Electrolytes Paulson Flashcards
What diagnostics should be ordered for hypermagnesia?
- Mg level
- BMP
- EKG
What EKG findings might you see with hypermagnesia?
- Diminished conduction
- Wide QRS
- Prolonged PQ interval
What is the treatment for hypermagnesia when you want to stabilize the cardiac membrane?
Calcium gluconate given IV
What med helps renal excretion of Mg?
Loop diuretics (cause ppl to pee out Mg)
What are three things that can cause HYPOmagnesia?
- diuretics
- diarrhea
- chronic PPI usage
Are Chvostek and Trousseaus sign for hyper or hypomagnesia?
hypomagnesia
Patients with hypomagnesia often have concurrent _________ & _________
For a patient with hypomagnesia with severe symptoms (tetany, arrythmias, seizures) what is the tx?
IV Mg sulfate
Severe = sulfate
*Need continuous cardiac monitoring
For a patient with hypomagnesia with asymptomatic or minimal symptoms, what is the treatment? What is a major s/e
-Oral replacement
=MgCl or Mg oxide
**Diarrhea is a major s/e
What major ddx should be on the top of your list of a patient with hypercalcemia?
- ***Malignancy
- Endocrine (***hyperparathyroidism)
- Granulomatous disease
- *Thiazide diuretics
Stones, bones, groans, psychiatric overtones are symptoms of what?
Hypercalcemia
ST elevation and short QT interval are classic findings of what?
Hypercalcemia
What dx to order for hypercalcemia?
Serum total calcium in blood
When checking for hypercalcemia, you need to correct for ______
albumin
A patient comes in and has hypercalcemia, what do you do next?
- Check Ca again
- Check PTH
- Still elevated –> check Vit D and PTHrP (if elevated could be a malignancy)
What is the treatment for hypercalcemia?
-IV fluids and cardiac monitoring
What tx should be AVOIDED in hypercalcemia?
Furosemide (Lasix)
What are some osteoclast-inhibiting treatments for hypercalcemia?
- Bisphosphonates
- Calcitonin
- Glucocorticoids (pred)
Pt has hypercalcemic crisis + hyperparathyroidism, what is the tx?
Parathyroidectomy
An EKG finding in hypercalcemia is ______ QT whereas hypocalcemia is a ______ QT
short QT, prolonged QT
What are the three most common pathophysiology reasons of hypocalcemia?
- Vit D deficiency
- PTH resistance
- Renal disease
Two main clinical features of hypocalcemia?
Trosseau & Chvostek sign
DIagnostics for hypocalcemia?
- Total serum calcium (corrected for albumin)
- Serum phosphate
- Vit D level
- Serum pth
- Mg level
- EKG
- BMP
A patient comes in with acute and severely symptomatic hypocalcemia, what is the treatment??
IV calcium gluconate
What is the treatment for mild hypocalcemia?
Oral calcium + vitamin D
T/F: Treat any concurrent hypomagnesmia first to effectively treat the hypocalcemia
T
Calcium does the _____ of phosphate, so when the calcium is high, the phosphate is ______. What regulates the two of these?
opposite, low, PTH
What are three acute causes of hyperphosphatemia?
- Acute renal Failure
- Tumor lysis syndrome
- Parathyroidectomy
What are two main chronic causes of hyperparathyroidism?
- CKD
2. Hypoparathyroidism
What labs to order for hyperphosphatemia?
- Serum phosphorous
- PTH to see if this is the cause
- serum calcium
- Vit D
Treatment for acute hyperphosphatemia and normal renal fxn?
Saline + diuresis
Treatment for hypoparathyroidism causing hyperphosphatemia?
Calcium + Vit D
Treatment for AKI caused by hyperphosphatemia?
phosphate binders
Treatment for CKD and hyperphosphatemia?
Restrict dietary phosphate and need to take phosphate binders forever
How to diagnose hypophosphatemia?
- Serum phosphorous
- Urinary phosphorous excretion
Treatment of asymptomatic hypophosphatemia with serum phosphate <2.0?
oral phosphate
Treatment of symptomatic hypophosphatemia 1.0-1.9
Oral but IV if rhabdo, CNS or hemolysis
Treatment of symptomatic hypophosphatemia <1.0
IV phosphate but switch to PO once serum phosphate is >1.5
Treatment of hypophosphatemia urinary phosphate wasting?
Dipyridamole QID
-helps to increase phosphate levels
