Fluid and electrolyte imbalance

Question 1

what is the electrolyte range for calcium?

Answer 1

2.2-2.6mmol/L

Question 2

what is the electrolyte range for magnesium?

Answer 2

0.6-1mmol/L

Question 3

what is the electrolyte range for phosphate?

Answer 3

0.87-1.45mmol/L

Question 4

what is the electrolyte range for sodium?

Answer 4

133-146mmol/L

Question 5

what is the normal range for potassium?

Answer 5

potassium 3.5-5.3mmol/L

Question 6

what side effects can occur from hypokalaemia?

Answer 6

muscle cramps, rhabdomyolysis, fatigue, palpitations, arrhythmias

Question 7

what side effects can occur from hyperkalaemia?

Answer 7

fatigue, numbness, nausea, SOB , chest pain, palpitations

Question 8

what side effects can occur from hyponatraemia?

Answer 8

nausea, headaches, confusion, fatigue, irritability , seizures

Question 9

what side effects can occur from hypernatraemia?

Answer 9

thirst, fatigue, confusion

Question 10

what side effects can occur from hypocalcaemia?

Answer 10

muscle cramp, confusion, depressed, forgetful

Question 11

what side effects can occur from hypercalcaemia?

Answer 11

nausea, lethargy, muscle cramp, confusion and arrhythmias

Question 12

what drugs can cause hypokalaemia?

Answer 12

ABCDE I
-aminophylline/ theophylline
-beta agonists
-corticosteroid’s
-diuretics (loop/thiazides)
-Erythromycin/ clarithromycin
Insulin

Question 13

what drugs cause hyperkalaemia?

Answer 13

THANKS, B
-Trimethoprim
-Heparins
-ACEi/ARBs
-NSAIDS
-K-sparing diuretics
-Beta blockers

Question 14

imbalances with potassium can lead to what occurring?

Answer 14

cardiac side effects such as arrhythmias

Question 15

what drug toxicity can hypokalaemia predispose a patient to?

Answer 15

digoxin and lithium toxicity

Question 16

what is the treatment from mild to moderate hypokalaemia?

Answer 16

oral replacements therapy (sando-K tablets)

Question 17

what is the treatment for severe hypokalaemia?

Answer 17

IV KCL in Nacl

Question 18

in what type of patients do you have to replace potassium cautiously with?

Answer 18

renal impaired patients
risk of hyperkalaemia secondary to impaired potassium excretion

Question 19

what is the treatment for acute severe hyperkalaemia? plasma conc >6.5mmol/L

Answer 19

-urgent treatment
-IV calcium chloride 10%/ calcium gluconate 10%
-IV soluble insulin (5-10 units) with glucose 50/5 given over 5-15mins
-salbutamol (nebulisation or slow IV injection
-drugs exacerbating hyperkalaemia should be reviewed and stopped

Question 20

what is the treatment for mild-moderate hyperkalaemia?

Answer 20

-ion-exchange resins may be used to remove excess potassium (calcium resonium)

Question 21

what drugs cause hyponatraemia?

Answer 21

Certain Drugs Ditch Salt
-carbamazepine
-diuretics
-desmopressins/vasopressin
-SSRIs

Question 22

what drug drugs cause hypernatraemia?

Answer 22

-sodium bicarbonate/ chloride
-corticosteriods
-effectvescent formulations
-oestrogens/ androgens

Question 23

what is the treatment for hyponatraemia mild?

Answer 23

oral supplements : sodium chloride ir sodium bicarbinate

Question 24

what is the treatment for severe hyponatareamia?

Answer 24

IV NaCl

Question 25

what is the recommendation of calcium for those with osteoporosis?

Answer 25

double recommend amount reduces rate of bone loss

Question 26

what other medication is given with calcium?

Answer 26

vitamin D

Question 27

what should be done in cases of severe acute hypocalcaemia?

Answer 27

-IV calcium gluconate 10% slowly. with plasma-calcium and ECG monitoring too fast can cause arrythmias
-repeat if needed or follow with continuous infusion to prevent recurrence

Question 28

what should be done to treat severe hypercalcaemia?

Answer 28

-correct dehydration
-discontinue drugs , restrict dietary calcium
-bisphophonates and pamidronate disodium used
-corticodsteriods used if hypercalaemia is due to sarcoidosis or via d toxicity
-calcitonin used n hypercalaemia with maligancy

Question 29

what is the treatment for hypercalcuria?

Answer 29

-increase fluid intake and give bendroflumethaizide
-reduce dietary calcium

Question 30

what is hyperparathyroidism?

Answer 30

excess parathyroid hormone which can lead to hypercalcaemia, hypophosphataemia and hypercalciuria

Question 31

what can hyperpararthyroidism cause?

Answer 31

-thirst, polyuria, constipation, fatigue, memory impairment, CVD, kidney stones and osteoporosis
and affects women more than men most common in 50-6 years olde

Question 32

what is treatment for hyperparathyroidism?

Answer 32

parathyroidecomy surgery
then assess CVD risk and fracture risk

drug therapy
-cinacalcet if surgery has been unsuccessful/declined
-secondary care measure vit D levels and supplement if needed
give bisphosphonate to reduce fracture risk

Question 33

what is magnesium used for?

Answer 33

essenial in enzyme systems, energy generation- stored in skeleton

Question 34

how is magnesium excreted?

Answer 34

kidneys therefore retained in renal failure leading to hypermagnesaemia

Question 35

what can cause hypermagnesaemia? and treatment

Answer 35

-can cause muscle weakness and arrhymias
-calcium glutinate injection is used for management of magnesium toxicity

Question 36

what is the treatment of hypomagnesaemia?

Answer 36

symptomatic: IV/IM magnesium sulfate
mild: oral magnesium

Question 37

What patients get hypophsphataemia?

Answer 37

alcohol dependance or severe DKA

Question 38

What is the treatment for hypophosphateaemia?

Answer 38

phosphate supplements

Question 39

what is the treatment for hyperphosphateamia?

Answer 39

-phosphate binding agents (calcium-based or non-calcium based preps)

Question 40

patients with stage 4/5/ CKD what should be recommended to them with hyperphosphataemia?

Answer 40

manage diet + dialysis before starting agent

Question 41

what is 1st, 2nd, 3rd line for hyperphostpahtaemia?

Answer 41

1st- calcium acetate
2nd- sevelamer
3rd- CaCO3 calcium-based or sucroferric oxygdroxide (non-calcium based