Exam 1 Treatment Options

Question 1

therapy for asymptomatic hypokalemia

Answer 1

oral potassium supplements (potassium chloride) such as Micro-K, Klor-Con, etc

Question 2

general rules for hypokalemia therapy (how to replace deficit)

Answer 2

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

Question 3

therapy for severe hypokalemia cases (K<2.5, EKG changes, muscle spasms, or cannot tolerate oral therapy)

Answer 3

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)

Question 4

how to calculate potassium deficit

Answer 4

(4-current potassium level) x 100

Question 5

what dose of IV potassium requires EKG monitoring

Answer 5

> 10 mEq/hr

Question 6

how to infuse a larger dose of IV potassium

Answer 6

40-60 mEq diluted in 1L 0.45% NaCl and infused at 40 mEq/hr via central line with EKG monitoring

Question 7

alternative therapies for hypokalemia

Answer 7

K sparing diuretics: spironolactone, amiloride, triamterene

Question 8

what do you give for hyperkalemia to antagonist adverse cardiac effects and stabilize cardiac membrane

Answer 8

calcium gluconate 10% 1 gm or calcium chloride 1 gm

Question 9

what do you give for hyperkalemia to reverse symptoms/ decrease extracellular potassium by shifting it into the cell

Answer 9

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)

Question 10

what do you give for hyperkalemia to return serum and total body stores to normal/remove potassium from the body

Answer 10

either diuretics (loop: furosemide 20-40 mg IV) or potassium binders (if non acute setting)

Question 11

treatment options for chronic hyperkalemia

Answer 11

furosemide 20-40 mg po, potassium binders like patiromer, fludrocortisone 0.1 mg po qd

Question 12

how to treat asymptomatic hypomagnesemia

Answer 12

oral supplementation (best response from magnesium chloride bc oxide causes the most diarrhea)

Question 13

how to treat severe hypomagnesemia (Mg <1 or symptoms)

Answer 13

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

Question 14

how to treat hypermagnesemia

Answer 14

cardiac symptoms: calcium gluconate 10% 1 gm, calcium chloride 1 gm. forced diuresis: saline with furosemide IV

Question 15

treatment for hypovolemic hyponatremia

Answer 15

normal 0.9% saline

Question 16

treatment for symptomatic isovolemic hyponatremia

Answer 16

3% saline, conivaptan or tolvaptan

Question 17

treatment for asymptomatic isovolemic hyponatremia

Answer 17

water restriction 1000-1200 mL per day, demeclocycline

Question 18

treatment for symptomatic hypervolemic hyponatremia

Answer 18

3% saline and diuretic

Question 19

treatment for asymptomatic hypervolemic hyponatremia

Answer 19

water restriction and increased Na intake

Question 20

2 causes of isovolemic hypernatremia

Answer 20

central diabetes insipidus, nephrogenic diabetes insipidus

Question 21

treatment options for central diabetes insipidus

Answer 21

DDVAP 10 mcg intranasal, chlorpropamide, carbamazepine, clofibrate

Question 22

treatment options for nephrogenic diabetes insipidus

Answer 22

sodium restriction 2 g per day, thiazide diuretics, amiloride, NSAIDs (indomethacin, tolmetin)

Question 23

treatment for hypervolemic hypernatremia

Answer 23

D5W first line, furosemide to get rid of sodium and water

Question 24

treatment for hypovolemic hypernatremia

Answer 24

normal 0.9% saline

Question 25

treatment of hypercalcemia to increase renal excretion

Answer 25

0.9% saline, furosemide

Question 26

treatment of hypercalcemia to decrease bone resorption

Answer 26

bisphosphonates (pamidronate, etidronate, zolendronate), calcitonin, plicamycin, gallium nitrate

Question 27

hypocalcemia treatment acute

Answer 27

IV calcium gluconate/chloride 1 gm

Question 28

hypocalcemia treatment chronic

Answer 28

oral calcium preparations, vitamin D preparations

Question 29

treatment of acute hyperphosphatemia

Answer 29

IV calcium administration; hypocalcemia is more critical

Question 30

treatment of chronic hyperphosphatemia

Answer 30

dietary phosphate restriction, phosphate binding agents: calcium containing, selevamer, iron based (ferric citrate, sucroferric oxyhydroxide), lanthanum carbonate. WITH MEALS

Question 31

treatment of symptomatic hypophosphatemia

Answer 31

IV phos replacement (Na phosphate or K phosphate) 15-30 mmol Phos over 1-3 hours

Question 32

treatment of asymptomatic hypophosphatemia

Answer 32

oral phosphate preparations such as neutra-phos, k-phos, etc