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On call with MedOrganized > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

**ORIENTATION**

I hope these flashcards from MedOrganized.com help you learn about managing electrolytes on call. I use them myself, but I am just one person reviewing these and I cannot guarantee that there aren’t errors. Please use your clinical discretion in managing your patients and let me know if you find something amiss.

A

These flashcards are compiled from Toronto Notes 2014, David Hui’s “Approach to Internal Medicine”, the “MD On Call” app by Messil.com, and my own website, MedOrganized.com.

Mark this card as “5” to see it infrequently.

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2
Q

What should you ask a nurse who calls for hyper-K?

A

vitals, GCS, glucose

IV fluids, Foley

renal failure

K supp, TMP/SMX, NSAIDs, digoxin

ACEi, ARB, spironolactone, amiloride, triampterene

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3
Q

What should you ask a nurse who calls for hypo-K?

A

vitals, IV fluids

NG tube, vomiting

furosemide, digoxin

Mg level

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4
Q

What should you ask a nurse who calls for hypo-Na?

A

vitals, GCS

IV fluids

symptoms

glucose, urea, sodium levels in last 48 hours

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5
Q

What should you ask a nurse who calls for hyper-Na?

A

vitals, GCS

symptoms, seizures

other sodium levels in 48 hours

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6
Q

What should you ask a nurse who calls for hypoglycemia?

A

vitals, GCS, IV access

symptoms, diet

insulin, DM meds

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7
Q

What should you ask a nurse who calls for hyperglycemia?

A

vitals, glucose, GCS

symptoms, sugar intake, diabetic diet

diabetes

insulin, insulin pump, diabetic meds, steroids

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8
Q

What should you ask a nurse who calls for hyper-Ca?

A

vitals, GCS

Ca supplements, vitamin D

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9
Q

What should you ask a nurse who calls for hypo-Mg?

A

vitals

IV fluids

heart disease

furosemide

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10
Q

What should you ask a nurse who calls for hypo-Ca?

A

vitals, current IV fluids, IV access

symptoms, paresthesias

Mg, albumin level

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11
Q

What should you ask a nurse who calls for hypo-PO4?

A

CaCO3 and meals

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12
Q

What are the criteria for hyperglycemia?

A

BG > 8.0 mmol/L

(technically, although a random glucose of 11 mmol/L is a negative screen for diabetes)

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13
Q

What are the criteria for mild hypo-Ca?

A

iCa > 0.8 mmol/L

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14
Q

What are the criteria for mild hyper-K?

A

K ≤ 6.5 without ECG changes

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15
Q

What are the criteria for mild hypo-PO4?

A

asymptomatic with PO4 > 0.64

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16
Q

What are the criteria for moderate hyper-Ca?

A

3.0-3.5 mmol/L

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17
Q

What are the criteria for moderate hyper-K?

A

K 6.5-7.0 without ECG changes

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18
Q

What are the criteria for moderate hypo-K?

A

K ≤ 3.0

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19
Q

What are the criteria for moderate hypo-Na?

A

Na ≤ 128 mmol/L

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20
Q

What are the criteria for severe hyper-Ca?

A

> 3.5 mmol/L or symptoms

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21
Q

What are the criteria for moderate hypo-PO4?

A

symptoms or PO4 < 0.64

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22
Q

What are the criteria for severe hyper-K?

A

K > 7.0 or ECG changes

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23
Q

What are the criteria for severe hypo-Ca?

A

iCa ≤ 0.8 mmol/L

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24
Q

What are the criteria for severe hypo-K?

A

K < 3.0 and symptoms

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25
Q

What are the risk factors for osmotic demyelination syndrome?

A

alcoholism, malnutrition, liver disease

chronic Na ≤ 105, hypokalemia

(slower correction of Na required)

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26
Q

What patients with hypo-Na are at low risk of osmotic demyelination syndrome?

A

acute hypo-Na over hours

primary polydipsia

ecstasy

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27
Q

What are the investigations for DKA?

A

** SCROLL DOWN **

fingerstick q1h

ECG, ABG, VBG

CBC

corrected Na, lytes, glucose, urea, serum osm, Cr q1h

Ca, Mg, PO4,

ketones, lactate,

lipase, troponin

urine ketones, glucose

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28
Q

What are the investigations for HHS?

A

fingerstick q1h

ECG

CBC

ABG, VBG

corrected Na, lytes, glucose, urea, Cr q1h

Ca, Mg, PO4, serum osm q1h, ketones, lactate

urine ketones, glucose

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29
Q

What are the investigations for hyperglycemia?

A

repeat fingerstick in 1 hour

lytes, urea, glucose, osm, Cr, ketones

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30
Q

What are the investigations for mild hyper-K?

A

ECG,

fingerstick glucose,

CBC/d,

repeat lytes, glucose, urea, Cr, serum osm

CK, dig level

urinalysis, urine lytes, urine osm

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31
Q

What are the investigations for mild hypo-Ca?

A

ECG,

urea, Cr,

iCa, PO4, Mg

urine Ca

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32
Q

What are the investigations for mild hypo-K?

A

repeat lytes, urea, Cr, serum osm

Mg,

urinalysis, urine K, urine Cr, urine osm

dig level

33
Q

What are the investigations for mild hypo-Mg?

A

ECG

lytes, urea, Cr, serum osm

Ca, Mg, PO4,

albumin

urinalysis, urine Mg, urine Cr

34
Q

What are the investigations for mild hypo-PO4?

A

lytes, urea, Cr, serum osm

Ca, Mg, PO4

CK

PTH

urinalysis, urine PO4, urine Cr

35
Q

What are the investigations for moderate hyper-K?

A

ECG,

fingerstick glucose,

CBC/d,

repeat lytes, glucose, urea, Cr, serum osm

CK, dig level

urinalysis, urine lytes, urine osm

36
Q

What are the investigations for moderate hyper-Na, hypervolemic?

A

volume assessment

weight q6h

lytes, glucose, urea, Cr, serum osm q4h

free water deficit q4h

urinalysis, urine lytes, urine Cr, urine osm

37
Q

What are the investigations for moderate hyper-Na, hypovolemic?

A

volume assessment

weight q6h

lytes, glucose, urea, Cr, serum osm q4h

free water deficit q4h

urinalysis, urine lytes, urine Cr, urine osm

38
Q

What are the investigations for moderate hypo-K?

A

ECG

repeat lytes, urea, Cr, serum osm

Mg

urinalysis, urine K, urine Cr, urine osm

dig level

39
Q

What are the investigations for moderate hypo-Na?

A

** SCROLL DOWN **

volume assessment

lytes, glucose, urea, Cr, serum osm

β-HCG, TSH, free T4, cortisol,

triglycerides, serum electrophoresis

urinalysis, urine lytes, urine Cr, urine osm

±CXR, CT head

40
Q

What are the investigations for severe hyper-Ca?

A

ECG,

lytes, urea, Cr

Ca, PO4, Mg

ALP, albumin,

PTH, vit D,

urine Ca, urine Cr

41
Q

What are the investigations for severe hyper-K?

A

ECG,

fingerstick glucose,

CBC/d,

repeat lytes, glucose, urea, Cr, serum osm

CK, dig level

urinalysis, urine lytes, urine osm

42
Q

What are the investigations for severe hyper-Na, hypovolemic?

A

volume assessment

weight q4-6h, free water deficit q4h

lytes, glucose, urea, Cr, serum osm q4h

urinalysis, urine lytes, urine Cr, urine osm

43
Q

What are the investigations for severe hypo-Ca?

A

ECG,

urea, Cr,

iCa, Ca, PO4, Mg

ALP, albumin,

PTH, vit D,

urine Ca

44
Q

What are the investigations for severe hypoglycemia?

A

lytes, glucose, Cr, ketones

bilirubin, INR, albumin

insulin, C-peptide, proinsulin

cortisol, ACTH, TSH, free t4

tox screen

45
Q

What are the investigations for severe hypo-K?

A

ECG

repeat lytes, urea, Cr, serum osm

Mg

urinalysis, urine K, urine Cr, urine osm

dig level

46
Q

What are the investigations for severe hypo-Mg?

A

ECG

lytes, urea, Cr, serum osm

Ca, Mg, PO4, albumin

urinalysis, urine Mg, urine Cr

47
Q

What are the symptoms of moderate hypo-PO4?

A

non-specific

48
Q

What are the symptoms of severe hyper-Ca?

A

altered mental status oliguria/anuria

49
Q

What is the management for hyperglycemia?

A

insulin SC 1% of daily insulin dose per glucose point

50
Q

What is the management for mild hyper-Ca?

A

D/C calcium supplements

small fluid bolus

51
Q

What is the management for DKA?

A

IV access, monitors, strict ins/outs, O2

target BG fall 5 mmol/h to 10-15, target AG 8-12

if K > 3.3 then insulin R 25 units in D5W 250 mL at 0.1 mL/kg/hr

fingerstick q1h

Plasmalyte 1000 mL/hr IV for 2 hours

if BG ≤ 15 then alert MD to consider D5NS + 20 mEq KCl IV 500 mL/hr, do not turn off insulin

thiamine 100 mg IV once

52
Q

What is the management for mild hyper-Na, hypovolemic?

A

free water PO/NG, 2 mL/kg/h (maximum 3 mL/kg/h total)

53
Q

What is the management for HHS?

A

IV access, monitors, strict ins/outs, O2

target BG 10-15, target AG 8-12

if K > 3.3 then insulin R 25 units in D5W 250 mL at 0.1 mL/kg/hr

fingerstick q1h

NS 1000 mL/hr IV for 2 hours

if BG ≤ 15 then alert MD to consider D5NS + 20 mEq KCl IV 500 mL/hr

54
Q

In SIADH, what IV fluid should be chosen?

A

one with higher electrolyte concentration than patient’s urine

55
Q

What is the management of overcorrected hypo-Na?

A

stop IV fluid

free water PO/NG or D5W IV to match urine output

ddAVP 2 mcg SQ q8h

56
Q

What is the management for mild hyper-K?

A

hold potassium supplements

hold TMP-SMX, NSAID’s

hold ACEi, ARB’s, spironolactone, amiloride, triampterene

57
Q

What is the management for mild hypo-Ca?

A

confirm PO4, ionized calcium for precipitation

CaCO3 1250 mg PO tid between meals (500 mg Ca)

MgSO4 2 g IV once

vitamin D3 1000 IU PO daily

± calcitriol 0.25 mcg PO daily

58
Q

What is the management for mild hypoglycemia?

A

IV access

glucose tablets 15 g PO once

fingerstick q15min until BG > 5

snack or meal afterward

59
Q

What is the management for mild hypo-K?

A

KCl 20 mEq PO tid

60
Q

What is the management for mild hypo-Mg?

A

Mg chloride 2% (20 mg/mL) 10 mL PO bid

MgSO4 2 g IV over 2 hours

61
Q

What is the management for mild hypo-Na?

A

correct hypokalemia

high sodium diet

fluid restriction 1-1.5 L/day

62
Q

What is the management for mild hypo-PO4?

A

vitamin D 800 U PO daily

hold mealtime CaCO3, Mg, aluminum antacids

63
Q

What is the management for moderate hyper-K?

A

cardiac monitor

rule out digoxin toxicity

calcium gluconate 10% 10 mL IV push once

D50W 50 mL IV, insulin R 10 units IV once, and then fingerstick q30 min for 2 hours

NaHCO3 3 ampoules in 1 L D5W over one hour

furosemide 40 mg IV once

hold potassium-raising meds

64
Q

What is the management for moderate hyper-Ca?

A

target euvolemia, target urine output 2.5 L/day

Plasmalyte 500 mL IV, repeat up to 5 L after MD reassess

furosemide 20 mg IV

65
Q

What is the management for moderate hyper-Na, hypervolemic?

A

furosemide 40 mg IV once, then MD reassess after 12h

D5W 2 ml/kg/hour IV for 12 hours, then MD reassess

66
Q

What is the management for moderate hyper-Na, hypovolemic?

A

D5W 2 ml/kg/hour IV for 12 hours, then MD reassess

67
Q

What is the management for moderate hypo-Ca?

A

calcium gluconate 1-2 gram over 10-20 minutes

68
Q

What is the management for moderate hypo-Na?

A

target increase in Na by less than 8-12 mmol/L per day

correct hypokalemia

NS IV 3 mL/kg/h for 12 hours, then MD reassess

free water (PO) restriction

69
Q

What is the management for moderate hypo-PO4?

A

reduce feeds

NaPO4 1 g PO tid
OR
NaPO4 16 mmol/4 mmol PO tid

vitamin D 800 U PO daily

70
Q

What is the management for severe hyper-Ca?

A

target euvolemia and urine output 2.5 L/day

Plasmalyte 1 litre IV over 2 hours, repeat up to 5 L after MD reassess

furosemide 20 mg IV q4h

pamidronate 60 mg IV once

calcitonin 4 IU/kg IM/SC q12h

± prednisone 60 mg PO daily x 10 days

71
Q

What is the management for severe hyper-K?

A

cardiac monitor

rule out digoxin toxicity

calcium gluconate 10% 10 mL IV push once

D50W 50 mL IV, insulin R 10 units IV once, and then fingerstick q30 min for 2 hours

salbutamol 0.5 mg IV once, vitals after and q30min x 3

NaHCO3 3 ampoules in 1 L D5W over one hour

furosemide 40 mg IV once

hold potassium-raising meds

72
Q

What is the management for severe hypo-Mg?

A

MgSO4 5 g IV over 6-12 hours

73
Q

What is the management for severe hyper-Na, hypovolemic?

A

D5W 2 ml/kg/hour IV for 12 hours, then MD reassess

74
Q

What is the management for severe hypo-Ca?

A

target low-normal serum calcium

calcium gluconate 10%, 10 mL over 10-20 minutes, two or three times

then calcium gluconate IV 1 mg/kg/hour

MgSO4 2 g IV over 2 hrs

75
Q

What is the management for severe hypoglycemia?

A

IV access

thiamine 100 mg IM once

D50W 50 mL IV push

glucagon 1 mg SC/IM once

fingerstick q15min until BG > 5

D10NS maintenance fluids

76
Q

What is the management for severe hypo-K?

A

KCl 10 mEq in 100 mL D5W IV bolus over 30 minutes, repeat once

MgSO4 5 mg IV once over 4 hours

Plasmalyte (±D5) 1 L IV over two hours

77
Q

What is the management for severe hypo-PO4?

A

reduce feeds

potassium phosphate (22/15 mmol) in 250 mL NS IV over 4 hours

sodium phosphate (20/15) in 250 mL NS over 4 hours

Ca, Mg, PO4 q6h

78
Q

What is the management for acute hypo-Na?

A

3% saline 25-100 mL push, repeated q10min if symptoms persist

NS IV 1 mL/kg/h for 12 hours, then MD reassess

On call with MedOrganized (1 decks)

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