolemic hyponatremia associated with

A

cirrhosis, HF, nephrotic syndrome

50
Q

treatment of hypovolemic hyponatremia

A

IV nacl 0.9%

51
Q

treatment of euvolemic or hypervolemic hyponatremia

A

fluid restriction first

52
Q

rapid swings in sodium can cause

A

osmotic demyelination syndrome - damage to myelin sheath of the brainstem
rapdi water movement out of brain cells as serum osmolalty increases
can result in paralysis and death

53
Q

rule of correcting sodium levels

A

never increase serum Na more than 12mmol/L/24hr*******

more conservative if chronic

Clinical 2.0 winter (28 decks)

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