Exam 1 Treatment Options Flashcards
therapy for asymptomatic hypokalemia
oral potassium supplements (potassium chloride) such as Micro-K, Klor-Con, etc
general rules for hypokalemia therapy (how to replace deficit)
give total deficit in divided doses over several days: replace 50-75% of total body deficit within 24 hours. aim to replace 25% of total body deficit within first 6 hours
therapy for severe hypokalemia cases (K<2.5, EKG changes, muscle spasms, or cannot tolerate oral therapy)
IV potassium replacement: 10-20 mEq MUST be diluted in 100 mL NSS for administration over 1 hour (NEVER IV PUSH POTASSIUM IT WILL KILL)
how to calculate potassium deficit
(4-current potassium level) x 100
what dose of IV potassium requires EKG monitoring
> 10 mEq/hr
how to infuse a larger dose of IV potassium
40-60 mEq diluted in 1L 0.45% NaCl and infused at 40 mEq/hr via central line with EKG monitoring
alternative therapies for hypokalemia
K sparing diuretics: spironolactone, amiloride, triamterene
what do you give for hyperkalemia to antagonist adverse cardiac effects and stabilize cardiac membrane
calcium gluconate 10% 1 gm or calcium chloride 1 gm
what do you give for hyperkalemia to reverse symptoms/ decrease extracellular potassium by shifting it into the cell
regular insulin 10 units with dextrose 50% in water, or albuterol 10-20 puffs, or sodium bicarbonate 50-100 mg IV over 2-5 minutes (best if acidosis)
what do you give for hyperkalemia to return serum and total body stores to normal/remove potassium from the body
either diuretics (loop: furosemide 20-40 mg IV) or potassium binders (if non acute setting)
treatment options for chronic hyperkalemia
furosemide 20-40 mg po, potassium binders like patiromer, fludrocortisone 0.1 mg po qd
how to treat asymptomatic hypomagnesemia
oral supplementation (best response from magnesium chloride bc oxide causes the most diarrhea)
how to treat severe hypomagnesemia (Mg <1 or symptoms)
IV magnesium sulfate 2-4 mg over 2-4 hours (bolus would cause flushing, sweating)
dilute to 20% before injection to avoid venous sclerosis and pain. decrease dose by 50% in renal insufficiency
how to treat hypermagnesemia
cardiac symptoms: calcium gluconate 10% 1 gm, calcium chloride 1 gm. forced diuresis: saline with furosemide IV
treatment for hypovolemic hyponatremia
normal 0.9% saline
treatment for symptomatic isovolemic hyponatremia
3% saline, conivaptan or tolvaptan
treatment for asymptomatic isovolemic hyponatremia
water restriction 1000-1200 mL per day, demeclocycline
treatment for symptomatic hypervolemic hyponatremia
3% saline and diuretic
treatment for asymptomatic hypervolemic hyponatremia
water restriction and increased Na intake
2 causes of isovolemic hypernatremia
central diabetes insipidus, nephrogenic diabetes insipidus
treatment options for central diabetes insipidus
DDVAP 10 mcg intranasal, chlorpropamide, carbamazepine, clofibrate
treatment options for nephrogenic diabetes insipidus
sodium restriction 2 g per day, thiazide diuretics, amiloride, NSAIDs (indomethacin, tolmetin)
treatment for hypervolemic hypernatremia
D5W first line, furosemide to get rid of sodium and water
treatment for hypovolemic hypernatremia
normal 0.9% saline
treatment of hypercalcemia to increase renal excretion
0.9% saline, furosemide
treatment of hypercalcemia to decrease bone resorption
bisphosphonates (pamidronate, etidronate, zolendronate), calcitonin, plicamycin, gallium nitrate
hypocalcemia treatment acute
IV calcium gluconate/chloride 1 gm
hypocalcemia treatment chronic
oral calcium preparations, vitamin D preparations
treatment of acute hyperphosphatemia
IV calcium administration; hypocalcemia is more critical
treatment of chronic hyperphosphatemia
dietary phosphate restriction, phosphate binding agents: calcium containing, selevamer, iron based (ferric citrate, sucroferric oxyhydroxide), lanthanum carbonate. WITH MEALS
treatment of symptomatic hypophosphatemia
IV phos replacement (Na phosphate or K phosphate) 15-30 mmol Phos over 1-3 hours
treatment of asymptomatic hypophosphatemia
oral phosphate preparations such as neutra-phos, k-phos, etc
