Electrolyte Imbalance

Question 1

normal intracellular K level

Answer 1

3.5-5 mmol/L

Question 2

elimination of potassium

Answer 2

secretion from distal tubules

Question 3

homeostasis of potassium levels affected by

Answer 3

hormones
acid base status
hyperosmolality

Question 4

how insulin affects potassium levels

Answer 4

stimulates NA K ATPase pump to transport K+ intracellularly

Question 5

how catecholamines affect potassium levels

Answer 5

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

Question 6

how does aldosterone affect potassium levels

Answer 6

acts at distal tubule, increases the urinary potassium excretion

Question 7

decreased pH affect of K

Answer 7

moves H into cells and K out

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

Question 8

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

Answer 8

not actually increasing the total amount just shifting K into serum

Question 9

increased blood pH effect on K

Answer 9

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

Question 10

hyperosmolality effect on K

Answer 10

K shits to extracellular fluid

Question 11

mild hypokalemia

Answer 11

3.1 - 3.5

Question 12

mod hypokalemia

Answer 12

2.5-3

Question 13

severe hypokalemia

Answer 13

<2.5

Question 14

effects of hypokalemia

Answer 14

mod - cramps, weakness, myalgia

sev - EKG, arrhythmia, increased dig toxicity

Question 15

causes of hypokalemia

Answer 15

GI loss
metabolic alkalosis
hypomagnesemia increases renal excretion of K

Question 16

100mmol of oral replacement increase serum K by

Answer 16

1mmol/L

Question 17

oral K replacement products

Answer 17

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

Question 18

dosing of oral K replacement

Answer 18

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

Question 19

slow k dosing in chronic K deficiency

Answer 19

8-16meq daily

Question 20

use IV K replacement if

Answer 20

severe hypokalemia

vomiting

Question 21

monitoring in acute setting correcting severe hypokalemia

Answer 21

monitor serum levels numerous times daily

EKG with high rate infusions

Question 22

monitoring inpatient in mild-mod acute K deficiency

Answer 22

replace and check serum levels daily to every 3 days

Question 23

if K replacement is not correcting serum levels check…

Answer 23

magnesium levels

Question 24

ambulatory setting K supplement monitorin

Answer 24

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

Question 25

mild hyperkalemia

Answer 25

5.1-5.9

Question 26

moderate hyperkalemia

Answer 26

6-7

Question 27

severe hyperkalemia

Answer 27

>7

Question 28

problems with hyperkalemia

Answer 28

usually asymptomatic when mild | more severe EKG changes, arrhythmias, mortality

Question 29

4 main causes of hyperkalemia

Answer 29

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

Question 30

foods with high potassium

Answer 30

``` potatoe prunes carrots yogurt milk orange juice bananas KCL salt substitutes ```

Question 31

increased intake of K usually only a problem in ...

Answer 31

severe renal impairment or dialysis

Question 32

causes of impaired K excretion

Answer 32

``` renal failure ACEIs ARBs K sparing diuretic NSAID minor: digoxin, tmpsmx, heparin ```

Question 33

what is blood sample hemolysis

Answer 33

if sample sits too long intracellular K can spill from RBC | falsely elevated serum K

Question 34

first step in severe hyperkalemia treatmemt

Answer 34

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

Question 35

ways to drive K intracellular in severe hyperkalemia

Answer 35

regular insulin 10units IV* x 1 + dextrose or beta 2 agonists salbutamol 10mg nebule inhaled x 1

Question 36

if not hyperglycemic and giving insulin have to give**

Answer 36

dextrose 25g IV

Question 37

if severe hyperkalemia from metabolic acidosis

Answer 37

sodium bicarc 100mg to moves K back into cells

Question 38

who wouldnt we treat severe hypokalemia with a beta blocker

Answer 38

ppl on beta blockers

Question 39

why dont we give insulin SC for hyperkalemia

Answer 39

longer duration of effect than dextrose and patient becomes hypoglycemic

Question 40

kayexalate MOA and use

Answer 40

exchanges K for Na in the intestine mild hyperkalemia 15g

Question 41

problems with kayexalate

Answer 41

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

Question 42

treatment options for mild hyperkalemia

Answer 42

furosemide 40mg IV x 1 | onset within minutes

Question 43

monitoring of hyperkalemia | also see chart slide 28

Answer 43

K levels every 2 hr until <5

Question 44

sodium bicarb not appropriate in

Answer 44

ESRD

Question 45

normal sodium serum levels

Answer 45

135-147

Question 46

rapid swings in sodium levels assiciated with

Answer 46

significant morbidity and mortality

Question 47

hypovolemic hypotonic hyponatremia common with

Answer 47

thiazides

Question 48

euvolemic hyponatremia associated with

Answer 48

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

Question 49

hypervolemic hyponatremia associated with

Answer 49

cirrhosis, HF, nephrotic syndrome

Question 50

treatment of hypovolemic hyponatremia

Answer 50

IV nacl 0.9%

Question 51

treatment of euvolemic or hypervolemic hyponatremia

Answer 51

fluid restriction first

Question 52

rapid swings in sodium can cause

Answer 52

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

Question 53

rule of correcting sodium levels

Answer 53

never increase serum Na more than 12mmol/L/24hr********* | more conservative if chronic