Electrolytes

Question 1

Hyponatremia

Answer 1

Na < 135

Question 2

Signs & symptoms of hypotnatremia

Answer 2

Lethargy
Nausea
Malaise

Less common
- stupor
- seizures
- coma

Question 3

Plasma osmolarity of hyponatremia

Answer 3

Usually low
<275

Question 4

Urine osmolarity of hyponatremia

Answer 4

< 100

Question 5

Treatment of symptomatic hyponatremia

Answer 5

3% Normal saline
100 ml bolus up to 3 does

Question 6

Treatment for asymptomatic hyponatremia

Answer 6

Isotonic saline (0.9% saline )

Question 7

Correction of hyponatremia should not exceed

Answer 7

8 mEqs/ day

Question 8

Hypernatremia Na+ level

Answer 8

Na+ >145

Question 9

Hypernatremia is usually due to

Answer 9

Na+ gain
water deficit
Osmotic diuresis
Diabetes insipidus

Question 10

Signs and symptoms of Hypernatremia

Answer 10

Severe symptoms
- Altered mental status
- weakness
- coma
- seizures
- polyuria/ thirst

Question 11

Diagnostic tests for Hypernatremia:
Urine osmolarity =

Answer 11

> 800

Question 12

Rate of correction for Hypernatremia should not exceed

Answer 12

10-12 mEq/L/day

Question 13

Treatment fluids for Hypernatremia

Answer 13

D5W or quarter NS (0.22%)

Question 14

Hypokalemia range

Answer 14

K+ < 3.5

Question 15

Causes of hypokalemia

Answer 15

• decreased net intake
• transcellular shift
• increased renal k+ loss

Question 16

S/S of hypokalemia

Answer 16

• fatigue
• muscle weakness
  -myalgias
• Lowe extremity cramps

Question 17

Severe symptoms of hypokalemia

Answer 17

Complete paralysis
Hypoventilation
Rhabdomyolysis

Question 18

Testing for Hypokalemia

Answer 18

Urine k+
Acid base- usually metabolic alkalosis

Question 19

Hypokalemia EKG changes

Answer 19

• flattened t waves or inversion
• prominent U waves
• Prolonged PR interval
• widened QRS complex

Question 20

Treatment of hyperkalemia

Answer 20

• Calcium gluconate
• Insulin
• NaHCO3
• B2 Adrenergic agonist (albuterol)
  Dialysis

Question 21

Treatment of hypokalemia

Answer 21

40 Meq oral
or IV KCL- 10 Meq

Question 22

Calcium balance is regulated by

Answer 22

parathyroid hormone (PTH) and calcitriol.

Question 23

PTH increases serum calcium by

Answer 23

stimulating bone resorption, increasing calcium reclamation in the kidney, and promoting renal conversion of vitamin D to calcitriol

Question 24

Calcitriol

Answer 24

is the active form of vitamin D

Question 25

hypocalcemia diagnostics

Answer 25

- albumin- pseudo eval PTH serum phosphorus vitamin D Magnesium Ecg- prolonged QT and bradycardia

Question 26

Hypocalcemia

Answer 26

serum calcemia- < 8.4 ionized calcium <4.2

Question 27

hypocalcemia causes

Answer 27

- effective hypoparathyroidism - vitamin D deficiency - profound elevations in phosphorus

Question 28

clinical manifestation of hypocalcemia

Answer 28

SEVERE laryngospasm, confusion, seizures, or vascular collapse with bradycardia decompensated heart failure. moderate - excitability of nerves and muscles, paresthesia, tetany

Question 29

Trousseau's sign

Answer 29

Trousseau sign is the development of carpal spasm when a blood pressure cuff is inflated above systolic pressure for 3 minutes.

Question 30

Chvostek sign

Answer 30

refers to twitching of the facial muscles when the facial nerve is tapped anterior to the ear.

Question 31

treatment of hypocalcemia

Answer 31

- if hypomagnesemia is present that much be treated first - calcium supplement - IV for severe or symptomatic CACL or Calcium gluconate initial dose of 90–180 mg of elemental calcium car 1–2 g of calcium gluconate

Question 32

hypercalcemia

Answer 32

A serum calcium >10.3 mg/dL with a normal serum albumin or an ionized calcium >5.2 mg/dL defines hypercalcemia.

Question 33

More than 90% of cases are due to

Answer 33

primary hyperparathyroidism or malignancy.

Question 34

Clinical manifestations generally are present only if serum calcium exceeds

Answer 34

12 mg/dL

Question 35

hypercalcemia manifestations

Answer 35

Renal manifestations include polyuria and nephrolithiasis. If serum calcium rises above 13 mg/dL, renal failure with nephrocalcinosis and ectopic soft tissue calcifications are possible. GI symptoms include anorexia, vomiting, constipation, and rarely, signs of pancreatitis. Neurologic findings include weakness, fatigue, confusion, stupor, and coma.