Electrolytes and Acid-Base Disorders

Question 0

Treatment of hypernatremia

Answer 0

Hypovolemic: D5W; if vs are unstable, then use NS BEFORE D5W
Euvolemic: use D5W or D51/2NS
Hypervolemic: use diuretics and D5W to remove excess sodium

Question 1

Neuro symptoms a/w hypernatremia

Answer 1

Mental status change, weakness, focal neurologic deficits, sz

Question 2

Neurologic damage a/w correcting hypernatremia and hyponatremia

Answer 2

Hypernatremia: cerebral edema
Hyponatremia: central pontine myelinolysis

Question 3

Symptoms of hyponatremia

Answer 3

confusion, lethargy, muscle cramps, hyporeflexia, nausea

Sz, coma, brainstem herniation

Question 4

When to correct hyponatremia with hypertonic saline?

Answer 4

If pt is having seizures or Na < 120. Otherwise just use NS

Question 5

Central pontine mylinolysis

Answer 5

Paraparesis/quadriparesis
Dysarthria
Coma

Question 6

Symptoms of hyperkalemia

Answer 6

Nausea, vomiting
Flaccid paralysis, weakness, paresthesias
Arrhythmias
Intestinal colic

Question 7

Treatment of hyperkalemia

Answer 7

C BIG K
Calcium gluconate
Beta agonists/Bicarbonate
Insulin
Glucose
Kayexalate

Question 8

Causes of metabolic alkalosis, hypokalemia, and a normal BP

Answer 8

Surreptitious vomiting, diuretic abuse

Gittelmans syndrome, Bartter’s syndrome

Question 9

What ion abnormality can cause hypokalemia?

Answer 9

Hypomagnasemia

Question 10

Symptoms of hypokalemia

Answer 10

Fatigue, hypotension
Hyporeflexia, muscle weakness, paresthesias, ascending paralysis
Rhabdomyolysis

Question 11

EKG findings in hyperkalemia and hypokalemia

Answer 11

Hyperkalemia: peaked T waves, QRS widening, blunted P waves, PR prolongation

Hypokalemia: T wave flattening, U wave (additional wave after T wave), ST depression; AV block can occur

Question 12

Causes of hypercalcemia

Answer 12

CHIMPANZEES
Calcium supplementation
Hyperparathyroidism/hyperthyroidism
Iatrogenic (thiazides, TPN), Immobility
Milk-alkali syndrome
Paget's disease
Adrenal insufficiency/Acromegaly
Neoplasm
Zollinger-Ellison syndrome ie MEN 1
Excess vitamin A
Excess vitamin D
Sarcoidosis and other granulomatous diseases

Question 13

Bisphosphonates MOA

Answer 13

Inhibits osteoclasts

Question 14

Etiology of hypocalcemia

Answer 14

Hypoparathyroidism, hypomagnasemia, acute pancreatitis, pseudohypoparathyroidism
Malnutrition and vitamin D deficiency
DiGeorge syndrome in infants (shortly after birth, lacks thymic shadow)

Question 15

Symptoms of hypocalcemia

Answer 15

abdominal muscle cramps, dyspnea, tetany, perioral and acral paresthesias and convulsions

Question 16

Chvoestek’s and Troussea’s signs

Answer 16

Chvoesteks: tapping of facial nerve causes facial spasm

Trousseau’s: carpal spasm after arterial occlusion by BP cuff

Question 17

Most common patients with hypomagnasemia

Answer 17

Alcoholics

Question 18

What electrolyte abnormalities does hypomagnasemia cause?

Answer 18

Hypocalcemia and hypokalemia

Question 19

Causes of anion gap acidosis and their treatments

Answer 19

Methanol: Fomepizole
Uremia: dialysis
DKA: insulin, fluids, calcium gluconate, potassium
Paraldehyde, Phenformin
Iron and INH: GI lavage, charcoal for INH
Lactic acidosis
Ethylene glycol: fomepizole
Salicylate overdose: alkalinize urine

Question 20

Ethylene glycol poisoning symptoms

Answer 20

Anion gap metabolic acidosis
Calcium oxalate crystals in urine
Renal failure

Question 21

Osmolar gap

Answer 21

Osmolality - (2*Na + Glucose/18 + BUN/2.8)

Ethylene glycol, methanol, ethanol

Question 22

Methanol poisoning symptoms

Answer 22

Anion gap metabolic acidosis
Snowy vision
Acute pancreatitis