Fluids & Electrolytes

Question 1

Sxs of Hypercalcemia

Answer 1

Asxs
Coma, lethargy, confusion, polyuria (nephrogenic DI), muscle weakness, anorexia, nausea, vomiting, pancreatitis, constipation, kidney stones

EKG: shortened QT internal. Arrhythmia w/ use of digitalis

Question 2

Signs/Sxs hypocalcemia

Answer 2

Trousseau sign (carpopedal spasm w/ inflation of BP cuff)
Circumoral numbness
Chvostek sign: twitching of cheek muscles w/ tapping (stimulates facial nerve)

EKG: prolonged QT interval

Question 3

Maintenance fluids for peds

Answer 3

D5NS + 20 K at 4-2-1 rule rate

isotonic for Peds population; adults would be 1/2 NS

Question 4

Causes of NAG metabolic acidosis (hyperchloremic)

Answer 4

IV infusion
Renal (renal tubular acidosis, ureteral diversion)
GI (diarrhea, high output fistulas/stomas)

d/t bicarb loss

dx: urine anion gap = (Una + Uk) - Ucl. gives urinary ammonium excretion. normally, increase in ammonium is excreted renal w/ metabolic acidosis. + urine anion gap (20-90mEq/L) indicates low urinary ammonium excretion which means there is renal cause of NAG MA.

Question 5

Transfusion of stored packed RBCs causes what electrolyte abnormality

Answer 5

Hyperkalemia

Increases by ~1 mEq/L per day due to passive leakage of K from RBCs