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Renal > Fluid and Electrolyte Disorders (Part 2) > Flashcards

Fluid and Electrolyte Disorders (Part 2) Flashcards

1
Q

Which electrolytes are highly regulated by kidneys, need prominent renal reabsorption, and are large intracellular concentrations?

A

K+ and Mg 2+

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2
Q

Which electrolytes have large bony deposits and are regulated by vitamin D and the parathyroid hormone (PTH)?

A

Ca 2+ and Phosphate

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3
Q

Normal serum K+ levels

A

3.5 - 5 mEq/L

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4
Q

Define hypokalemia

A

< 3.5 mEq/L

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5
Q

What are the main causes of hypokalemia?

A
  • Intracellular shifting
  • Total body deficit
  • Hypomagnesemia
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6
Q

In hypokalemia patients, why does intracellular shifting happen?

A
  • Metabolic alkalosis

- Drugs: albuterol, insulin, theophylline

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7
Q

In hypokalemia patients, why does total body deficit happen?

A
  • Poor intake of dietary potassium

- Excessive loss due to renal (diuretics, amphotericin B) or extra-renal (vomiting, diarrhea)

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8
Q

(T/F) - The clinical presentation of hypokalemia can be variable and independent on the degree of hypokalemia

A

FALSE - it’s variable and DEPENDENT on the degree of hypokalemia

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9
Q

What are some symptoms from hypokalemia?

A
  • Muscle cramping/impaired muscle contractions
  • Severe EKG changes: ST segment depression or flattening
  • Cardiac arrhythmias (heart block, ventricular fibrillation)
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10
Q

If patient has hypokalemia, what is the first treatment option?

A

Treat underlying cause

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11
Q

If the patient has mild (3.0 - 3.5 mEq/L) hypokalemia, what is the best treatment?

A

Oral K+ supplements

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12
Q

What is a main adverse effect from oral K+ supplements?

A

GI upset (to reduce, give patient < 20 mEq of K+)

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13
Q

Once hypomagnesemia has been treated in hypokalemia patients and they’re asymptomatic, what should be given for treatment?

A

Oral K+ supplements

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14
Q

Once hypomagnesemia has been treated in hypokalemia patients and they’re symptomatic, what should be given for treatment?

A

IV K+ replacements

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15
Q

What are the types of IV K+ replacements given to hypokalemic patients?

A

Peripheral line

Central line

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16
Q

The maximum dose for a central line K+ replacement in hypokalemic patients is…

A

20 mEq/hr

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17
Q

The maximum dose for a peripheral line K+ replacement in hypokalemic patients is…

A

10 mEq/hr

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18
Q

(T/F) For every 10 mEq given to a patient raises their serum K+ levels ~0.1 mEq/L

A

TRUE

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19
Q

Define hyperkalemia

A

> 5.0 mEq/L

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20
Q

What are the main causes of hyperkalemia?

A
  • Extracellular shifting
  • Increased intake
  • Decreased output
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21
Q

In hyperkalemia patients, why does extracellular shifting happen?

A

Metabolic acidosis

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22
Q

In hyperkalemia patients, why does increased intake happen?

A
  • Exogenous [K+ supplement; salt substitutes (DASH)]

- Endogenous [hemolysis, burns, muscle crush injuries]

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23
Q

In hyperkalemia patients, why does decreased output happen?

A
  • Renal failure (acute or chronic)

- Drugs: TMP/SMX, ACEi/ARBs, NSAIDs, K+ sparring diuretics

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24
Q

(T/F) - Hyperkalemic patients are typically symptomatic

A

False - typically asymptomatic

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25
Q

What are some symptoms from hyperkalemia?

A
  • Palpitations
  • Skipped heart beats
  • Weakness
  • Bradycardia
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26
Q

Do life-threatening arrhythmias occur in hyperkalemia? If so, at what serum K+ level?

A

Yes, > 6.0 mEq/L

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27
Q

Before starting pharmacological treatments for hyperkalemic patients, what should be done?

A

Treat underlying disease

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28
Q

If the patient has mild (5.5 - 6.0 mEq/L) hyperkalemia, what pharmacological treatment can be given?

A
  • Sodium polystyrene sulfonate

- Furosemide IV

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29
Q

(T/F) - Sodium polystyrene can be given to patients who have constipation

A

FALSE - contraindicated in constipated patients

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30
Q

If the patient has moderate/severe (> 6.0 mEq/L) hyperkalemia who is symptomatic, what pharmacological treatment should be given first?

A

Patient experiencing severe cardiac arrhythmias - administer calcium gluconate IV

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31
Q

After symptoms have been controlled from moderate/severe hyperkalemia, what other pharmacologic treatment can be given?

A
  • Insulin

- Albuterol

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32
Q

What are the normal serum Mg 2+ levels?

A

1.5 - 2.2 mEq/L

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33
Q

Define hypomagnesemia

A

< 1.5 mEq/L

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34
Q

What are the causes of hypomagnesemia?

A
  • Diet
  • GI sources
  • Renal sources
  • Hypoparathyroidism
  • Hyperaldosteronism
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35
Q

How does diet affect hypomagnesemia?

A

Poor nutrition

36
Q

How does GI sources affect hypomagnesemia?

A

Vomiting, diarrhea, and malabsorption

37
Q

How does renal sources affect hypomagnesemia?

A

Loop diuretics, amphotericin, aminoglycosides, ATN

38
Q

(T/F) - Hypomagnesemia is typically asymptomatic

A

TRUE

39
Q

What are some symptoms from hypomagnesemia?

A
  • Twitching
  • Tetany
  • Generalized convulsions
  • Heart palpitations
40
Q

What are some signs from hypomagnesemia?

A
  • Tremors
  • Cardiac arrhythmias
  • EKG changes (widened QRS interval with peaked T waves; PR interval prolonged)
41
Q

How is mild (1.0 - 1.4 mEq/L), asymptomatic hypomagnesemia treated (give class of drug)?

A

Oral magnesium supplementation

42
Q

What is the drug name that is under the class of oral magnesium supplementation?

A

Magnesium oxide 400 mg PO

43
Q

(T/F) - Diarrhea is a common adverse effect from magnesium oxide 400 mg

A

TRUE

44
Q

On day 1, how is moderate/severe (< 1.0 mEq/L) symptomatic hypomagnesemia treated?

A

1st: Magnesium sulfate 2 g IV bolus once
2nd: Magnesium sulfate 6 g IV in 24 hrs

45
Q

On day 2, how is moderate/severe (< 1.0 mEq/L) symptomatic hypomagnesemia treated?

A
  • Magnesium sulfate 4 g IV in 24 hrs
46
Q

How long can it take for moderate/severe hypomagnesemia to return to normal levels?

A

3 - 5 days

47
Q

If a patient has a disorder of K+ and Mg 2+ levels, what would be treated first?

A

Abnormal magnesium levels

48
Q

Define hypermagnesemia

A

> 2.2 mEq/L

49
Q

What are the causes of hypermagnesemia?

A
  • Excess intake
  • Renal sources
  • Hypothyroidism
  • Lithium
  • Addison’s disease
50
Q

When does hypermagnesemia become symptomatic?

A

> 4.0 mEq/L

51
Q

What are the symptoms of hypermagnesemia?

A
  • Cardiac abnormalities (heart block, QRS prolongation, QT prolongation)
  • Somnolence
  • Coma
  • Respiratory depression
  • Hyporeflexia
52
Q

(T/F) - Before treating hypermagnesemia with pharmacological treatment, underlying disease needs to be treated first

A

TRUE

53
Q

If hypermagnesemia is moderate/severe, how is it treated? (pharmacological treatment)

A

1st: Calcium gluconate IV
2nd: Loop diuretics
3rd: Fluids

54
Q

Would hemodialysis be given to patients who have severe and poor kidney function in patients with hypermagnesemia?

A

YES

55
Q

What are the normal serum calcium levels?

A

8.5 - 10.8 mg/dL

56
Q

What are the normal serum phosphorus levels?

A

2.6 - 4.5 mg/dL

57
Q

Define hypocalcemia

A

< 8.5 mg/dL

58
Q

Define hyperphosphatemia

A

> 4.5 mg/dL

59
Q

What are some causes in hyperphosphatemia?

A
  • CKD (secondary - hyperparathyroidism)

- Rhabdomyolysis

60
Q

What are some causes in hypocalcemia?

A
  • CKD (reduced calcium absorption due to decreased active vitamin D production by kidneys)
  • Surgically induced hypoparathyroidism
  • Malnutrition
61
Q

What are signs/symptoms of hyperphosphatemia?

A
  • Deposits of calcium-phosphorus crystals in joints, eyes, skin and vasculature
62
Q

What are signs/symptoms of hypocalcemia?

A
  • Tetany
  • Paresthesia
  • Confusion
  • Hypotension
  • Bradycardia
  • QT prolongation
  • Osteoporosis (long-term)
63
Q

(T/F) - Calcium is insignificantly protein bound

A

FALSE - calcium is SIGNIFICANTLY protein bound

64
Q

(T/F) - Corrected calcium should only be done when patients have hypocalcemia (low in calcium)?

A

TRUE

65
Q

Equation of corrected calcium

A

[(4 - albumin) x 0.8] + Ca2+ serum level

66
Q

If the patient is asymptomatic, how would hypocalcemia be treated in a patient?

A

With oral calcium (calcium carbonate)

67
Q

If the patient has CKD, how would hypocalcemia be treated in a patient?

A

Ergocalciferol (D2) PO

68
Q

If the patient is symptomatic, how would hypocalcemia be treated in a patient?

A

1st: Calcium gluconate IV bolus
2nd: Calcium gluconate IV continuous

69
Q

(T/F) - For every 1 gram of calcium gluconate, 90 mg of elemental calcium is given

A

TRUE

70
Q

If the patient has normal renal function, how would hyperphosphatemia be treated?

A
  • IV fluids
  • Furosemide
  • promotes excretion of phosphorus*
71
Q

If the patient has renal failure, how would hyperphosphatemia be treated first?

A

1st: Restrict on dietary phosphorus

72
Q

Continuation: If the patient has renal failure and a calcium-phosphorus produce < 55, how would hyperphosphatemia be treated next?

A
  • Calcium salts
  • Renagel
  • Fosrenol
73
Q

Continuation: If the patient has renal failure and a calcium-phosphorus product > 55, how would hyperphosphatemia be treated next?

A
  • Sevelamar

- Lanthanum

74
Q

Continuation: If the patient has renal failure and are undergoing dialysis, what is the best medication to give for hyperphosphatemia?

A

Velphoro

75
Q

Define hypercalcemia

A

> 10.8 mg/dL

76
Q

Define hypophosphatemia

A

< 2.6 mg/dL

77
Q

What are some causes of hypercalcemia?

A
  • Malignancy (lung, bone, breast)
  • Hyperparathyroidism
  • Excess intake
  • Drugs: calcium supplements, lithium, thiazides, tamoxifen
78
Q

What are some causes of hypophosphatemia?

A
  • Refeeding syndrome
  • Phosphate binders
  • Alcoholism
79
Q

What are the symptoms related to malignancy in hypercalcemia?

A
  • N/V
  • polyuria
  • polydipsia
  • Ca2+ > 15 = acute renal failure
  • Ventricular arrhythmias
80
Q

What are the symptoms related to hyperparathyroidism in hypercalcemia?

A
  • Calcification of organs/skin
  • Shortening of QT interval
  • Chronic renal failure
81
Q

If the patient has functioning kidneys, what treatment can be given in patients?

A
  • Zoledronic acid (IV 4 mg over 15 mins)
  • Normal saline
  • Furosemide
  • Ibandronate
  • Pamidronate
  • Prednisone (chronic treatment)
82
Q

If the patient has non-functioning kidneys, what treatment can be given in patients?

A
  • Hemodialysis (immediately)
  • Calcitonin
  • Prednisone (chronic treatment)
83
Q

What are the symptoms related to CNS in hypophosphatemia?

A
  • Weakness
  • Tingling
  • Confusion
  • Numbness
84
Q

What are chronic symptoms in hypophosphatemia?

A
  • Osteomalacia

- Osteopenia can lead to osteoporosis

85
Q

If the patient is asymptomatic and phosphate > 1 mg/dL, how would you treat hypophosphatemia?

A

Neutra-phos 250 mg

86
Q

If the patient is symptomatic and phosphate < 1 mg/dL, how would you treat hypophosphatemia?

A

IV phosphate salts

87
Q

Do you want to correct other electrolyte disorders when a patient has hypophosphatemia?

A

Yes, to prevent redistribution

Renal (4 decks)

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