Fluid and Electrolytes 2 Flashcards
What are a major cause of electrolyte abnormalities?
Diuretics
What are two conditions that no abnormality exists so there is no need to treat?
Pseudohyperkalemia from RBC lyses
Hypocalcemia from hypoalbumenia
What is used for K+ replacement?
No bolus of IV doses
Infusion rate should not exceed 10-20 Eq/hr
Usually have limitations on concentration for peripheral infusion (max 60 mEq/L)
When should IV calcium be used?
If cardiac sx exist for hyperkalemia or hypermagnesemia
When do low serum concentrations of K+, Mg2+, and PO4+?
Low serum concentrations can occur with refeeding syndrome, add higher than standard doses to PN and glucose containing IV solution if patient at risk
When do high serum concentrations of K+, Mg2+, and PO4+?
High serum concentrations can occur in renal failure, use reduced doses in PN and IV fluids
What occurs when calcium and phosphorous are mixed PN?
- Increased risk for calcium-phosphorous precipitation if PN mixed with
- Sodium bicarbonate when treating hyperkalemia
- Infusions of calcium or phosphorous when treating deficiencies
What are the laboratory electrolyte tests?
Chem 7
Chem 10
Electrolyte panel
Need to order ionized calcium seperate
What drugs lead to hyperkalemia?
K+ sparing diuretics
ACE-I, NSAIDS
Beta-antagonists
Not drug related but be aware of the possibility of pseudohyperkalemia (lysis of RBC during collection)
What drugs lead to hypokalemia?
Diuretics (except K+ sparing)
Insulin, refeeding syndrome, treatment of DKA
Beta-agonist, glucocorticoids
Amphotericin B, aminoglycosides
What drugs lead to hypermagnesia?
Lithium
What drugs lead to hypomagnesemia?
Diuretics Amphotericin B, aminoglycosides Cyclosporin, alcohol Digoxin Laxative abuse Refeeding syndrome
What drugs lead to hypercalcemia?
Thiazide diuretics (but not loop or K+ sparing) Lithium, Vitamin A and D toxicity, calcium
What drugs lead to hypocalcemia?
Loop diuretics
Oral Phosphorus
Phenytoin, barbituates
Vitamin D deficiency
What drugs lead to hyperphosphatemia?
Phosphate- containing enemas
IV phosphorous to treat hypercalcemia
What drugs lead to hypophosphatemia?
Diuretics
Insulin, dextrose, refeeding syndrome, treatment of DKA
Sucralfate, antacids, calcium salts
What type of symptoms and treatment is associated with electrolyte abnormalities with a slow and chronic onset?
Electrolyte abnormalities with a slow and chronic onset usually have less severe symptoms and can be gradually corrected
What type of symptoms and treatment is associated with electrolyte abnormalities with an acute onset?
Electrolyte abnormalities with an acute onset may have more severe symptoms and should be treated more aggressively
What are the treatment goals of electrolyte abnormalities?
- Treat or prevent severe life-threatening signs and symptoms
- Improve or correct serum electrolyte concentration to within normal values
- Do not overcorrect
- Avoid undesirable effects of treatment
- Correct cause for abnormality
- Factors to consider: Presence and severity of symptoms, Acuteness of onset
What is the most abundant cation in the ICF?
Potassium
Is the serum K+ a good measure of total body potassium?
Intracellular; serum K+ not good measure of total body potassium
Clinical manifestations correlate well with serum potassium
What are the cardiac abnormalities associated with hyperkalemia?
Ventricular fibrillation
Asystole
ECG: peaked T waves
**Life threatening
What are the muscle abnormalities associated with hyperkalemia?
Weakness
Paralysis
What is hyperkalemia defined as?
Defined as serum K+ >5mEq/L