Electrolytes Flashcards
Normal Plasma Potassium Levels?
3.5-5.1 mEq/L
Hypokalemia is Potassium below what value?
Categorize Mild, Moderate and Severe
- <3.5
- Mild = 3.1-3.5
- Moderate = 2.5-3
- Severe = <2.5
What can cause hypokalemia? (4)
- Decr intake (rare)
- Incr potassium loss (kidney, GI, sweat, V/D)
- Hypomagnesemia -> renal K wasting and decr of intracellular K
- Drug induced
Name some drugs that can cause Hypokalemia
- beta 2 agonists
- Theophylline
- Levothyroxine
- Thiazide and loop diuretics
- High dose penicillin
- Laxatives
- Sodium polystyrene sulfonate
- Patiromer
Clinical presentation of Mild vs Moderate to severe
Mild = usually no sx’s
Mod to severe : depends on severity and rapidity of onset
- cramping, weakness, malaise and myalgias
Cardiac : ECG changes and arryhthmias
- What to do about hypokalemia and hypomagnesemia together?
- What agents preferred for asx pt’s and symptomatic pt’s w/severe depletion?
tx for magnesium first! Mg is needed for K uptake
- Oral preferred
- IV may be necessary
Hypokalemia : Non pharm?
Food : OJ, spinach, bananas, tomatoes, nuts, chocolate
Hypokalemia : oral Potassium
- best for?
- Which is often used?
- adverse effects?
- asx patients
- potassium chloride
- Abdominal pain or cramping
-diarrhea, nausea, flatulence
-Hyperkalemia
General rules
1. Admin of 10 mEq of Kcl = increase in serum K by how much?
2. Divide doses to minimize ?
- common dosing?
- 0.1 mEq/L
- GI effects
- 10-40 mEq daily to qid
Hypokalemia and Iv products
1. For severe or ____ pt’s or pt’s unable to ?
2. Cons? (3)
3. MUST BE ____ before use. USe as infusion
4. What’s used to dilute it?
- Dosing schemes? (2)
- Recheck K after _____
- symptomatic , take oral
- Considered high risk and high alert meds , pain at infusion site , can be fatal if admined undiluted or IV push
- DILUTED
- NS or 0.45% saline, avoid D5W
- 10 meq/100 mL over 1 hr (peripheral admin ok)
20mEq/50 mL over 1 hr via central line only (recc to check ECG)
- 30-40 meq total. At least 30-60 mins after end of last infusion.
Hyperkalemia
1. K greater than?
2. What’s Mild, mod, and severe?
3. Caused by?
- 5.1
- 5.2-5.9 , 6-6.4, >6.5
- Incr dietary intake. Incr endog K (tumor lysis syndrome)
Decr renal CL , Drug induced, Low renin and aldosterone state , adrenal insufficiency, hyperglycemia
What drugs can cause Hyperkalemia?
Nsaids, beta blockers, cyclosporine, diabetes, elderly
Spironolactone , ACEI’s and ARBS
Hyperkalemia : Clinical presentation ?
Sx’s range from asx to severe
- heart palpitations or skipped heartbeats
-Cardiac can be life threatening
Hyperkalemia TX for MILD cases with NO ecg change
- Remove potassium from Body using any K+ Binder
- Can use furosemide 20-40 mg IVP x 1
Moderate TX with NO ECG CHANGE?
- Name agents and process
- Shift potassium intracellularly
- use Insulin 0.1 units/kg IVP or Albuterol nebulizer 10 mg
-or sodium bicarb infusion 50-125 mL/hr or 50 meq IVP if pH <7.15 or HCO3 <15 - REMOVE K FROM BODY
-Use any potassium binder
SEVERE Hyperkalemia tx with ECG changes?
-3 steps and agents
- Stabilize myocardium
- Calc Gluc 2g IVP x1 over 10 min
-Calc Cl 1G IVP over 5 min central line only - SHift potassium intracellulary (Insulin )
- Remove potassium (K+ binders or Furosemide)
Calc Gluconate
1. What does it do?
2. Dose and route
3. onset and duration
4. ae’s
5. MOA
- stabilize heart
- 2g IV over 10 mins
- 1-2 mins /10-30 mins
- Local irritation, hypercalcemia, hypotension, bradycardia
- INCR cardiac threshold potential and reverse ECG changes
Regular Insulin
1. What does it do?
2. Dose and route
3. onset and duration
4. ae’s
5. MOA
Dextrose 50%
1. only given with insulin to prevent ____ if glucose < ____
2. DOse and route?
3. AE’s?
- shift K intracellularly
- 10 units IV or 0.1 units/kg
- 30 mins / 2-6 hrs
- hypoglycemia
- incr K uptake into cells
- hypoglycemia, 300
- BG < 150 (25 g or 50 mL IV over 5 mins for 2 doses)
-BG 150-300 : 25 g (50 mL) IV over 5 mins x 1 dose - Hyperglycemia
Albuterol : Shift K
- Dose?
- AE’s
Sodium Bicarb : Shift K
- For what conditions?
- Dose and route?
- Ae’s ?
- 10-20 mg nebulized
- tachycardia and tremor
- pH < 7.15 or HCO3 < 15
- 50 meq IV over 5 mins or 50-125 mL/hr infusion
- hypernatremia , metabolic alkalosis
Remove the K
- Furosemide
Dose? AE’s? - Sodium Polystyrene sulfonate (Kayexalate)
Dose? AE?s Instructions?
- 20-40 mg IV push x 1 dose
- low electrolytes , metab alkalosis, dehydration - Oral : 15-30 grams every 4-6 hrs as needed. Rectal : 30 g in 100 mL, retain 30 mins
- N/V, diarrhea, Decr Mg, K, and Ca, Incr Na, edema and colon necrosis
-sep from other meds by 3 hrs
Remove the K
- Patiromer (Veltassa) Powder
Dose? AE’s - Sodium zirconium cyclosilicate (Lokelma powder)
- Dose and AE’s ?
- 8.4 mg by mouth once daily (Max is 25.2 g/day)
- GI Upset, constipation , DECR Mg and K, sep from other meds by 3 hrs and store in fridge
- 10 g TID for up to 48 hrs; then 10 g once daily
- GI upset, DECR K, Edema, Separate from other meds by 2 hrs, store at room temp
Which can be used for recurrent episodes or chornic hyperkalemia?
Most commonly used in pt’s with ?
Patiromer and sodium zirc cylclo
-CKD , HF. Can help facilitate optimal RAASi therapy
MAGNESIUM
1. Normal?
2. Causes of HYPO?
3. Most pt’s are?
4. What general sx’s?
- 1.7-2.6
- GI like malnutrition of alcoholism, Vomiting, diarrhea. Drug induced like laxatives, aminoglycosides, amphotericin B
- Asymptomatic
- Neuro –> convulsions in severe
Neuromusc –> Muscle twitching, tremor, weakness, cramping
Cardio –> Changes in ECG , wide QRS, peaked T wave
- if severe, prolonged pr and diminished T wave
What’s Moderate and severe hypomag?
Mod : 1.2-1.6
Severe <1.2
Hypomag tx
- If Severe Mag with life threatening sx’s?
- If severe, but sx’s are NOT life threatening?
- Mag sulfate 2g IV over 2 mins (Hypotension, flush, sweat) -only used in emerg
- followed by 2g IV over 20 mins
-followed by 2-4g IV over 2-4 hrs then repeat serum Mg
- Mag sulfate 8 grams IV over 8 hrs, then repeat serum Mg
- If mag levels are 1.2-1.6 but umable to take oral, Mg sulfate 4 g IV over 4 hrs, repeat serum Mg
How do you tx moderate or asymptomatic (1.2-1.6)?
Incr dietary mg
- oral mag replacement
-Usually magOX 400 mg tab 1-2 tabs BID or TID. HIghest risk of diarrhea
HYPERmagnesemia
- rare except in ?
-___ disease, hypo___, DKA
- Drug induced ?? (3)
- Kidney disease (AKI or CKD stages 4 or 5)
-renal impairment + taking mag containing antacids
Addison’s. thyroidism.
lithium, overusing mag citrate or mag antacids
-parenteral mag for preeclampsia
HYPERmag Clinical manifestations ?
TX 3 steps
lethargy, confusionn, dysrhythmias, muscle weakness
- Protect myocard
-1-2 g IV calc gluc to antag Mg effects - INCR Mg Output
- lasix 20-40 mg IV with 0.45% sodium chloride if normal renal function or CKD stage 1-4
-pt’s with ESRD –> dialysis
- STOP input. Limit mag in diet or meds
Normal Plasma Ca2+ ?
Normal Ionized or free calcium thats active?
8.6-10.2
1.13 -1.32
What’s the corrected calcium equation?
-Not recommended to use in ?
measured Ca (mg/dL) + 0.8 (4-albumin g/dL)
-critically ill pt’s
Hypocalcemia Values?
-caused by?
calcium < 8.6 mg/dL; ionized Ca <1.1 mMol/L
Alteration in PTH or VITD
-Vit D deficiency (most common)
-Hypomag(Impairs PTH activity)
IV calcium products : describe 2 and elemental Ca per each product
- Calc chloride
-elemental Ca = 27.3%
-vein irritation! tissue necrosis!
-best with central line!
-Max rate 1 g over 10 mins - Calc gluc
- elemental = 9.3%
Less vein irritation
Max rate = 3g IV over 10 mins
Oral calcium products? (2)
-elemental ca?
- Calc acetate
- 169 mg per 667 tab - Calc carb
Hypercalcemia Values ?
Mild-mod
severe
Causes ? meds ?
Sx’s?
Name 1 tx
> 10.2
Mild/mod : 10.3-13
Severe > 13
-TZD diuretics, VitD, Lithium, calc, theophylline, tamoxifen, ganciclovir
-Fatigue, weakness, anorexia, cog dysfunction, Polyuria, polydipsia, nocturia
-Normal Saline. 1-2 L bolus followed by 200-300 mL/hr until fluid resuscitated
Phosphorous
Normal?
Hypophos can be due to ?
Hypophos acute sx’s?
Severe?
2.5-4.5
Impaired intest abs. Diarrhea, alcoholism, diet, binders such as alum and mag antacids
-increased renal elim thru VitD deficiency, hyperparathyroidism, hyperglycemia induced osmotic diuresis
-drugs like diuretics, glucocorticoids (dex, pred), sodium bicarb
ACUTE : organ dysfunction, seizure, coma
SEVERE : Muscle weakness, confusion, seizures, coma
IV PHOS
-For what condition?
-Products?
-How much phos in each ?
-How does each product differ?
- Severe< 1.5 mg/dL or unable to take oral
- Sodium phos, potass phos
- 3 mmol/mL
- Sodium Phos has 4 mEq Na+/mL
Potass Phos has 4.4 mEq K+/mL
For asympt mild-mod do u need tx?
For mild to mod with evidence of deficit what’s the tx?
usually no
Oral phos
What oral phos products are available and describe how much phos, potassium, and sodium are in them ?
- K-phos, neutral
- 8 mmol of phos, 1.1 mEQ of Potass, 13 mEq of Sodium - Neutra phos K
-8mmol of phos, 14.3 mEq of potassium
