Fluid, Electrolytes, Acid Base Pharm

Question 1

Potassium Chloride

Answer 1

• Most potassium supplements: Potassium chloride (MOST common 80% of time) or potassium phosphate
• Available IV and PO in different forms
• Indications: hypokalemia
• AE: PO: GI- N/V/D, ab discomfort, esophagitis (give with food and water), IV: very caustic, can cause local irritation and pain
• Monitoring parameters: watch serum K+ levels, watch for s/s of hyperkalemia, watch IV sites
• Contraindications: monitor closely in pts with renal dysfunction, watch in patients on meds that can increase potassium

Question 2

Considerations for IV Potassium Chloride Admin

Answer 2

• Peripheral Line: 10 mEq over 1 hour
• Central Line: 20 mEq over 1 hour
• May add K+ to maintenance IV fluid
• Concentrated KCl shouldn’t be available on patient care unit

Question 3

Treatment of Hyperkalemia

Answer 3

First: protect the heart and prevent dysrhythmias (administer calcium IV but this doesn’t treat hyperkalemia)

1. Shift potassium back into cells: regular insulin and D5W, sodium bicarb, albuterol
2. Increase excretion of potassium: kidneys = diuretic, dialysis, gut

Question 4

IV Calcium Products

Answer 4

• Calcium Gluconate and Calcium Chloride

- Rate of admin depends on indication, ex. Hyperkalemia = 10-30 min (fast), calcium replacement = 1g/hr (slower)

Question 5

Calcium Gluconate

Answer 5

• 3 g gluconate = 1 g chloride

- May be given peripherally

Question 6

Calcium Chloride

Answer 6

• 1 g chloride = 3 g gluconate
• More elemental calcium/More potent
• More caustic to the vasculature
• Should be administered centrally

Question 7

Relationship btw Potassium and Insulin

Answer 7

• Na-K ATPase pump in cell membrane
• maintains K concentrations and enhances movement of K into cell
• Pump uses ATP hydrolysis as energy source = activation requires insulin and glucose

Question 8

Regular Insulin + Dextrose 50%

Answer 8

• Used to treat hyperkalemia
• Regular insulin: may be given IV or SC
• used to treat diabetes and hyperkalemia
• essential for cellular uptake of glucose
• can accumulate in renal dysfunction
• Monitor: blood sugar
• Dextrose 50% injection: concentrated dextrose
• used to treat hypoglycemia and hyperkalemia in conjunction with insulin

Question 9

Sodium Bicarb

Answer 9

• For adults, use 8.4% product (base)
• Uses: severe metabolic acidosis, hyperkalemia (shift potassium back into cell via H+-K+ pump)
• AE: can be caustic to vasculature, can cause hypokalemia, can cause metabolic alkalosis
• Monitor: K+ very closely, edema, fluid retention, heart problems, overcorrection

Question 10

Continuous Inhalation Albuterol

Answer 10

• Short acting B2 agonist
• Binds to B2 in lungs: bronchodilation
• Bind to B2: activate cAMP which is used by Na-K ATPase pump to move K intracellularly
• AE: tachycardia, K levels (look hypokalemic but really K is just inside cell)

Question 11

Increase K+ Elimination

Answer 11

• Diuresis with furosemide, hemodialysis, or Kayexalate

Question 12

Kayexalate

Answer 12

• Sodium polystyrene
• Resin that exchanges Na for K in the gut
• Given PO or rectal
• Onset: a few hours, not used in emergencies
• Associated with intestinal necrosis and has other serious GI AE

Question 13

Mag Products

Answer 13

• IV: Mag sulfate
• PO: Mag oxide
• Role of mag in the body: activates intracellular enzymes, binds mRNA to ribosomes, regulates skeletal muscle contractility and blood coagulation

Question 14

Mag Sulfate

Answer 14

• IV
• Used for hypomagnesemia
• Preeclampsia and eclampsia
• Migraines
• Status asthmaticus (bronchodilation)
• Precautions: use with caution in renal dysfunction, monitor patient’s cardiac and neuromuscular status

Question 15

Mag Oxide

Answer 15

• PO
• Take over several days
• Large doses can cause diarrhea