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Concepts in Critical care > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

Define an ion

A

An ion is any atom or group of atoms that bears one or more positive or negative electrical charges

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2
Q

Define Cation

A

A positively charged ion

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3
Q

Define anion

A

A negatively charged ion

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4
Q

What are the 7 primary electrolytes?

A

Sodium
Potassium
Calcium
Magnesium
Chloride
Bicarb
Phosphorus

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4
Q

Define an electrolyte

A

A substance that has a positive or negative electrical charge when it is dissolved in water

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4
Q

T/F: electrolytes are passive solutes

A

False. Electrolytes are not passive solutes as they have charges and energy needs to be used in order to facilitate their movement

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5
Q

What is a non-electrolyte?

A

A chemical compound that when placed in a solution does not ionize

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6
Q

What is the normal value for sodium?

A

135-145 mEq/L

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7
Q

What are common non-electrolytes?

A

Sugar
Alcohol

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8
Q

What is the normal value for potassium?

A

3.5-4.5 mEq/L

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9
Q

What is the normal value for chloride?

A

90-100 mEq/L

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10
Q

What are the normal values for magnesium?

A

1.5-2.4 mEq/L

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11
Q

What are the normal values for bicarb?

A

22-26 mEq/l

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11
Q

What are the normal values for calcium?

A

4.5-5.5 mEq/dL

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11
Q

What is the standard test for analyzing electrolyte content in the blood?

A

Basic metabolic panel
BMP

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12
Q

What are the normal values for phosphorus?

A

3-4.5 mg/dL

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13
Q

What metabolic functions can be tested via a Basic metabolic panel (BMP)?

A

Kidney function
Fluid and electrolyte balance
Blood sugar levels
Acid and base balance
Metabolism

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14
Q

What is sodium primary role in the body

A

Primary role is regulating the distribution of water throughout the body

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15
Q

What is the most prevalent cation found in the extracellular compartment?

A

Sodium

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16
Q

What controls and regulates sodium levels?

A

The kidneys

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17
Q

What level of sodium is required to be considered hyponatremic?

A

Less than 135 mEq/L

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18
Q

What are common ways electrolytes are lost?

A

Vomiting
Diarrhea

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19
Q

Besides increased output, what are other ways that sodium content in the blood can be decrease?

A

Increases in fluid levels in the body can dilute sodium content

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20
Q

What disease processes commonly cause fluid retention?

A

CHF
Kidney failure

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21
Q

What level of sodium is required to be considered hypernatremic?

A

Greater than 145 mEq/l

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21
Q

What can cause hypernatremia?

A

Pure water loss or excretion
Diuretics
Excessive sweating

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22
Q

What is the main cation of the intracellular compartment?

A

Potassium

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23
Q

T/F: dehydration is not clinically confirmed with findings of hypernatremia

A

False

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24
Q

What can happen if potassium is too high or too low?

A

Serious cardiac dysrhythmias may develop

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24
Q

WHat are the most common causes of hypokalemia?

A

Urine
GI tract
Skin
NG tube output
Alcoholism, diuretics, laxatives

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24
Q

What is the role of potassium in the body?

A

Critical role is mediating electrical impulses in the nerves and muscles, including the heart

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25
Q

T/F: Potassium has no role in maintaining the acid base balance

A

False

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26
Q

What is the benchmark for being considered hypokalemic?

A

K+ less than 3.5 mEq/L

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27
Q

What are the symptoms of hypokalemia?

A

EKG changes
Muscle weakness
AMS (altered mental status)

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28
Q

How does hypokalemia change an EKG?

A

Decrease in the amplitude of the T waves
Decreased S-T segment
Prominent U waves

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29
Q

How is hypokalemia treated?

A

Eliminate beta agonists
KCl- for metabolic alkalosis
KHCO3- for renal tubular acidosis

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30
Q

What is the benchmark for hyperkalemia?

A

K+ > 4.5 mEq/L

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31
Q

What are the symptoms of hyperkalemia?

A

Muscle weakness
Changes in EKG

32
Q

How does hyperkalemia change an EKG?

A

Tall narrow T waves (tent like)
Decreases amplitude of P wave (may disappear entirely)
Prolonged R-R interval
Prolonged QRS complex
May lead to asystole

32
Q

What can cause hyperkalemia?

A

Pharmacologics
Lack of insulin
Renal insufficiency

33
Q

What are treatment options for hyperkalemia?

A

insulin /glucose infusion
Calcium gluconate
Diuretics to promote K+ clearance
Kayexalate
Dialysis
Beta adrenergics

34
Q

What drugs can cause hyperkalemia?

A

ACE inhibitors
Potassium sparing diuretics
NSAIDS
Heparin

35
Q

What would the acid-base balance of a patient with hyperkalemia potentially look like?

A

Metabolic acidosis

36
Q

What is the root cause of hyperkalemia?

A

Transcellular shift of K+ out of the cell

37
Q

What is the most common clinical cause of hyperkalemia?

A

Impaired urine output
Or excessive intake

38
Q

What does albuterol do to combat hyperkalemia?

A

May help shift potassium into the intracellular space by stimulating the sodium potassium pump

38
Q

What drug can RTs administer to patients who are hyperkalemic?

A

Albuterol

39
Q

How much can albuterol lower the serum potassium level of the blood?

A

0.5-1.5 mEq/L

40
Q

What patients can benefit from albuterol administration for hyperkalemia?

A

Patients with renal failure who are fluid overloaded

41
Q

What is the dosage of albuterol for patients with hyperkalemia?

A

20 mg

42
Q

Where is the potassium concentration typically higher, outside the cell or inside the cell?

A

Inside the cell
Intracellularly

42
Q

What is the resting membrane potential?

A

Difference of electrical voltage inside to the outside of the cell

43
Q

What is the resting membrane potential dependent upon?

A

The functionality of the sodium potassium pump

44
Q

Where is sodium concentration typically higher, outside the cell or inside the cell?

A

Outside the cell
Extracellularly

45
Q

Describe the movement of sodium and potassium in a single “cycle” of the sodium potassium pump

A

The pump binds 3 sodium ions and 1 molecule of ATP
The ATP provides energy to change the shape of the channel and the sodium is excreted into the extracellular space
The new shape of the channel allows 2 potassium ions to bind
A release of phosphate allows the channel to revert to its original shape and release the potassium into the cell

46
Q

What are the functions of magnesium in the body?

A

Plays important role as coenzyme in the metabolism of proteins and carbs
Helps regulate neuromuscular irritability

47
Q

What is magnesium used to treat?

A

Torsade de pointes
Smooth muscle relaxation effects (asthma)

48
Q

How is lactate used clinically?

A

Represents a clinically obtainable surrogate marker of tissue hypoxia and disease severity independent of blood pressure

48
Q

What are normal serum lactate levels?

A

0.5-2.0 mmol/L

49
Q

What causes an increase in serum lactate?

A

Anaerobic metabolism due to lack of oxygen delivery to the tissues

50
Q

What ions are generally found in the extracellular compartment?

A

Sodium
Chloride
Bicarbonate

51
Q

What ions are generally found in the intracellular compartment?

A

Potassium
Magnesium
Phosphate

52
Q

Describe the relationship between hypervolemia and hyponatremia

A

In hypervolemia, the total body fluid has increased lowering the concentration of sodium in the blood

52
Q

Describe the relationship between hypovolemia and hyponatremia

A

In hypovolemia the total body fluid has decreased resulting in decreased amounts of sodium

53
Q

What causes hypernatremia?

A

Water loss exceeding sodium loss
Pure water loss
Increases in total body sodium

54
Q

In what situations would water loss exceed sodium loss resulting in hypernatremia?

A

Diuretics
Sweating
Diarrhea

55
Q

What conditions cause pure water loss resulting in hypernatremia?

A

Diabetes insipidus
Excessive sweating

56
Q

hat can cause an increase in total body sodium resulting in hypernatremia?

A

Cushing syndrome
Hypertonic sodium bicarb administration

57
Q

When is hypertonic sodium bicarbonate administered?

A

CPR

58
Q

T/F: 90% of total body potassium is found extracellularly

A

False. 90% of total body potassium is found intracellularly

59
Q

What can cause hypokalemia?

A

GI losses
Diuretics
insulin/ B2 agonists
Malnutrition
Alcoholism

60
Q

What can cause hyperkalemia?

A

Acute or chronic renal failure
NSAIDS, diuretics, ACE inhibitors
Blood transfusion

61
Q

What rhythm is associated with hypokalemia?

A

V-fib
Torsades de points

62
Q

What is the role of calcium in the body?

A

Bone development
Blood clotting
Neuromuscular activity
Muscle contraction

63
Q

What muscular symptoms might an individual with improper calcium levels experience?

A

Muscle irritability
Convulsions
Compromise of cardiac contractility

64
Q

What is the anion gap?

A

The anion gap is the difference between the measured cations and the unmeasured anions in the blood

65
Q

What is diagnosed if the anion is greater than normal?

A

High anion gap metabolic acidosis is diagnosed

66
Q

What are the unmeasured anions?

A

Protein
Phosphate
Sulfate
Organic acids

67
Q

What are the unmeasured cations

A

Potassium
Calcium
Magnesium
Trace

68
Q

What is the normal anion gap?

A

Less than or equal to 15

69
Q

How do you calculate the anion gap?

A

Unmeasured anions - unmeasured cations = anion gap

70
Q

What are the options for fluid replacement?

A

Crystalloids
Colloids
Blood products

71
Q

What is the first choice of fluid replacement for resuscitation, maintenance, solvent for drug administration?

A

Crystalloids

72
Q

What are crystalloids primarily used for?

A

Resuscitation
maintenance
Solvent for drug administration

73
Q

What fluid replacement is used as a plasma substitute?

A

Colloids

73
Q

What are the benefits of crystalloids?

A

Do not exert an osmotic effect
Increase fluid levels without causing significant fluid shifts

74
Q

what are common crystalloids?

A

normal/hyper/hypotonic saline
Dextrose
Lactated ringer

75
Q

What are examples of colloids?

A

Albumin
Hesban
Hetastarch

76
Q

What are the benefits of colloids?

A

Believed to remain in IV space and be more effective at maintaining oncotic pressure

77
Q

What are blood products commonly used for?

A

Replacement therapy or hematocrit or hemoglobin

78
Q

When are blood products typically used?

A

Rapid infusion protocol for trauma patients

79
Q

What are the kinds of blood products?

A

Packed red blood cells
Fresh frozen plasma
Platelets
Cryoprecipitate
Whole blood

80
Q

Why are blood transfusions considered risky?

A

Risk for adverse reactions

81
Q

What are the 4 standard categories of diuretics?

A

Thiazides
Potassium sparing diuretics
Osmotic diuretics
Loop diuretics

Concepts in Critical care (5 decks)

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