Electrolytes Flashcards
**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.
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.
What should you ask a nurse who calls for hyper-K?
vitals, GCS, glucose
IV fluids, Foley
renal failure
K supp, TMP/SMX, NSAIDs, digoxin
ACEi, ARB, spironolactone, amiloride, triampterene
What should you ask a nurse who calls for hypo-K?
vitals, IV fluids
NG tube, vomiting
furosemide, digoxin
Mg level
What should you ask a nurse who calls for hypo-Na?
vitals, GCS
IV fluids
symptoms
glucose, urea, sodium levels in last 48 hours
What should you ask a nurse who calls for hyper-Na?
vitals, GCS
symptoms, seizures
other sodium levels in 48 hours
What should you ask a nurse who calls for hypoglycemia?
vitals, GCS, IV access
symptoms, diet
insulin, DM meds
What should you ask a nurse who calls for hyperglycemia?
vitals, glucose, GCS
symptoms, sugar intake, diabetic diet
diabetes
insulin, insulin pump, diabetic meds, steroids
What should you ask a nurse who calls for hyper-Ca?
vitals, GCS
Ca supplements, vitamin D
What should you ask a nurse who calls for hypo-Mg?
vitals
IV fluids
heart disease
furosemide
What should you ask a nurse who calls for hypo-Ca?
vitals, current IV fluids, IV access
symptoms, paresthesias
Mg, albumin level
What should you ask a nurse who calls for hypo-PO4?
CaCO3 and meals
What are the criteria for hyperglycemia?
BG > 8.0 mmol/L
(technically, although a random glucose of 11 mmol/L is a negative screen for diabetes)
What are the criteria for mild hypo-Ca?
iCa > 0.8 mmol/L
What are the criteria for mild hyper-K?
K ≤ 6.5 without ECG changes
What are the criteria for mild hypo-PO4?
asymptomatic with PO4 > 0.64
What are the criteria for moderate hyper-Ca?
3.0-3.5 mmol/L
What are the criteria for moderate hyper-K?
K 6.5-7.0 without ECG changes
What are the criteria for moderate hypo-K?
K ≤ 3.0
What are the criteria for moderate hypo-Na?
Na ≤ 128 mmol/L
What are the criteria for severe hyper-Ca?
> 3.5 mmol/L or symptoms
What are the criteria for moderate hypo-PO4?
symptoms or PO4 < 0.64
What are the criteria for severe hyper-K?
K > 7.0 or ECG changes
What are the criteria for severe hypo-Ca?
iCa ≤ 0.8 mmol/L
What are the criteria for severe hypo-K?
K < 3.0 and symptoms
What are the risk factors for osmotic demyelination syndrome?
alcoholism, malnutrition, liver disease
chronic Na ≤ 105, hypokalemia
(slower correction of Na required)
What patients with hypo-Na are at low risk of osmotic demyelination syndrome?
acute hypo-Na over hours
primary polydipsia
ecstasy
What are the investigations for DKA?
** 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
What are the investigations for HHS?
fingerstick q1h
ECG
CBC
ABG, VBG
corrected Na, lytes, glucose, urea, Cr q1h
Ca, Mg, PO4, serum osm q1h, ketones, lactate
urine ketones, glucose
What are the investigations for hyperglycemia?
repeat fingerstick in 1 hour
lytes, urea, glucose, osm, Cr, ketones
What are the investigations for mild hyper-K?
ECG,
fingerstick glucose,
CBC/d,
repeat lytes, glucose, urea, Cr, serum osm
CK, dig level
urinalysis, urine lytes, urine osm
What are the investigations for mild hypo-Ca?
ECG,
urea, Cr,
iCa, PO4, Mg
urine Ca
What are the investigations for mild hypo-K?
repeat lytes, urea, Cr, serum osm
Mg,
urinalysis, urine K, urine Cr, urine osm
dig level
What are the investigations for mild hypo-Mg?
ECG
lytes, urea, Cr, serum osm
Ca, Mg, PO4,
albumin
urinalysis, urine Mg, urine Cr
What are the investigations for mild hypo-PO4?
lytes, urea, Cr, serum osm
Ca, Mg, PO4
CK
PTH
urinalysis, urine PO4, urine Cr
What are the investigations for moderate hyper-K?
ECG,
fingerstick glucose,
CBC/d,
repeat lytes, glucose, urea, Cr, serum osm
CK, dig level
urinalysis, urine lytes, urine osm
What are the investigations for moderate hyper-Na, hypervolemic?
volume assessment
weight q6h
lytes, glucose, urea, Cr, serum osm q4h
free water deficit q4h
urinalysis, urine lytes, urine Cr, urine osm
What are the investigations for moderate hyper-Na, hypovolemic?
volume assessment
weight q6h
lytes, glucose, urea, Cr, serum osm q4h
free water deficit q4h
urinalysis, urine lytes, urine Cr, urine osm
What are the investigations for moderate hypo-K?
ECG
repeat lytes, urea, Cr, serum osm
Mg
urinalysis, urine K, urine Cr, urine osm
dig level
What are the investigations for moderate hypo-Na?
** 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
What are the investigations for severe hyper-Ca?
ECG,
lytes, urea, Cr
Ca, PO4, Mg
ALP, albumin,
PTH, vit D,
urine Ca, urine Cr
What are the investigations for severe hyper-K?
ECG,
fingerstick glucose,
CBC/d,
repeat lytes, glucose, urea, Cr, serum osm
CK, dig level
urinalysis, urine lytes, urine osm
What are the investigations for severe hyper-Na, hypovolemic?
volume assessment
weight q4-6h, free water deficit q4h
lytes, glucose, urea, Cr, serum osm q4h
urinalysis, urine lytes, urine Cr, urine osm
What are the investigations for severe hypo-Ca?
ECG,
urea, Cr,
iCa, Ca, PO4, Mg
ALP, albumin,
PTH, vit D,
urine Ca
What are the investigations for severe hypoglycemia?
lytes, glucose, Cr, ketones
bilirubin, INR, albumin
insulin, C-peptide, proinsulin
cortisol, ACTH, TSH, free t4
tox screen
What are the investigations for severe hypo-K?
ECG
repeat lytes, urea, Cr, serum osm
Mg
urinalysis, urine K, urine Cr, urine osm
dig level
What are the investigations for severe hypo-Mg?
ECG
lytes, urea, Cr, serum osm
Ca, Mg, PO4, albumin
urinalysis, urine Mg, urine Cr
What are the symptoms of moderate hypo-PO4?
non-specific
What are the symptoms of severe hyper-Ca?
altered mental status oliguria/anuria
What is the management for hyperglycemia?
insulin SC 1% of daily insulin dose per glucose point
What is the management for mild hyper-Ca?
D/C calcium supplements
small fluid bolus
What is the management for DKA?
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
What is the management for mild hyper-Na, hypovolemic?
free water PO/NG, 2 mL/kg/h (maximum 3 mL/kg/h total)
What is the management for HHS?
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
In SIADH, what IV fluid should be chosen?
one with higher electrolyte concentration than patient’s urine
What is the management of overcorrected hypo-Na?
stop IV fluid
free water PO/NG or D5W IV to match urine output
ddAVP 2 mcg SQ q8h
What is the management for mild hyper-K?
hold potassium supplements
hold TMP-SMX, NSAID’s
hold ACEi, ARB’s, spironolactone, amiloride, triampterene
What is the management for mild hypo-Ca?
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
What is the management for mild hypoglycemia?
IV access
glucose tablets 15 g PO once
fingerstick q15min until BG > 5
snack or meal afterward
What is the management for mild hypo-K?
KCl 20 mEq PO tid
What is the management for mild hypo-Mg?
Mg chloride 2% (20 mg/mL) 10 mL PO bid
MgSO4 2 g IV over 2 hours
What is the management for mild hypo-Na?
correct hypokalemia
high sodium diet
fluid restriction 1-1.5 L/day
What is the management for mild hypo-PO4?
vitamin D 800 U PO daily
hold mealtime CaCO3, Mg, aluminum antacids
What is the management for moderate hyper-K?
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
What is the management for moderate hyper-Ca?
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
What is the management for moderate hyper-Na, hypervolemic?
furosemide 40 mg IV once, then MD reassess after 12h
D5W 2 ml/kg/hour IV for 12 hours, then MD reassess
What is the management for moderate hyper-Na, hypovolemic?
D5W 2 ml/kg/hour IV for 12 hours, then MD reassess
What is the management for moderate hypo-Ca?
calcium gluconate 1-2 gram over 10-20 minutes
What is the management for moderate hypo-Na?
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
What is the management for moderate hypo-PO4?
reduce feeds
NaPO4 1 g PO tid
OR
NaPO4 16 mmol/4 mmol PO tid
vitamin D 800 U PO daily
What is the management for severe hyper-Ca?
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
What is the management for severe hyper-K?
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
What is the management for severe hypo-Mg?
MgSO4 5 g IV over 6-12 hours
What is the management for severe hyper-Na, hypovolemic?
D5W 2 ml/kg/hour IV for 12 hours, then MD reassess
What is the management for severe hypo-Ca?
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
What is the management for severe hypoglycemia?
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
What is the management for severe hypo-K?
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
What is the management for severe hypo-PO4?
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
What is the management for acute hypo-Na?
3% saline 25-100 mL push, repeated q10min if symptoms persist
NS IV 1 mL/kg/h for 12 hours, then MD reassess
