Fluids and Electrolytes Part 3 Flashcards
Signs/ symptoms of checking hypocalcemia include: (7)
- mental status changes
- tetany
- laryngospasm
- hypotension
- dysrrhythmias
- Chvostek’s sign
- Trousseau’s sign
Tetany is due to hyperexcitable neurons caused by hypocalcemia.
Carpopedal spasm can be elicited by doing what?
This test is known as what?
inflating a BP cuff and maintaining the pressure above SBP
Trousseau’s sign
Chvostek’s sign involves which nerve? How do you test and what does the test elicit?
facial
tapping on the nerve anterior to the earlobe
twitching of the lip cause it to spasm at the corners of the mouth and indicates hypocalcemia
What electrolyte disorder is due to:
- hyperparathyroidism
- excessive vit D
- renal failure
- paraneoplastic disorder (cancer)
EKG changes?
Hypercalcemia
Man on a big round hill.
Symptoms are due to what electrolyte imbalance? Abdominal pain or discomfort
Bone pain and fractures
Decreased appetite
Difficulty concentrating
Excessive thirst
Excessive urination
Fatigue
Low back pain
Malaise or lethargy
Muscle twitching or weakness
Nausea and vomiting
Depression
hypercalcemia
What is the treatment for hypercalcemia disorders? (5)
- parathyroidectomy
- diuretics
- fluid replacement
- dialysis
- calcitonin type medications
What electrolyte is this?
- Essential for production/function of ATP
- Essential for DNA, RNA, and protein synthesis.
- Regulates calcium access into the cell and the actions of calcium in the cell.
- Natural physiological calcium antagonist
Magnesium
________ is a membrane stabilizer useful in the treatment of arrhythmias.
Magnesium
Many times hypokalemia can not be fully corrected by administration of K + alone .
Magnesium is required for adequate processing of K+, and if the patient’s magnesium is low, they will have refractory ________.
hypokalemia
_________ stabilizes and slows everything down, while __________ speeds everything up!
Magnesium
Calcium
These patients are at risk for what imbalance?
Critical care patients, athletes, high metabolic states (pregnancy), diuretics/prolonged diarrhea, chronic alcoholics.
Hypomagnesemia
Hypomagnesemia <___ mEq/L
1.5
What is given?
- Torsades de pointes . Note: It does not shorten the QT interval significantly but still effective in torsades. It is THE treatment
- Any refractory VT especially , post MI.
magnesium
IV Mag has 100% ____ elimination.
Magnesium also potentiates the NMB, as well as anesthetics, opioids, and hypnotics. AVOID in patients with___ ____!!!!
renal
heart block
Hypermagnesemia >____ mEq/L
2.5
What condition does this describe?
- Iatrogenic, laxatives, antacids, patients with renal failure
- Depresses CNS (Anesthetic?!)
- Anticonvulsant, due to cerebral vasodilatation.
- Interferes with NT release, potentiates LA’s and NMB.
- Decreases PVR
hypermagnesia
What do these symptoms describe?
Decreased DTR’s, sedation, hypoventilation, bradycardia, hypotension, muscle weakness. EKG changes
DTR= deep tendon reflex
hypermagnesemia
When do we sample blood gases? (3)
significant changes in hemodynamics, blood loss, and desaturation
Treatment for hypermagnesemia: 3
Diuretics, fluid loading, dialysis
Respiratory acidosis
pH < ______
PaCO2 > ___mmHg
7.35
45
Respiratory alkalosis
pH is high or low?
PaCO2 is high or low?
high, >7.45
low, < 35 mmHg
Metabolic acidosis
pH is high/low?
HCO3 is high/low?
BE >___ mEq/L (Base Excess)
Base Excess is the amount of proton needed to bring pH back to normal levels
low, < 7.35
low < 22 mEq/L
-2
Metabolic alkalosis
pH is high/low?
HCO3 is high/low?
high, >7.45
high, > 26
Treatment for what condition?
HCO3- (mEq/L)=BE x kg x 0.3 Treat underlying cause: (Hypovolemia, DKA, Hypoxia, etc) Blood products, fluid, oxygen, insulin, respiratory compensation (hyperventilation).
Metabolic acidosis
Treatment: Chloride administration, volume correction with NaCl, respiratory compensation (hypoventilation).
Treat underlying cause ( citrate toxicity, vomiting/GI suction, diuretics)
Metabolic alkalosis
Signs and symptoms of hypomagnesemia: (3)
CNS irritability:
seizures, hyperreflexia, muscle spasm, signs are similar to hypocalcemia.
Treatment for hypomagnesemia: (3)
- Magnesium Sulfate (1-2 mEq/kg) over 8-12 hrs.
- Arrhythmias: IV Infusion: 1-2 g (2-4 ml of a 50% solution) in 10 ml of D5W over 1-2 minutes
- IV push in cardiac arrest
__________ is 18 times more concentrated in the heart than in the plasma and acts as an anticoagulant and vessel dilator, which helps keep the coronary arteries patent.
Magnesium
Alcohol is a _______ diuretic.
magnesium
_______ reduces acetylcholine release at the nerve terminal, therefore _______will lead to hyperactive reflexes and ______will lead to hypoactive reflexes.
Magnesium
deficiency
overload
Hypermagnesemia causes what on EKG? (4)
wide QRS
long P-R interval
hypotension
myocardial depression.
What is an indicator of the metabolic component of pH in the blood.
base excess (BE)
Hypoxemia is indicated by a PaO2 ratio less than ____.
300
