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Foundations of Clinical Practice II > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

How does aldosterone affect sodium

A

aldosterone causes:

  • increased sodium reabsorption
  • increased potassium excretion
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2
Q

What is the most common electrolyte abnormality in hospitalized patients

A

hyponatremia

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3
Q

What is the most common result of hyponatreamia?

A

Seizures

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4
Q

What is pseudohyponatremia?

A

Serum Na is <135 but NORMAL osmolality due to hyperlipidemia and hyperproteinemia

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5
Q

What is a common cause of redistributive hyponatremia?

A

hyperglycemia

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6
Q

Euvolemic Hyponatremia: treatment

A

fluid restriction, treat underlying cause

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7
Q

Euvolemic Hyponatremia: causes

A
  1. SIADH
  2. Primary polydipsia
  3. Hypothyroidism
  4. Adrenal Insufficiency
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8
Q

What are the hallmark findings of SIADH?

A

-concentrated urine with low serum osmolality and euvolemia

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9
Q

If a patient presents with hyponatremia, what are the first labs you would want?

A
  1. UA -sodium
  2. UA - osm
  3. serum osm
  4. CMP
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10
Q

What should you do if a patient’s Na is less than 125?

A

Hospitalize!!

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11
Q

Rapid increase in serum sodium can lead to what?

A

cerebral pontine myelinolysis

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12
Q

Treatment of Hyponatreamia: rate of correction

A

First 24 hours: 6-12 mEq/L

First 48 hours: Less than 18 mEq/L in 48 hours

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13
Q

How often should you check serum sodium when you are replacing to make sure you aren’t overcorrecting?

A

every 2 hours

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14
Q

If a patient has low serum sodium and high serum osmolarity what is the most likely cause?

A

Hyperglycemia

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15
Q

If a patient has high urine osmolarity and is hypervolemia what two things might you suspect?

A
  1. CHF

2. Cirrhosis

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16
Q

If a patient has high urine osmolarity and is euvolemic what might you suspect?

A
  1. SIADH
  2. Hypothyroid
  3. Adrenal Insufficiency
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17
Q

If a patient has high urine osmolarity and is hypovolemic and urine sodium is <10 what might be the cause?

A

vomiting or diarrhea

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18
Q

If a patient has high urine osmolarity and is hypovolemic and has urine sodium >20 what might be the cause?

A

Adrenal insufficiency

Diuretics

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19
Q

At what level is someone technically hypernatremic?

A

> 145mEq/L

20
Q

What are the two causes of Diabetes insipidus?

A
  1. Central DI - ADH isn’t being secreted

2. Nephrogenic DI - kidneys aren’t responding to ADH

21
Q

What is the treatment for nephrogenic diabetes insipidus?

A

Thiazide diuretic**

22
Q

How is water deficit calculated?

A

Normal Total Body Water - current Total Body Water

23
Q

Where does regulation of renal K+ excretion take place in the nephron?

A

distal nephron

under the influence of aldosterone which increases sodium reabsorption and increases renal K+ excretion

24
Q

Hypokalemia: clinical manifestations

A
  1. Hyporeflexia*
  2. Muscle cramps*
  3. Weakness, fatigue
  4. Flaccid paralysis (ascending)
25
Q

Hypokalemia: ECG findings

A
  • PVCs
  • Flattened T waves
  • Prominent U waves
  • Depressed ST segments
26
Q

Name the causes of Hypokalemia (8)

A
  • insulin
  • caffeine
  • bronchodilators
  • hyperthyroidism
  • Metabolic alkalosis
  • Diuretics***
  • Cushing’s
  • Vomiting or diarrhea
27
Q

If a patient is low on potassium what is the best way to replace?

A

oral potassium replacement is preferred over IV as it has better absorption and won’t damage vessels

28
Q

Hyperkalemia - ECG

A

(in order of progression):

  • peaked T waves
  • Widened QRS
  • Junctional rhythm
  • Ventricular fibrillation
29
Q

Name some causes of Hyperkalemia

A
  • Drugs (ACE, ARB, K+ sparing diuretics, NSAIDs, Bactrim)
  • rhabdomyolysis
  • Acidosis
  • Decreased Insulin
30
Q

Hyperkalemia: Emergent Treatment

A
  1. IV calcium to stabilize membrane
  2. Sodium Bicarbonate (increases pH, K+ is exchanged for H+ in the cells)
  3. Insulin (add with sugar)
  4. IV lasix
31
Q

Hyperkalemia: not urgent

A

Kaexalate - exchanges sodium for potassium in the gut

or

Lasix (furosemide)

32
Q

When calicum goes up ______ will go down

A

phosphate

33
Q

ECF calcium

A

Free - 50%
Protein bound - 40%
Complexed - 10%

34
Q

Serum calcium is impacted by what other substance?

A

albumin

So, in hypoalbuminemia need to correct the measured calcium level

35
Q

At what level is calcium considered Hypercalcemia?

A

Calcium >10.1

36
Q

What are the symptoms of hypercalemia?

A
  1. Kidney stones
  2. Bone pain
  3. Abdominal pain, N/V, constipation
  4. Fatigue, lethargy, memory loss, psychosis
  5. Decreased neuromuscular excitability
37
Q

What will happen to the QT interval with Hypercalcemia?

A

shortened QT

38
Q

What are the 2 biggest causes of hypercalcemia

A
  1. Malignancy

2. Primary hyperparathyroidism

39
Q

Which medications can cause Hypercalcemia?

A
  • Thiazide diurectics
  • Antacids
  • Lithium
  • Vitamin A analogs (Accutane)
40
Q

Hypercalcemia: Treatment

A
  1. Volume expansion - Normal saline!***
  2. Calcitonin
  3. Pamidronate
  4. Zoledronic Acid
41
Q

Hypocalemia: clinical presentation

A
  • Increased neuromuscular excitability (tetany)**
  • Parestheisas around lips, fingers and toes
  • Hyperreflexes
  • Chvostek’s Sign
  • Trousseau’s Sign
42
Q

What are the cardiovascular effects of hypocalcemia?

A
  1. Prolonged QT inverval, arrhythmia

2. Hypotension

43
Q

Hypocalcemia: Causes

A
  1. Hypoalbuminemia
  2. Large blood transfusion (citrate additives bind free calcium)
  3. Hypomagnesemia (need Mg to help PTH work properly)
  4. Hypoparathyroidism
  5. Renal failure - retention of phosphate and reciprocal loss of Ca
  6. Malabsorption/Vitamin D deficiency
44
Q

What will happen to phosphate in refeeding syndrome?

A

Phosphate floods into cells and causes cell death

45
Q

What two conditions do you need to first correct hypomagnesemia before you can fix them?

A
  1. Ca++

2. K+

Foundations of Clinical Practice II (25 decks)

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