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Nayla Foundations Exam 5 > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

What are the electrolytes

A 
Na
K
Cl
CO2
calcium 
(order Mg and phosphorus separately)
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2
Q

What influences sodium retention

A

thirst
ADH
hyponatremia
( ADH is made in hypothalamus, goes to anterior pituitary, and then released to blood)

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3
Q

What influences NaCl retention

A

RAAS (increases Na/decreases K in blood)
ANP/catecholamines
renal factors (GFR)

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4
Q

What are the MC electrolyte abnormality in hospitalized patients

A

Hyponatremia (danger <125, seizures <120)

the faster Na drops, the more severe the situation

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5
Q

Hyponatremia is MC in

A

very young
very old
associated with pulmonary disease or CNS disorder

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6
Q

What are clinical manifestations of hyponatremia

A 
HA, dizziness
N/V
lethargy
weakness
confusion
HYPOventilation 
seizure, coma
(Sx depend of level of cerebral edema)
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7
Q

What are some types of hyponatremia

A
  • Pseudohyponatremia, redistributive hyponatremia

- Hypo, hyper, or euvolemic hyponatremia

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8
Q

What is pseudohyponatremia

A

falsley low sodium (<135) with normal osmolality
Sx: HLD, hyperproteinemia
(if suspected, talk to lab and get true Na level)

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9
Q

What is redistributive hyponatremia

A

in HYPERosmolar state, solutes in the ECF draw water from cells and dilute serum Na
ex: with high glucose, water follows so you get more water in the blood
(for every 100mg glucose >100mg, add 1.5 to Na)

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10
Q

What is hypovolemic hyponatremia due to

A 
Renal (diuretics, addisons) 
non renal (burns, external or internal GI)
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11
Q

How do you treat hypovolemic hyponatremia

A

replace lost fluid (isotonic .9% NS) and treat underlying cause

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12
Q

What is hypervolemic hyponatremia due to

A

Cirrhosis
CHF
Renal failure

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13
Q

How do you treat hypervolemic hyponatremia

A

Diuretics
Dialysis
fluid restriction

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14
Q

What is Euvolemic hyponatremia due to

A

SIADH
Hypothyroid
adrenal insufficiency

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15
Q

How do you treat Euvolemic hyponatremia

A

Fluid restrict

treat underlying cause

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16
Q

What is SIADH

A

too much ADH is released= water retention, but SAME sodium excretion
leads to concentrated urine w/ low osmolality and euvolemia

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17
Q

What can cause SIADH

A 
CNS disease
small cell lung cancer
meds
surgery
stress
psych d/o
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18
Q

How do you treat SIADH

A

fluid restrict

If refractory: give hypertonic NS, demeclocycline, or lithium (vaptans are new)

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19
Q

How do you evaluate hyponatremia

A

good H&P (meds, underlying d/o, fluid status)
check labs (UA sodium/osmolality, CMP)
TSH, Sr cortisol

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20
Q

What do you do with hyponatremia

A

<125 or symptomatic: hospitalize

chronic: slow cautious correction (can use demeclocycline)
severe: hypertonic solution (3% NS)

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21
Q

What is the rate of correction for hyponatremia

A

Severe: 6-12 mEq in first 24 hr// <18 mEq in 48 hr
Chronic: <8 mEq in first 24 hr (check Na q2 hr)

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22
Q

What is central pontine myelinolysis

A

irreversible demyelination in and around the pons, but Sx dont occur until 1-3 days after the overcorrection of Na
Sx: dysarthria, dysphagia, AMS, hypotension, quadriparesis

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23
Q

What is hypernatremia

A

too little water relative to salt (Na >145)

either due to too little water intake, or too high sodium intake, or excess water loss

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24
Q

What happens to the brain in hypernatremia

A

high Na in the ECF causes the brain to shrink

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25
Q

What are some causes of hypernatremia

A 
GI, skin, and renal losses **
diabetes insipidus
hypothalamic lesion (decreased thirst)
hypertonic Na solution 
drugs (diuretics, lithium)
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26
Q

What are clinical features of hypernatremia

A

Usually asymptomatic
thirst, AMS, weakness, seizure, coma, focal neuro deficit
Symptoms related to rate of onset (slow onset= less sx)

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27
Q

What does hypernatremia work up NEED

A

Urine osmolality! If urine osmolality is:
600): DI, external water loss
(if osm high and Na <25, vomiting/diarrhea)
(if osm high and Na >100, salt/hypertonic saline ingestion)

28
Q

What is the normal homeostatic response to hypernatremia

A

create thirst and increase fluid intake

maximize urine concentration to prevent further water loss

29
Q

What is diabetes insipidus

A

urine H2O loss with high sodium= dilute urine (oppo of SIADH)
water is not reabsorbed, collecting ductules are impermeable

30
Q

What are types of diabetes insipidus

A

Central: 2/2 decreased ADH secretion in brain
Nephro: 2/2 kidneys not responding to ADH when present

31
Q

Nephrogenic diabetes insipidus is

A

genetic of acquired (chronic renal insufficiency, lithium, amyloidosis)

32
Q

How do you treat Nephrogenic diabetes insipidus

A

Thiazide (prevent NaCl reabsorption in DCT)
Amiloride (K sparing)
Chlorpropamide
NSAID (indomethacin)

33
Q

What do you do with hypernatremia

A

Severe: hospitalize
replace H2O deficit (drink, NG, hypotonic IVF)
acute hypernatremia can be corrected more rapidly than chronic hypernatremia

34
Q

How do you calculate H2O deficit

A

normal TBW (kg x 0.6) - current TBW (normal srNa x normal TBW)/(measured srNa)

35
Q

Where is K mainly found

A

intracellularly (2% ECF)
it is excreted renally
it is regulated in the distal nephron

36
Q

What does aldosterone do

A

increase Na reabsorption

increase potassium excretion

37
Q

What are symptoms of hypokalemia

A

weakness, fatigue, muscle cramps, decreased DTR, ascending flaccid paralysis, cardia arrhythmia, hypercanis

38
Q

What are hypokalemic EKG findings

A

prominent U waves
Flat T waves
PVC
ST depression

39
Q

What is the way to remember Hypokalemia

A 
YOUCRAMP
hYpOkalemia 
U waves flat 
Cramp 
Respiratory failure/Rhabdo 
Anorexia, n/v
Muscle weakness
Paralysis, flaccid
40
Q

What causes hypokalemia

A

Transcellular shift: insulin, caffeine, hyperthyroid, metabolic acidosis (more K goes into cell)
Renal loss*: high aldosterone, Cushing’s, renal tubular acidosis
Extrarenal loss: vomit, diarrhea, low Mag
(need mag to be normal to correct K)

41
Q

What do you do with hypokalemia

A 
Oral K* (IV if cant eat or emergent- give w/ lidocaine) 
-DONT push K >20 mEq/hr
Telemonitor (arrhythmia) 
for every 0.1mEq <4 mEq, give 10 mEq K+ 
Severe: draw mag levels 
Hypokalemia can cause digoxin toxicity
42
Q

What is hyperkalemia

A

When K >5 (severe >6.5)

rare in the absence of renal failure

43
Q

What are symptoms of hyperkalemia

A

Asymptomatic usually

Ascending flaccid paralysis, arrhythmia

44
Q

What is a way to remember hyperkalemia

A 
AFACT! 
Arrhythmia 
Flaccid paralysis 
Ascending muscle weakness 
Conduction abnormality 
T waves peaked
45
Q

Pseudohyperkalemia can be due to

A

Hemolysis

repeat fist clenching with tourniquet in place

46
Q

Causes of hyperkalemia include

A 
Impaired renal excretion (renal failure, Addisons, hypoaldosterone) 
Drugs (ACE, ARB, NSAID, Bactrim, K sparing diuretic)
high intake (bananas, oranges) 
Rhabdo, low insulin, acidosis (K shift from ICF-ECF) 
(pH drop 0.1= K increase 0.5-1)
47
Q

What is urgent hyperkalemia treatment

A

IV calcium (decrease threshold of myocyte)
NaHCO3 IV push (increase pH)
Insulin (shift K ECF to ICF)
Nebulized albuterol, IV lasix, dialysis

48
Q

What is less urgent treatment for hyperkalemia

A

Kayexalate (exchange Na for K in gut= massive diarrhea full of potassium)
Lasix
treat underlying cause

49
Q

What is “total calcium”

A

Free (ionized) + protein bound

calcium is inverse to phosphate

50
Q

What does calcium help with

A

evaluating metabolism

monitoring hyperparathyroid, malignancy, renal failure

51
Q

Where is calcium found

A

99% in bone
0.8-1% ICF
0.1-0.2% ECF
(in ECF, 50% free, 40% protein bound, 10% complexed)

52
Q

What are the types of calcium

A

Ionized: not affected by albumin- cardiac function and clotting
Complexed: bound to citrate, sulfate, phosphate
Protein bound: if albumin decreases, so does calcium

53
Q

What is calcium physiology

A

absorbed through GI (with vitamin D), stored in bone, excreted by kidney
low serum Ca triggers PTH release= bone resorption (release) an kidney reuptake (saves Ca)
high serum Ca triggers calcitonin release= inhibit bone resorption (stays in bone)
1g decrease in albumin= 0.8mg decrease in calcium

54
Q

What is hypercalcemia

A

calcium >10.1 (common, self limiting)

55
Q

Hypercalcemia symptoms are

A

“Stones, bones, abdominal moans, and psych groans”
renal stones, bone pain, abd pain, n/v, constipation, fatigue, memory loss, psychosis, depression
-loss of tone, HTN, SHORT QT

56
Q

What causes hypercalcemia

A

Malignancy, primary hyperparathyroid**

thiazide, lithium, antacids, accutane

57
Q

What do we evaluate in hypercalcemia

A 
If >13, malignancy 
PTH is decreased in malignancy 
TSH
cortisol 
plasma electrophoresis
58
Q

How do you treat hypercalcemia

A

Volume expansion (NS)*
Calcitonin (takes 2 hr)
Pamidronate (decrease Ca in 1-2 d, stop bone resorption)
Zoledronic Acid (1st line for malignancy)
Prednisone
Dialysis (last resort)

59
Q

How does hypocalcemia present

A 
Tetany (increased NM excitability) 
paresthesias 
increased DTR 
chvostek, Trousseau 
prolonged QT, arrhythmia, hypotension
60
Q

What tetany is seen with hypocalcemia

A

carpopedal tetany, lip toe finger paresthesia
Chvostek: tap facial nerve= face muscle contraction
Trousseau: occlude brachial artery for 3 min- carpal spasm

61
Q

What causes hypocalcemia

A 
low albumin 
large transfusion (citrate binds Ca) 
low Mag (inhibits PTH) 
low PTH
renal failure
low vitamin D
intestine malabsorption
62
Q

What is phosphate used for

A

investigating parathyroid and calcium abnormalities (phosphate is inverse of calcium)

63
Q

DDx for hyperphosphatemia

A

renal failure
hypocalcemia
rhabdo

64
Q

DDx for hypophosphatemia

A 
chronic alcoholism 
diarrhea
insulin 
refeeding syndrome 
decreased intestinal absorption
65
Q

What is magnesium involved in

A

NM and cardiac function- binds to ATP and is excreted by kidneys (tied to Ca and K)
inhibits PTH= hypocalcemia
low mag= kidneys cant save K

66
Q

DDx for hypermagnesemia

A

large amt. ingested
IV (preeclampsia Tx)
renal insufficiency

67
Q

DDx for hypomagnesemia

A 
malnutrition
diarrhea
alcoholism 
hypocalcemia
cellular shift

Nayla Foundations Exam 5 (7 decks)

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