Electrolyte imbalances

Question 1

Tx for honeycomb pattern on CT?

Answer 1

Diffuse interstitial pulm fibrosis

Azathioprine or cyclophosphamide

NAC can be used

Question 2

What is psueodohyponatremia?

Answer 2

Hyperlipidemia in which serum Na looks low, but it isnt

Question 3

Na+ change resulting from correction of hyperglycemia?

Answer 3

Na+ will go up 1.6 for every 100 glucose pulled off

Question 4

Patient hyponatremic, what do you do next?

Answer 4

Check osmolarity

If high, check glucose

If normal, check lipids or for MM

If low, check urine sodium to see if spilling salts, or trying to save salts

Question 5

Patient with hypovolemia, hypoosmolar, and UNa is less than 10 and euvolemic state?

Answer 5

Psychogenic polydipsia

Question 6

Tx of hyponatremia?

Answer 6

Restrict free water
Loops
Hypertonic saline
VAsopressin antagonist (vaptans)

Question 7

SIADH tx?

Answer 7

How you treat any hyponatremia

Hypertonic saline
Fluid restriction
Vasopressin antagoinists
Loop

Question 8

Serum osmolarity calculation?

Answer 8

2*(Na+K)+Gluc/18+BUN/2.8

Question 9

Hypernatremia rare with hyperaldosteronism, but remember it!

What is triad of hyperaldosteronism?

Answer 9

Hypertension
Hypokalemia
Alkalosis (met)

Question 10

Dx of Diabetes insipidus? Then how do you tell if from central or not?

Answer 10

Water deprivatin

Urine osmolarity should rise when holding back water

It stays low if DI is present

Give ADH (desmopressin)
If urine concentrates, its central

Question 11

Tx of central DI?

Answer 11

desmo

Question 12

Nephrogenic DI tx?

Second line tx of nephrogenic DI?

Answer 12

Salt restriciton
Increase water intake
Thiazide (gets rid of some sodium, slight volume depletion and kidney resorbs more)

indomethacin decreases renal flow so hold more water as second line

Question 13

tx lithium induced nephrogenic DI?

Answer 13

Amiloride

Lithium blocks the channels that Lithium uses so can’t affect it!!!

Question 14

Causes of hyperkalemia?

Answer 14

Low insulin
Beta Blockers
Acidosis
Digoxin I GUESS
Cell lysis

Question 15

Emergency treatment hyperkalemia

Especially first thing you do?

Answer 15

C BIG K Drop

IV Calcium gluconate or calcium chloride (stabilize cardiac membrane)

Insulin and glucose
Beta agonist (albuterol)
Sodium bicarb

dialysis
Kayexalate
Loop

Question 16

Hypercalcemia tx?

Answer 16

Hydration
Calcitonin
Bisphosphonates
Glucocorticoids can decrease absorption

Question 17

What is familial hypocalciuiric hypercalcemia?

How do you recognize it?

Answer 17

Family history

Low Ca++
Absence of osteopenia and absence of nephrolithiasis

Question 18

Hypocalcemia can be caused by what?

Answer 18

hypoparathyroid
chronic renal failure
hyperphosphatemia
Vit D
Pancreatitis

HYPERPHOPHATEMIA

Question 19

Albumin affect on Ca?

Answer 19

As albumin goes down, total calcium also goes down

0.8 per 1 g of albumin

Question 20

Hypocalcemia on EKG?

Answer 20

QT prolongation (think how that can become torsade)