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PPS 946 > Fluids and Electrolytes > Flashcards

Fluids and Electrolytes Flashcards

1
Q

Where is potassium reabsorbed in the nephrons?

A

The proximal tubule

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2
Q

Where is potassium reabsorbed in the nephrons?

A

The proximal tubule

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3
Q

How is potassium eliminated?

A

90% renally

10% in feces

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4
Q

What are 4 medications that can help bring potassium into cells?

A

Beta-adrenergic agents, insulin, aldosterone, and acid/base.

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5
Q

During acidosis would the patient be at risk for hyperkalemia or hypokalemia? Why?

A

Hyperkalemia because the body will push H+ into cells and exchange it with K+ to increase the pH of the blood.

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6
Q

During alkalosis would the patient be at risk for hyperkalemia or hypokalemia? Why?

A

Hypokalemia because there will be a lack of H+ and the body will push H+ out of the cell exchanging it with K+ and lead to a reduction in blood pH.

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7
Q

What is the serum potassium in hypokalemia?

A
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8
Q

If I give someone 10mEq of potassium how much will their serum levels of potassium increase?

A

0.1mEq/L.

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9
Q

How much potassium can be given orally at one time?

A

40mEq.

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10
Q

Can you push potassium IV?

A

No!

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11
Q

How much potassium can you give in a peripheral line?

A

10mEq/hour

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12
Q

How much potassium can you give in a central line?

A

20mEq/hour

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13
Q

What is the serum potassium level during hyperkalemia?

A

> 5mEq/L

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14
Q

What is the serum potassium level during hyperkalemia?

A

> 5mEq/L

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15
Q

How is potassium eliminated?

A

90% renally

10% in feces

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16
Q

What are 4 medications that can help bring potassium into cells?

A

Beta-adrenergic agents, insulin, aldosterone, and acid/base.

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17
Q

During acidosis would the patient be at risk for hyperkalemia or hypokalemia? Why?

A

Hyperkalemia because the body will push H+ into cells and exchange it with K+ to increase the pH of the blood.

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18
Q

During alkalosis would the patient be at risk for hyperkalemia or hypokalemia? Why?

A

Hypokalemia because there will be a lack of H+ and the body will push H+ out of the cell exchanging it with K+ and lead to a reduction in blood pH.

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19
Q

What is the serum potassium in hypokalemia?

A
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20
Q

For severe hyperkalemia, what are the acute temporary tx options?

A

10 units insulin + dextrose
Beta agonist
Bicarbonate

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21
Q

How much potassium can be given orally at one time?

A

40mEq.

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22
Q

Can you push potassium IV?

A

No!

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23
Q

How much potassium can you give in a peripheral line?

A

10mEq/hour

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24
Q

How much potassium can you give in a central line?

A

20mEq/hour

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25
Q

What is the most common form of potassium that we give?

A

KCl

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26
Q

What is the serum potassium level during hyperkalemia?

A

> 5mEq/L

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27
Q

What are 4 things that decrease the output of potassium?

A

Kidney disease
Medications
Acidosis
Diabetes

28
Q

What are 4 things that increase input of potassium?

A

Over replacement
Overuse of K supplements
Medications
Potassium rich foods (kale)

29
Q

Medications that reduce _______ secretion will cause a lower output of potassium.

A

Aldosterone

30
Q

What are some symptoms of hyperkalemia?

A

Peak T waves on the EKG
Muscle cramping
Arrhythmias

31
Q

When is hyperkalemia severe?

A

Potassium>7 or EKG changes

32
Q

How do you treat severe hyperkalemia?

A

Stabilize the myocardium with Calcium IV. Then you use acute tx.

33
Q

For severe hyperkalemia, what are the acute temporary tx options?

A

10 units insulin + dextrose
Beta agonist
Bicarbonate

34
Q

Where is magnesium absorbed in the nephrons?

A

Loop of Henle

35
Q

Where is magnesium found?

A

Bone and muscle

36
Q

What is the serum level for hypomagnesemia?

A
37
Q

What is the serum level for hypermagnesemia?

A

> 2.3mg/dL

38
Q

What are the 4 big things that can lead to hypokalemia?

A

Diuretics, diarrhea, decreased absorption, and low magnesium

39
Q

What are 4 causes of low magnesium?

A

Alcoholism, diarrhea, low calcium, and low magnesium.

40
Q

What are symptoms of hypomagnesium?

A

Muscle cramping, disruption in nerve conduction (seizures, coma, etc.), sometimes asymptomatic, and QT prolongation (Torsades de Pointes)

41
Q

How do you treat low magnesium?

A

You want to give magnesium through IV at a slow rate (usually MgSulfate). If you must use oral magnesium use MgOxide b/c of the high Mg percentage.

42
Q

What are some causes of hypermagnesium?

A

Kidney failure or disease, over consumption of antacids, and over correction of hypomagnesium.

43
Q

How do you treat hypermagnesium?

A

Avoid magnesium, diuretics, can use calcium chloride if they have an arrhythmia.

44
Q

Where is phosphorus found?

A

Bone and intracellular fluid

45
Q

Where is phosphorus reabsorbed in the nephrons?

A

The proximal tubule.

46
Q

What is the serum level of hypophosphatemia?

A
47
Q

What are some symptoms of hypophosphatemia?

A

Issues breathing, respiratory failure, body can’t use oxygen as efficiently, muscle cramping, rigid red blood cells, compromised immune system.

48
Q

How do you treat hypophosphatemia?

A

You want to give PO over IV. You can give IV when the patient has diarrhea, which prevents absorption.

49
Q

What are the serum levels for hyperphosphatemia?

A

> 4.5 mEq/L

50
Q

What are some causes of hyperphosphatemia?

A

Renal failure, red blood cell lysis, a decrease in calcium, carbonated beverages.

51
Q

What are some symptoms of hyperphosphatemia?

A

Usually asymptomatic
Muscle cramping
Calcium phosphate precipitation (can lead to obstructive nephrpathy)

52
Q

How do you treat hyperphosphatemia?

A

Use binders to decrease the absorption of phosphorus (can be calcium acetate or aluminum, but you can’t use aluminum in patients with renal failure)

53
Q

What are the serum levels in hypocalcemia?

A
54
Q

What are some causes of hypocalcemia?

A

Hypomagnesemia, hypoparathyroidism, medications, not enough intake, not enough vitamin D.

55
Q

What are the serum levels in hypercalcemia?

A

> 10.5 mg/dL

56
Q

What are some causes of hypercalcemia?

A

Lithium, no excretion, too much bone resorption, lack of water

57
Q

What are some symptoms of hypercalcemia?

A

Kidney stones, GI symptoms, short QT, and severe pain.

58
Q

How do you treat hypercalcemia?

A

Rehydration, diuretics, sometimes calcitonin

59
Q

What is the first line treatment for hypercalcemia in patients with cancer?

A

Bisphosphonates.
Might use corticosteroids may be used in cases of multiple myeloma or other malignancies where steroids are part of usual treatment

60
Q

How do you treat hypercalcemia in patients with kidney disease?

A

Avoid diuretics

May need diuresis

61
Q

What is normal osmolarity?

A

275-290 mOsm/kg

62
Q

What do we give when a patient is severely hyponatremic?

A

100 mL 3% saline every 10 minutes

63
Q

What is the rate at which you should correct hyponatremia if it is not severe?

A

8-10 mEq/L over 24 hours, or 18 mEq/L over 48 hours

64
Q

When a patient has isotonic hyponatremia what must you rule out?

A

Pseudohyponatremia

65
Q

What is the most common form of hyponatremia?

A

Hypotonic

66
Q

How do you treat hypotonic hyponatremia?

A

Establish a volume status

PPS 946 (22 decks)

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