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Therapeutics II > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

What is the normal range for Na levels?

A

135-145 mEg/L

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2
Q

Which is a primary extracellular cation needed to maintain cellular integrity by maintaining the osmolar gradient?
A. Na
B. K
C. Phos
D. Ca

A

A. Na

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3
Q

What value indicates hyponatremia?

A

< 135 mEq/L

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4
Q

What is the equation for Serum Osmolality?

A

Osm = (2 x Na) + (BUN/2.8) + (Glucose/18)

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5
Q

AW is a 46 yof admitted to the internal medicine service for “unknown intoxication.” Routine labs reveal:

What is AW’s calculated osmolality?

A

Osm= (2 x 145) + (10/2.8) + (90/18)= 299 mOsm/L

Elevated serum Osm indicates presence of other substance in blood

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6
Q

What value of mOsm indicates pseudo hyponatremia?

A

275-290 mOsm

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7
Q

Pseudohyponatremia can be seen with what two conditions?

A

hypertriglyceridemia or hyperproteinemia

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8
Q

What value of mOsm indicates hypertonic hyponatremia?

A

> 290 mOsm

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9
Q

KZ is a 63 yom with ESRD secondary to uncontrolled HTN and DM currently receiving HD. Today his labs reveal:

What is KZ’s calculated Osm? What does it indicate?

A

Osm= (2x128) + (50/2.8) + (600/18) = 307 mOsm/L

Hypertonic Hyponatremia

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10
Q

Serum sodium falls by ____ mEq/L for each _____ mg/dL incremental increase in BG > 100 mg/dL

A

Serum sodium falls by 1.6 mEq/L for each 100 mg/dL incremental increase in BG > 100 mg/dL

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11
Q

What is the equation for Corrected Na?

A

Na(serum) + 1.6[(BG-100)/100]

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12
Q

KZ is a 63 yom with ESRD secondary to uncontrolled HTN and DM currently receiving HD. Today his labs reveal:

What is his corrected serum sodium?
What is his treatment?

A

128 + 1.6[(600-100)/100]= 136 mEq/L

Normal (btwn 135-145), go give insulin

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13
Q

What value of mOsm indicates hypotonic hyponatremia?

A

<275 mOsm

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14
Q

Which volume status decrease TBW and highly decreases Na?

A

Hypovolemic Hypotonic Hyponatremia

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15
Q

Which volume status increases TBW and keeps Na neutral?

A

Isovolemic Hypotonic Hyponatremia

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16
Q

Which volume status increases TBW and increases Na?

A

Hypervolemic Hypotonic Hyponatremia

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17
Q

T/F: Hypovolemic hypotonic hyponatremia are only from renal causes

A

False: renal and non-renal

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18
Q

What is the common cause of isovolemic hypotonic hyponatremia?

A

SIADH- Syndrome of Inappropriate AntiDiuretic Hormone Release

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19
Q

What happens to extracellular fluid with an increase in TBW and around normal Na?

A

Slight excess of ECF

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20
Q

What type of medications most commonly cause drug-induced SIADH?
A. Diuretics
B. Diabetes Meds
C. Psychotropic Meds
D. Antibacterials

A

C. Psychotropic Meds

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21
Q

How should water intake and medication be regulated in the treatment of SIADH?

A

Restrict free water (limit water intake) and remove underlying cause (ex meds) if possible

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22
Q

What medication class may be used in the treatment of SIADH?

A

Vaptans

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23
Q

Which leads to expanded ECF volume and physical edema?
A. Hypovolemic hypotonic hyponatremia
B. Hypervolemic hypotonic hyponatremia

A

B. Hypervolemic hypotonic hyponatremia

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24
Q

In most cases the goal is to avoid rise in serum sodium > ____ mEq/L/hr or no more than (NMT) __-___ mEq/L/day

A

In most cases the goal is to avoid rise in serum sodium > 0.5 mEq/L/hr or no more than (NMT) 8-12 mEq/L/day

25
Q

What is the treatment option(s) for symptomatic hypovolemia?
A. 3% NaCl
B. 0.9% NaCl
C. Furosemide
D. Water Restriction

A

A. 3% NaCl

26
Q

What is the treatment option(s) for asymptomatic hypovolemia?
A. 3% NaCl
B. 0.9% NaCl
C. Furosemide
D. Water Restriction

A

B. 0.9% NaCl

27
Q

What is the treatment option(s) for symptomatic isovolemia?
A. 3% NaCl
B. 0.9% NaCl
C. Furosemide
D. Water Restriction

A

A. 3% NaCl
C. Furosemide

28
Q

What is the treatment option(s) for asymptomatic isovolemia?
A. 3% NaCl
B. 0.9% NaCl
C. Furosemide
D. Water Restriction

A

B. 0.9% NaCl and water restriction

29
Q

What is the treatment option(s) for symptomatic hypervolemia?
A. 3% NaCl
B. 0.9% NaCl
C. Furosemide
D. Water Restriction

A

A. 3% NaCl
C. Furosemide

30
Q

What is the treatment option(s) for asymptomatic hypervolemia?
A. 3% NaCl
B. 0.9% NaCl
C. Furosemide
D. Water Restriction

A

C. Furosemide

31
Q

What is the treatment recommendation for acute symptomatic hyponatremia?

A

Increase serum Na with 3% NaCl by 1-2 mEq/L/hr

32
Q

What is the Na goal for acute symptomatic hyponatremia?

A

120 mEq/L

33
Q

What can occur from correcting acute symptomatic hyponatremia too rapidly?

A

CPM (central pontine myelinolysis)

34
Q

What is the max increase of mEq/L for the first 24 hrs?

A

8-12 mEq/L

35
Q

What is the equation for Na deficit?

A

TBW x (Na(goal) - current Na(serum))

36
Q

Hypernatremia is always associated with hyper_____

A

hypertonicity

37
Q

What is the equation for free water deficit?

A

TBW x [(Na(serum)/140)-1]

38
Q

What is the preferred treatment for isovolemic hypernatremia in diabetes insipidus?
A. Diuretics
B. Magnesium depletion
C. Kayexalate
D. Vasopressin

A

D. Vasopressin

39
Q

What is the preferred treatment for hypervolemic hypernatremia?
A. Diuretics
B. Magnesium depletion
C. Kayexalate
D. Vasopressin

A

A. Diuretics (if needed)

40
Q

What is the normal range for potassium?

A

3.5-5 mEq/L

41
Q

What is the primary intracellular cation responsible for cell metabolism, glycogen and protein synthesis?
A. Na
B. K
C. Phos
D. Ca

A

B. K

42
Q

What is a main cause of hypokalemia? Why?
A. Magnesium depletion
B. Calcium depletion
C. Sodium depletion
D. Phosphate depletion

A

A. Magnesium depletion- cofactor for Na/K ATPase

43
Q

What value warrants treatment for hypokalemia?

A

<3 mEq/L

44
Q

What is the infusion rate of potassium without cardiac monitoring? With cardiac monitor?

A

W/O: 10 mEq/hr
W/: 20 mEq/hr; 40-60 if during cardiac arrest with severe hypokalemia

45
Q

What values indicate mild, mod, and severe hyperkalemia?

A

Mild: 5.5-6 mEq/L
Mod: 6.1-6.9 mEq/L
Severe: >7 mEq/L

46
Q

What is the goal of therapy for severe hyperkalemia (K>7 mEq/L)?

A

C A BIG K DROP
1. Antagonize the membrane actions (Calcium)
2. Decrease extracellular K conc (albuterol, bicarb, insulin + glucose)
3. Remove K from the body (Kayexalate/Lokelma, Diuretics (furosemide), renal unit for dialysis of patient)

47
Q

What is the preferred chronic hyperkalemia treatment option?
A. Diuretics
B. Valtassa
C. Kayexalate
D. Vasopressin

A

B. Valtassa

48
Q

What values are normal range for magnesium?

A

1.5-2.5 mg/dL

49
Q

What is the most common medication to cause hypomagnesemia?
A. Diuretics
B. Valtassa
C. Kayexalate
D. Vasopressin

A

A. Diuretics

50
Q

What is the normal range of calcium?

A

8.5-10.5 mg/dL

51
Q

What are the three common reasons for hypocalcemia?

A

Magnesium deficiency, large volumes of blood products, and hypoalbuminemia

52
Q

What is the equation for corrected Ca?

A

Measured Ca + [(4-measured albumin) x 0.8]

53
Q

Which contains more elemental calcium: Ca chloride or Ca gluconate?

A

Ca chloride
1 gm Ca chloride = 3 gm Ca gluconate

54
Q

What is the normal range for phosphorus?

A

2.5-4.5 mg/dL

55
Q

What values are more mild-mod and severe hypophosphatemia?

A

Mild-Mod: 1-2 mg/dL
Severe: <1 mg/dL

56
Q

Use __Phos when K < 4 mEq/L
Use __Phos when K > 4 mEq/L

A

Use KPhos when K < 4 mEq/L
Use NaPhos when K > 4 mEq/L

57
Q

1 mMol NaPhos= ?
1 mMol KPhos= ?

A

1 mMol NaPhos= 1.33 mEq Na + 1.33 mEq Phos
1 mMol KPhos= 1.47 mEq K + 1.47 mEq Phos

58
Q

During phos replacement, infuse IV doses no faster than ___ mMol/hr

A

During phos replacement, infuse IV doses no faster than 7 mMol/hr

Therapeutics II (9 decks)

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