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GI Exam 1 > Fluid and Electrolytes K and Mg > Flashcards

Fluid and Electrolytes K and Mg Flashcards

1
Q

Normal Potassium

A

3.5-5 mEq/L

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2
Q

Hypokalemia Sytpoms

A

Cardiac arrhythmias
Muscular myalgia/weakness
Constipation

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3
Q

Action Potential Explained

A

0: sodium rushes in
1: Cl rushes in
2: Slow Ca channels open
3: K leaves cell
4: Plateau

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4
Q

AV Node is predominately

A

Ca

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5
Q

P wave =

A

Depolarization of atrium

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6
Q

PR interval =

A

Evaluates the AV node

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7
Q

QRS Interval =

A

Depolarization of ventricle

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8
Q

T wave =

A

Repolarization

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9
Q

In potassium changes we should look at?

A

T wave

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10
Q

Low K + T wave =

A

Flattened

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11
Q

High K + T wave =

A

Spikes

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12
Q

Urine potassium readings

A

Less than 20 extrarenal losses like vomiting/laxative/diarrhea
Greater than 20 = renal losses due to drugs or acidosis

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13
Q

Most common causes of hypokalemia are:

A

Drugs
Diarrhea
Vomiting

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14
Q

Intracellular shift of K causes

A

Albuterol & other B2 agonists
Bicarbonate
Insuline

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15
Q

Enhanced renal excretion of K causes

A

Diuretics
High dose pencillin
AG and Amp B

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16
Q

***Enhanced fecal elimination of K causes

A

Sodium polystyrene sulfonate

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17
Q

1 mEq/L drop i K =

A

200 mEq depleted

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18
Q

Dietary content treatments for hypoK

A

Dried figs, molasses, dried fruits, avovados, nuts

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19
Q

Oral supplements for hypoK

A

KCl (best in treating diuretic or diarrhea induced)
KPO4 (good in ↓ PO4)
K acetate (good in acidosis pts)

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20
Q

IV Treatment of HypoK

A

Symptomatic ONLY or unable to tolerate oral

Mix with NaCl instead of dextrose

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21
Q

Peripheral vein infusion:

A

No more than 40 mEq/L

22
Q

Central vein infusion:

A

No more than 100 mEq/L

23
Q

Infusion rate

A

EKG: 20-40 mEq/hr
No EKG: 10 mEq/hr

EKG = telemetry

24
Q

****If K doesn’t correct in 48-72 hours, then

A

consider Mg deficiency

- Reabsorption of K needs Mg in the kidney so if you have a Mg deficiency your kidneys will drop all the K

25
Q

Hyperkalemia Symptoms

A

Muscles Weakness

EKG changes

26
Q

Sever hyperkalemia =

A

Very symptomatic
EKG Changes (peak t waves)
>6.5 mEq/L

27
Q

Causes of Hyperkalemia

A 
Pseudohyperkalemia due to hemolysis, leukocytosis, or thrombocytosis
Drugs
Renal failure (most common)
28
Q

Drugs that can cause hyperkalemia

A 
ACEi
ARBS
Trimethoprim
Spironolactone
Heparin
29
Q

1) Membrane Stabilization for HyperK

A

Infusion of IV calcium bc it antagonizes the effects of hyperK
Typically calcium gluconate
Bolus over 2-3 minutes and effects for 30-60 minutes

30
Q

2) Shifting K from extracellular to intracellular via

A

Insulin
Nebulized B2 agonists
Sodium bicarbonate

31
Q

Insulin Treatment of HyperK

A

10 units with 50 mL of dextrose (only in euglycemic)
Onset 10-20 minutes
***Decrease K by 0.6-1 mEq/L

32
Q

Nebulized B2 agonists Treatment of HyperK

A

Stimulate glucose
Works immediately and last 1-2 hrs
**Decrease K by 0.5-1 mEq/L

33
Q

Sodium bicarbonate

A

Increases blood pH

Not effective

34
Q

3) K Removal from Body

A

Ion exchange resins or Dialysis

35
Q

Ion exchange resins

A

Sodium Polysterene
Exchanges K for Na in the gut
Given with sorbitol to facilitate removal and prevent constipation
**Decreases K by 1 mEq/L every 24 hours

36
Q

Treatment of Severe Hyperkalemia Flow Chart

A

See notes
Abnormal EKG –> Adminster calcium gluconate if yes and if not keep monitoring
Hyperglycemia –> give insulin and follow sugar if yes and administer insulin and glucose if no
Now consider albuterol then consider bicarbonate (if acidotic) then give exchange resin or consider dialysis
*****FOLLOW K LEVELS EVERY 2 HOURS UNTIL LESS THAN 5.5

37
Q

Normal Mg

A

1.4-1.75

Primarily intracellular and eliminated by kidneys

38
Q

Normal daily requirement is

A

15-30 mEq/day

39
Q

GI causes of hypoMg

A

Malnutrition
Increased requirements
Bowel resection
Severe diarrhea

40
Q

Renal cause of hypoMg

A

Mg wasting

Drugs (cisplatin, Ag, cyclosproine, LOOP AND THIAZIDE DIURETICS, ALCOHOL)

41
Q

Endocrine causes of hypoMg

A

SIADH
Hyperthyroidism
Hyperaldosteronism
Post-parathyroidectomy

42
Q

Symptoms of HypoMg

A

Increased muscle spasiticity (tremors, seizures, tetany)
Weakness N/V
EKG (torsades de pointes)

43
Q

Asymptomatic with mild hypoMg treatment:

A

Oral 40 mEq/day with sustained-release prep

- Comes with lots of diarrhea

44
Q

Symptomatic HypoMg treatment

A

1-2 mEq/kg def: give 2-4 mEq/kg bc 1/2 is eliminated

Rate: 1 mEq/kg/24 hrs, .5 mEq/kg/2nd 24, continue for up to 4 days

45
Q

Life-threatening Hypo Mg treatment

A

16-32 mEq of Mg Sulfate as a short IV infusion over 2-4 minutes

46
Q

HyperMg Causes

A

Typically: renal insufficiency given Mg contain med (antacids/laxatives)

47
Q

Symptoms of HyperMg

A

Respiratory paralysis
HypOTN
Difficulty talking/swallowing
Widening QRS and abnormal P waves

48
Q

Mild HyperMg Treatment

A

Withhold all Mg

49
Q

Severe HyperMg Treatment

A

IV calcium and repeat
Normal renal function: IV furosemid + 1/2 NS
Hemodialysis if renal impaired

50
Q

SERUM LEVELS OF MAGNESIUM,

A

DO NOT REFLECT TOTAL BODY STORES

51
Q

Mg summary

A

Not commonly checked but should be in alcoholic or if volume depleted

GI Exam 1 (8 decks)

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