Electrolytes pt 3 Flashcards
Hypermagnesia is magnsium above?
2.5
Oral ingestion of laxatives, enemas, infusion, and renal insufficiency can all cause?
Hypermagnesia
What is the most common clinical feature of hypermagnesium?
Neuromuscular toxicity
Nausea, flushing, headahce, lethargy, drowsiness, and decreased DTRs occur at what level of magensium?
4-6
Somnolence, hypocalcemia, absent DTRs, hypotension, bradycardia, and EKG changes occur at what level of magnesium?
6-10
Muscle paralysis –> flaccid quadriplegia, apnea, respiratory failure, complete heart block and cardiac arrest occur at what magnesium levels?
>10
How do you diagnose hypermagnesia?
Magnesium level
BMP
EKG
What EKG changes will there be with hypermagnesia?
Diminished conduction
Widened QRS
Prolonged PQ
How do you treat hypermagnesia?
Stop offending agent, add diuretic maybe
Calcium gluconate is given IV - to help stabilize cardiac membrane
Hemodialysis if severe + renal impairment
Hypomagnesia occurs below?
1.8
What is the most common causes of hypomagnesia?
Chronic diuretic therapy (loop and thiazide)
Chronic alcoholism
Chronic diarrhea
Chronic PPI usage.
Tetany - positive Trousseau and chovstek sign, muscle spasm, seizures, involuntary movements are neurologic findings of what?
Hypomagnesia
What EKG findings are associated with hypomagnesia?
Widening of QRS, peaked T waves
Prolonged PR interval, QRS widening and diminished T wave (more severe)
Frequent PACs and PVCs - ventricular arrythmias.
Patients with hypomagnesia usually have concurrent?
Hypokalemia and hypocalcemia.
Can’t determine where your hypomagnesia is coming from. What test should you do?
24 hour urine magneisum excretion or fraction excretion of magnesium to help differentiate between GI and renal losses.
Treatment of severe symptoms like tetany, arrythmias, or seizures due to hypomagnesium should be treated with what?
IV magnesium sulfate
Continuous cardiac monitoring
Treatment of asymptomatic or minimal symptoms of hypomagneisum should be treated with?
Oral replacement - magnesium chloride or magnesium oxide - diarrhea major effect.
Malignancy such as ectopic secretion of PTH by tumor, multiple myeloma, and bone mets can cause what?
Hypercalcemia
Hyperparathyroidism, MEN, hyperthyroidism, pheochromocytoma, and adrenal insufficiency can cause?
Hypercalcemia
Granulomatous disease such as sarcoidosis, TB, histoplasmosis, Berylliosis and coccidiomycosis can cause what?
Hypercalcemia
Drugs such as Vitamins A and D, thiazide diuretics, estrogens, Milk-alkali syndrome, lithium can cause what?
Hypercalcemia.
Dehydration, prolonged immobilization, iatrogenic, rhabdo, familial, and lab error can cause?
Hypercalcemia.
Two most important causes of hypercalcemia?
Malignancy
Hyperparathyroidism.
Hypercalcemia symptoms?
Vague- nonspecific
Stones, groans, bones, and psychiatric overtones.
Severe hypercalcemia can present as?
Lethargy, altered mental status, seizures, coma
Cardiac conduction abnormalities - bradyarrhythmias, sinus arrests, av blocks, af, vt, lbbb, rbbb
What are EKG findings associated with severe hypercalcemia?
bradyarrythmias, sinus arrests, AV blocks, AF, VT, LBBB, RBB
ST segment elevation,
“short QT interval - classic finding”
How do you diagnose hypercalcemia?
Ionized calcium versus total calcium
Serum total calcium represents both bound and unbound calcium
ionized needs albumin
A patient with hypercalcemia might have normal caclcium if what protein is low?
Albumin
Corrected calcium equation?
CC = measured total calcium x [0.8 (4-albumin)]
After you confirm hypercalcemia what next test should you run?
Serum PTH
If Serum PTH is high, dx? Low?
High - primary hyperparathyroidism
low - check vit d levels and PTHrp
How do you treat hypercalcemia?
Usually dehydrated - NS open wide.
Bisphosphonates, calcitonin, glucocorticoids.
Short QT =
Prolonged QT
Short QT = hypercalcemia
Prolonged = hypocalcemia.
What are the major causes of hypocalcemia?
Hypoparathyroid
Drugs
Hypomagnesia
Carpal tunnel spasm after BP cuff is applied for 3 minutes
Trousseau sign
Spasm of facial muscle after tapping facial nerve in front of ear
Chovstek sign.
Acute and severely symptomatic hypocalcemia should be treated with?
IV calcium gluconate
Mild hypocalcemia should be treated with?
Oral calcium and vit D
What are acute causes of hyperphosphatemia?
Acute renal failure
Tumor lysis syndrome
Hypoparathyroidism.
What are chronic causes of hyperphosphatemia?
CKD
Hypoparathyroidism.
Although most asymptomatic from hyperphosphatemia, some can have accompanying symptoms from hypocalcemia like?
Tetany, muscle cramps, perioral numbness, tingling
Trousseau or chovstek sign.
Hyperphosphatemia may cause uremia signs which include?
Fatigue, n/v, pruritus, SOB, sleep disturbances
How do you diagnose hyperphosphatemia?
Serum phosphorus,
PTH, and serum calcium
Vit D levels
Renal ultrasound.?
Actue hyperphosphatemia and normal renal function can be treated with?
Saline and loop diuretics
AKI is treated with phosphate binders in hyperphosphatemia when levels are above? What type of binders?
>6
Depends on calcium levels too
Use calcium based bindings if calcium is low
Use noncalcium if calcium is high - sevelamer, aluminum hydroxide.
CKD patients should above what foods that are high in phosphates?
Dark colas, oysters, cheese, milk, organ meats, ice cream, chocolate, nuts/seeds
Treat hypophosphatemia if 1.0-1.9 with?
Below 1?
Oral phosphate
Iv phosphate. - switch above 1.5
Dipyridmadole can help treat what?
Phosphate wasting in the urine.
