electrolytes

Question 1

Signs of hypokalemia

Answer 1

muscle weakness (cervical ventroflexion), hypoventiliation
diminished T waves and tall P waves

Question 2

Causes of hyperkalemia

Answer 2

kidney failure, urethral/ureter obstruction
uroabdomen,addisons, chronic body cavity effusions, iatrogenic uptake, crushing or reperfusion injury (intra to extracellular)

Question 3

What is a non-circulatory rhythm?

Answer 3

asystole or ventricular fibrillation

Question 4

Treatment for hyperkalemia

Answer 4

IV calcium gluconate,
Fluids therapy
Dextrose +/- insulin
NaHco3-
terbutaline,

Question 5

Treatment for hypokalemia

Answer 5

Supplement with IV potassium in fluids (supplementation rate max is 0.5 meq/kg/hr)
reduce diuresis
if severe, Mg2+ supplementation may be required

Question 6

What are causes of hypocalcemia?

Answer 6

eclampsia, CKD, pancreatitis, critical illness, blood transfusion, NaHco3, ethylene glycol

Question 7

Clinical signs of hypocalcemia

Answer 7

none if mild
face rubbing/muscle tremors if moderate
seizure, obtundation, cardiac dysrhythmia, death if severe

Question 8

What are causes of hypercalcemia?

Answer 8

HARD IONS
hyperPTH, addisions, acute renal failure, hypervitamin D, idiopathic, osteolytic dz, neoplasia, spurios

Question 9

Clinical signs of hypercalcemia

Answer 9

PU/PD, poor app/lethargy, vomiting, AKI, generalized lymphoadenopathy (incidental finding)

Question 10

Treatment for hypercalcemia (iCa >1.8 mmol/L or azotemia+ elevated ca)

Answer 10

fluid therapy
furosemide
glucocorticoids
treat underlying disease

Question 11

What are causes of hypernatremia?

Answer 11

Excessive electrolyte free water loss: DI, panting (uncommon), diarrhea (rare), inadequate water intake, excessive sodium intake

Question 12

What are causes of hyponatremia?

Answer 12

increased water retention (diuretic therapy, addisons, ineffective circulating volume)
excess water intake (iatrogenic thru feeding tube)

Question 13

Clinical signs of dysnatremias

Answer 13

all NEUROLOGIC (obtunded, disoriented, head pressing, seizure, coma, death)

Question 14

Treating stable hypernatremia (no neuro signs, hypernatremia is incidental)

Answer 14

Administer electrolyte free water (3-7 ml/kg/hr) and monitor Na+ on single machine q 2-6 hours

Question 15

Treating neuro hypernatremia

Answer 15

Admin electrolyte free water 7-10 ml/hg/hr
5% DW IV
treat until neuro signs resolved then treat for stable hypernatremia

Question 16

Treatin hyponatremia

Answer 16

hypertonic saline to increase Na by 10-15% in first 24 hours, then slow when signs improve so you do not exceed 15 meq/L in first 24 hours
diuretic therapy with furosemide or mannitol

Question 17

Causes for hypokalemia

Answer 17

CKD, Diuretics. Diabetes.
diarrhea, vomiting, decreased intake, beta agonist toxin

Question 18

Treatment of hypocalcemia

Answer 18

IV calcium gluconate
IV calcium chloride
Monitor ECG for bradyarrhythmias