Electrolytes & Shock Flashcards
Hyperthermia, seizures, flushed skin, dilated pupils that react, wide QRS
TCA OD - QRS width = severity –> ventricular arrhythmia –> NaBicarb
Ascities management
Na, H2O restrict, spironolactone, furosemide paracentesis 2-4L
Anion gap
Na - (HCO3- + Cl-)
Methanol, Uremia, DKA, Lactic acidosis, Ethylene glycol, Salicylates
MUDPILES - anion gap acidosis
Inc pH –> inc albumin+Ca –> hypoCa (ionized)
Cramping, weakness, carpopedal spasm,
HypoCa, elevated phosphorous
HypoPT - d/t surgery or auto-immune
HypoCa, fatigue, weakness, depression, normal Mg, 2-HPTH, Low Phos
VitD deficiency, CKD
Hyperreflexia electrolyte abnormality
HypoCa or hypoMag –> low PTH
Grand-mal seizures, prolonged QT electrolyte abnormality
HypoCa
Normal/Low Ca, Low 1,25-OH, High Phos, High PTH
CKD –> secondary HPT
Low Ca, Short stature, 4th & 5th digits, High PTH, Phos
End organ resistance - Gs defect
S/P thyroidectomy, anxiety, fatigue, poor sleep, depression, prolonged QTc
HypoCa
Low Ca, Low PTH, High Phos
Hypoparathyroidism = surgical removal, auto-immune
Weight loss, irritable, palp, proptosis –> HTN mechanism?
Hyperdynamic circulation
Hypothyroidism mechanism of diastolic HTN
Inc systemic vasc resistance
Most common causes of hyperCa
Malignancy, primary HPT (adenoma 90%)
Malignancy vs. PHPT hyperCa
Malignancy >13, low PTH = IL-6
High Ca, high PTH, dec Phos, Sestamibi scan
Hyperparathyroid –> resect but can –> hypoCa
High Ca, High PTH levels
Primary hyperparathyroidism or Familial (low urine), Lithium
High Ca, Low PTH
Malignancy, Vit D, HTCZ, Theophylline, milk alkali
High Ca, Low PTH, High 1,25-OH
Granulomatous - Sarcoid or lymphoma
Mildly high Ca, abnormally high/normal PTH, No sx, urine Ca <0.01
Familial hypocalciuric hyperCa –> Abn Ca-sensing receptors
Tx for hyperCa
Only >14 = IVFs + calcitonin, avoid diuretics in all pts + bisphos LT
Saline non-responsive metabolic alkalosis
Cushing, Primary hyperaldosteronism, hypoK <2
Saline responsive metabolic alkalosis
Urine Cl <20, vomiting, diuretic, laxative, dehydration
Urine Cl >20, high renin, aldo, bicarb, lowK, lowNa
Diuretic abuse
Urine Cl <10
high renin, aldo, bicarb
lowK, lowNa
Vomiting or facitious diarrhea
Urine Cl >40, high renin, aldo, bicarb, lowK, normalNa
Bartter/Gitelman syndrome
Urine Cl >40, high aldo, bicarb, Na,
low renin, lowK
Primary hyperaldosteronism
Urine Cl >40, high renin, aldo, bicarb, Na
LowK
Renin-tumor
U-waves, muscle cramps, weakness electrolyte abnormality, alkalosis
Hypokalemia
Asystole, flaccid paralysis electrolyte abnormality, acidosis
HyperK
Tx of Sx acute hyperK
Calcium gluconate or insulin w/ glucose
Succ use is CI w/ what electrolyte abn?
HyperK – it leads to inc K release, no crush, burns, GB or tumor-lysis
Refractory hyperK
HypoMag
HypoK management
10mEq/h
Causes of hyperK
RF, crush injury, acidosis
HyperK management
50% dextrose + insulin, IV calcium –> hemodialysis
Hypovolemic hypoNa causes
Volume depletion, adrenal insufficiency, D/V, Diuretics/renal
Euvolemic HypoNa causes
SIADH, psychogenic polydipsia, sec adrenal insufficiency, hypothyroid
Hypervolemic hypoNa causes
CHF, cirrhosis, CKD
Serum Osm >290
Hyperglycemia, advanced renal failure
Serum Osm <100
Primary polydipsia, malnutrition (beer binge)
Serum Osm 100, Urine Na <25
Volume depletion, CHF, cirrhosis
Serum Osm 100, Urine Na >25
SIADH, adrenal insufficiency, hypothyroidism
Tx SIADH
Dec fluids, Na tablets, Loops –> hypERtonic saline until serum Na >120
Hypovolemic NyperNa management
IV 0.9% Saline –> 0.45 when vol replaced = no more than 1mEq/L/h dec
MILD Hypovolemic NyperNa management
IV 0.45 Saline + 5% Dextrose
Euvolemic or hypervolemic hyperNa management
D5W
HypoNa from SIADH tx
Water restriction
HypoNa, rapid developing, CNS sx, water intoxication tx
3% NS
Hypovolemic hypoNa Tx
NS or LR
Dec vol, dec pressure, inc HR, acidosis, inc osmolarity type of shock
Hypovolemic shock - diarrhea, heat, DKA
Ulcers, colon Ca, uterus, leukemia, red O2 shock type
Hemorrhagic shock
Dec SV, CO shock
Cardiogenic shock
Blood vessels dilate, blood pooling, dec VR shock
Neurogenic shock
Bronchial spasm, blood vessels dilate, histamine –> hives, V/D shock
Anaphylactic shock
Profound anion gap acidosis, very low bicarb, disc hyperemia
Methanol or ethylene glycol (kidney damage)
Dec preload (RA, PCWP), dec CI, O2 sat, INC AFTERLOAD type of shock
Hypovolemic shock
Inc preload (RA, PCWP), afterload, DEC CI, O2sat type of shock
Cardiogenic shock
Dec preload (RA, PCWP), afterload, SVR, INC CI, O2 sat
Septic shock
Dec CO, PCWP, BP, Inc SVR, HR shock
Hypovolemic shock
Flat neck veins, dec H&H, tachycardia type of shock
Hemorrhagic shock
JVD + resp distress, absent lung sounds, tracheal deviation
Tension pneumothorax
JVD + breathing ok, normal CXR, hypotension
Pericardial tamponade
Pink & warm extremities, low CVP type of shock
Vasomotor – sepsis, anaphylaxis, spinal trauma, anesthetics
Drugs and mech of hyperK
- BBs
- ACE/ARBs
- K+ sparing (amiloride)
- Digoxin
- NSAIDs
- Inhibit B2 K uptake into cells
- Inhibit AG-II/AT1 –> dec aldosterone
- Block ENaC or aldo receptor
- Inhibit Na/K pump
- Impairs local PGs –> dec renin and aldo
Imaging for free air/perforation
Upright CXR
Best initial imaging for osteomyelitis
XR
When to get head CT WITH contrast?
Cancer or infection
When to get abdominal CT scan?
Pancreas
Appendicitis
Most accurate for diverticulitis, Kidney stone (w/o contrast)
When to get chest CT?
Hilar nodes/sarcoidosis
Mass lesions
PE
Cavities
When to get endoscopic ultrasound?
Pancreatic head lesions
Gastrinoma
When to use gallium or indium scan?
Fever of unknown origin - follows iron metabolism transported on ferritin
Indium better for abdomen - tags WBCs
