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*OldPharm > Fluid and Electrolytes Part 2 > Flashcards

Fluid and Electrolytes Part 2 Flashcards

1
Q

what is one of the biggest causes of electrolyte abnormalities?

A

diuretics

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2
Q

what abnormality can occur from RBC lyses

A

pseudohyperkalemia

no need to treat

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3
Q

If you have hypoalbuminemia, what else will it look like?

A

hypocalcemia

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4
Q

How should you not administer K+?

A

No bolus of IV doses
infusion rate to not exceed 10-20 mEq/hr
limitations on concentrations for peripheral infusion

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5
Q

When can you only use IV calcium?

A

cardiac symptoms for hyperkalemia or hypermagnesia

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6
Q

low serum concentration can occur with ______ syndrome. may need to add high than standard doses to PN and glucose containing IV.

A

refeeding syndrome

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7
Q

High serum concentrations can occur in _______ __________, use reduced doses in PN and IV fluids

A

renal failure

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8
Q

what 2 elements can mix and form a precipitation?

A

calcium-phosphorous

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9
Q

when is there an increased risk for calcium-phosphorous precipitates?

A

sodium biacarb when treating hyperkalemia

infusions of calcium or phosphorous

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10
Q

what drugs can cause hyperkalemia?

A

K+ sparing diuretics
ACEI, NSAIDs
Beta antagonists
pseudohyperkalemia (lysis of RBC during collection)

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11
Q

What drugs can cause hypokalemia?

A

diuretics (except K+ sparing)
insulin, refeeding syndrome, treatment of DKA
Beta agonist, glucocorticoids
ampho B, aminoglycosides

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12
Q

what do insulin do to potassium?

A

forces potassium into cell

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13
Q

what drug can cause hypermagnesemia?

A

lithium

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14
Q

what drugs can can cause hypomagnesemia?

A 
Diuretics
Amphotericin B, aminoglycosides
Cyclosporin, alcohol
Digoxin
Laxative abuse
Refeeding syndrome
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15
Q

drugs that can cause hypercalcemia

A

thiaizde diuretics
lithium
Vit A and D toxicity
calcium

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16
Q

what drugs can cause hypocalcemia?

A

Loop diuretics
oral phosphorus
phenytoin, barbituates
vit D deficiency

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17
Q

what can cause hyperphosphatemia?

A

phosphate-containing enemas

IV phosphorous to tx hypercalcemia

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18
Q

what can cause hypophosphatemia?

A 
diuretics
insulin, dextrose, refeeding syndrome
tx of DKA
sucralfate
antacids
calcium salts
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19
Q

Electrolyte abnormalities with an acute onset may have more ______ ___________ and should be treated more aggressively

A

more severe

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20
Q

how is potassium bound?

A

intracellularly, so serum K+ not a good measure of total body potassium, but do correlate w/ symptoms

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21
Q

symptoms of hyperkalemia?

A 
cardiac abnormalities (ventricular fibrillation, asystole, ECG- peaked T waves) 
muscle abnormalities- weakness, paralysis
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22
Q

causes of hyperkalemia?

A

increase potassium intake
decrease potassium excretion
potassium release from intracellular space

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23
Q

tx approach for hyperkalemia

A

Antagonism of K+ if cardiac abnormalities exist
Promote intracellular redistribution
Remove K+ from the body

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24
Q

if cardiac symptoms are present w/ hyperkalemia what should you administer?

A

IV calcium gluconate give over 5-10 minutes and repeat every 30-60 minutes until ECG normalizes

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25
Q

does IV calcium gluconate reduce or redistribute serum K+

A

no, only restores normal conduction of heart

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26
Q

what is the first therapy for hyperkalemia (intracellular redistribution) if patient isn’t acidotic

A

regular insulin

onset of 30 minutes (duration 2-6 hours)

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27
Q

If a patient isn’t hyperglycemia and is hyperkalemic what do you give?

A

Dextrose with insulin
D10W 1 L over 1-2 hours
D50W, 50 mL over minutes

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28
Q

what does insulin promote?

A

cellular uptake of K+

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29
Q

2nd line therapy for hyperkalemia. Give if patient is acidodic.

A

Albuterol high dose nebulized of 10 minutes (10-20mg)

onset is 30 minutes, duration of 1-2 hours

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30
Q

what drug do you only use when hyperkalemia is due to acidosis?

A

Sodium bicarb IV over 2-5 minutes

onset 30 minutes, duration 2-6 hours

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31
Q

what should you not infuse sodium bicarb through

A

same IV lines as parenteral nutrition, or other calcium and phosphorous solution

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32
Q

what is a tx for hyperkalemia that removes K+ from the body

A

furosemide IV (if normal renal function)
sodium polystyrene sulfonate (oral route better)
hemodialysis

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33
Q

what drug exhcanges Na+ for K+ and removes K+ from the body

A

sodium polystyrene sulfonate

oral route is better tolerated

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34
Q

S/S of hypokalemia

A

flattened T waves, presence of U waves
bradycardia, PVCs, heart block, a-flutter/ v-fib
myalgia, muscle weakness, cramps, paralysis

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35
Q

causes of hypokalemia

A 
GI losses (V/D, NG suction)
inadequate K+ intake
alkalosis
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36
Q

Meds that cause hypokalemia

A

B2 agonists, insulin
loop and thiazide diuretics
high dose abxs (PCN)
AmphoB< foscarnet- depletion of mag diminished K+ intracellularly

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37
Q

when should you tx hypokalemia?

A 
low serum K+ if patient symptomatic 
cardiac condition that predisposes to arrhythmias
receiving digoxin therapy
consider w/ patients on diuretics
laxative abuse
any patient w/ serum K+ <3.0 mEq/L
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38
Q

Non-pharm tx for hypokalemia

A

some salt substitutes
dietary sources (fruits, veggies, meats)
dietary is usually in potassium phosphate form (potassium chloride is most often administered)
need to also consider replacing chloride in diuretic therapy, vomiting, diarrhea

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39
Q

how is oral Potassium available

A

K+ chloride (more common)
K+ phosphate- (use if both are depleted)
K+ bicarb (if patient acidodic)

40
Q

is oral or IV potassium better

A

oral, IV has risk of death

41
Q

when do you consider IV potassium?

A

oral route not feasible or life threatening symptoms
Administered over 1 hours- NO BOLUS
infusion to not exceed >10 (if needed monitor ECG)

42
Q

when do you need to monitor potassium with IV infusion

A

serum concentrations after 30-40 mEq

43
Q

what type solutions should you avoid w/ IV potassium?

A

dextrose containing solution (promotes insulin release)

44
Q

what is the 2nd most abundant ICF cation?

A

magnesium

45
Q

what do mag do?

A

provides neuromuscular stability

involved in MI contraction

46
Q

is magnesium part of a normal Chem 7?

A

no, need to order separately

47
Q

symptoms of hypermagnesium?

A 
muscle weakness, neuromuscular blockade (paralysis)
respiratory muscle paralysis
calcium channel blockade
HYPOTN
sinus brady, asystole
48
Q

what is a big cause of hypermagneisum

A 
renal failure in conjunction w/ meds that have magnesium (cathartics, antacids, magnesium supplements) 
lithium therapy (!!)
49
Q

hypermagnesemia tx?

A

DC all mag supplements or mag-containing meds
give elemental calcuim 100-200 mg IV (antagonizes neuromuscular and CV effects) requires repeated doses
Loop diuretics (furosemide) and saline if normal renal function
hemodialysis if renal dz

50
Q

what may be needed for a extreme cardiac symptoms w/ hypermagnesium

A

vasopressors

cardiac pacemakers

51
Q

Signs of hypomagnesemia

A

Neuromuscular- tremor, seizures, tetany/ hyperreflexia
Cardiac- tachy, v-fib, torsade de pointes.
EKG- prolonges QRS, increased PR interval and QT interval

52
Q

clinical presentation of hypomagnesemia?

A

metabolic alkalosis
hypocalcemia
digoxin toxicity
(strong relationship b/w hypo-K+ and hypo-Mg)

53
Q

Causes of hypomag

A 
inadequate intake (ETOH)
inadequate absorption (steatorrhea, cancer, malabosprtion, excessive Calcium)
Excessive GI/ urinary loss
54
Q

what meds can cause hypomag?

A

Aminoglycosides, amphoB, cisplatin, insulin, loop and thiazide diuretics, cyclosporin

55
Q

tx for hypomag?

A

IV route if severe and symptomatic, PO if mild

56
Q

how do administer IV Mag sulfate

A

avoid rapid bolus injection (flushing, sweating)
dilute administer to avoid pain and venosclerosis
only use IM if peripheral access not available
need to gradually replace deficit over days

57
Q

what is a major problem w/ IV mag?

A

kidneys clear 50% of it right away

may need to giver higher doses

58
Q

what is the main limiting factor of oral magneisum admin?

A

diarrhea

59
Q

what does calcium help with?

A 
nerve impulses
skeletal muscle contraction
myocardial contractions
maintenance of cellular permeability and formation of bones and teeth
will bind w/ phosphate 
1/2 protein bound and 1/2 free ionized
60
Q

what happens w/ acute hypercalcemia

A

Inability to concentrate urine
Acute renal failure
Coma
Ventricular arrhythmias

61
Q

symptoms w/ chronic hypercalcemia? (more likely)

A

Metastatic calcification
Nephrolithiasis
Chronic renal insufficiency

62
Q

what can cause hypercalcemia?

A 
hyperparathyroidism
malignancy
paget's dz
granulomatous dz (TB, sarcoidosis)
hyperthyroidism
immbolizilation (multiple bony fracture)- acute 
acidosis
63
Q

what meds can cause hypercalcemia? (more chronic picture)

A

thiazide diuretics, estrogens, lithium, tamoxifen, Vit A, Vit D, calcium supplements

64
Q

if a patient has life-threatening symptoms w/ hypercalcemia and functioning kidneys what do you do?

A 
saline rehydration
loop diuretics
hemodialysis
calcitonin
glucocorticoids
IV PO4 if low
65
Q

how to tx hypercalcemia w/ life-threatening symptoms and renal failure

A

hemodialysis
calcitonin
glucocorticoids

66
Q

with non-lifethreatening symptoms and hypercalcemia how do you treat?

A 
saline rehydration
loop diuretics 
calcitonin
glucocorticoids
IV bisphosphonate
mithramycin
67
Q

if a patient is asymptomatic and has hypercalcemia what do you do?

A

observe
correct reversible cause
(often an endocrine disorder)

68
Q

what can help if a patient has hypercalcemia that leads to vomiting and inability to concentrate urine.

A

NS rehydration therapy

helps improve volume status

69
Q

once patient is rehydrated and has hypercalcemia what can you do?

A

Loop diuretics (inhibits Ca@ reabsorption from ascending LOH)
prevents volume overload
monitor for hypokalemia and hypomagnesia

70
Q

what is a tx for hypercalcemia that interferes w/ Vit D. add to calcitonin to prolong effect

A

prednisone (glucocorticoid)

71
Q

why can’t you use phosphates to treat hypercalcemia?

A

crystals may precipitate in tissue

72
Q

if a patient has hyperparathyroid dz and hypercalcemia what can you use?

A

oral phosphates

73
Q

what are good long term therapy options for hypercalcemia?

A

glucocorticoids

bisphosphonate

74
Q

Hypoalbuminemia decreases total calcium concentrations but _________ may be normal

A

ionized (i.e. free calcium)

75
Q

what is the formula for correct calcium for patients with a low albumin level

A

serum calcium + 0.8(NL albumin- Pt’s albumin)

or you can draw a free calcium

76
Q

what are symptoms of hypocalcemia?

A

neuromuscular- tetany, muscle cramps
CV- HPOTN, decreased contractility, HF
seizures, areflexia
(can be seen in rickets and osteomalacia)

77
Q

what conditions can cause excess losses of calcium?

A

hypoparathyroidism
renal failure
alkalosis
pancreatitis

78
Q

what meds cause hypocalcemia?

A

Phosphate replacement products, loop diuretics, phenytoin, phenobarbital, corticosteroids, aminoglycosides

79
Q

how do you treat hypocalcemia if acute symptomatic?

A

Bolus with 100 to 300 mg of elemental calcium IV over 5 to 10 minutes
continuous infusion
monitor serum calcium every 4-6 hours

80
Q

what rate must you not exceed w/ IV calcium to avoid cardiac ADRs

A

Rate NTE 60 mg/min

81
Q

what form of IV calcium causes less phlebitis

A

calcium gluconate

82
Q

what form of calcium has a better correction of calcium (but more painful infusion)

A

calcium chloride

83
Q

where is phosphorous found?

A

bone, ICF, ECF

84
Q

what are signs of hyperphosphatemia (usually due to ypocalcemia)

A

crystals develop in joints, soft tissue, kidney

85
Q

Crystal formation is likely to occur when product of the serum calcium and phosphate concentrations exceed _____-____

A

50-60

86
Q

what are causes of hyperphosphatemia?

A 
renal failure, hypoparathyroidism 
redistribution to ECF (acid-base imablance, rhabdo, tumor lysis during chemo)
increased intake (enemas, Vit D supplements, bisphosphonates)
87
Q

how do treat severe s ymptomatic hyperphosphatemia?

A

IV calicum salts

88
Q

tx for less severe hyperpohsphatemia?

A

oral phosphate binders (decrease GI absorption)

exs- Ca, Mg, Al salts

89
Q

clinical presentation of hypophosphatemia

A

seizures
muscle weakness (diaphrgam muscle and fatigue)
decreased cardiac contractility
skeletal muscle weakness

90
Q

what are causes of hypophospatemia?

A

increased distribution to ICF (insulin therapy, malnutrition)
decreased absorption
increased renal loss

91
Q

what meds cause hypophosphatemia

A

Diuretics, antacids, foscarnet, phenytoin, phosphate binders, calcium acetate

92
Q

what must you consider w/ hypophosphatemia treatment?

A

figure out cause

if DKA, glucose infusion, refeeding, alcoholic

93
Q

tx for severe hypophosphatemia

A

IV phosphorous (may need higher doses)

94
Q

tx for moderate hypophosphatemia

A

oral phosphorous 1.5-2.0grams per day in 3-4 divided doses

95
Q

how often should you monitor serum phosphorous once you start therapy

A

every 6 hours during first 48-72 hours

*OldPharm (12 decks)

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