Fluids & Electrolytes

Question 1

what is a normal range of K

Answer 1

3.3-5

Question 2

renal failure is most likely to cause which type of imbalance with K

Answer 2

hyperkalemia (can’t rid dietary K)

Question 3

tissue destruction such as rhabdomyolysis, hemolysis, leukemia blast crisis can cause which type of electrolyte imbalance

Answer 3

hyperkalemia

Question 4

For every .1 shift in pH, how is K shifted?

Answer 4

.5-1.0

Question 5

acidosis causes which type of imbalance with K and why?

Answer 5

hyperkalemia, because a decrease in pH shifts K extracellularly (.1 in pH=.5-1.0 K)

Question 6

what are the most common signs/symptoms of hyperkalemia

Answer 6

EKG changes, arrhythmias (both atrial & ventricle) PVC’s,

Question 7

what are you likely to see in the EKG when K >7

Answer 7

ventricular fibrillation

Question 8

How does the EKG progress w/ increasing K

Answer 8

tall peaked T waves>wide QRS>sine wave appearance> asystole

Question 9

how would you treat a nonemergency hyperkalemia

Answer 9

discontinue any causes, loop diuretics, *Kayexalate-binds K in gut excreted in stool.

Question 10

how would you treat emergency hyperkalemia

Answer 10

glucose with insulin drive K into cell, Alkanizing serum with sodium bicarbonate, albuterol, and Ca gluconate (stabilizes myocardium) Dialysis if severe..

Question 11

what are some common causes of hypokalemia

Answer 11

diuretics, GI loss, **Burns, shift due to insulin/alkalosis, dietary intake

Question 12

signs symptoms of hypokalemia

Answer 12

mild >3…moderate < 3 primarily EKG changes, flattened T waves, prominent U waves, ectopy, arrhythmias, muscle weakness (including resp.) in severe low K

Question 13

tx hypokalemia

Answer 13

orally: 20-40 KCL parenterally- 10-20 mEq in adults & .25 in kids x2 hrs.

Question 14

what amount of KCL given IV is damaging to veins & may be painful

Answer 14

> 40 mEq

Question 15

which problem is often associated with hypokalemia that must be addressed first

Answer 15

hypomagnesmia

Question 16

what are normal Ca levels in seru

Answer 16

8.5-10.5 total and ionized 4.65-5.25

Question 17

what percent Ca is bound to proteins vs. ionized (free)

Answer 17

60% bound, 40% free

Question 18

what are the 3 factors regulating serum calcium

Answer 18

PTH, Vitamin D, and Calcium+phosphate

Question 19

how does PTH respond to lowered level of serum Ca

Answer 19

1. signal kidney to reabsorb more 2. signal gut to absorb more from diet 3. increase resorption of Ca from bone

Question 20

how does hypoalbuminemia affect calcium levels (both total and ionized)

Answer 20

lowers total, ionized may be normal

Question 21

how does alkalosis affect calcium levels

Answer 21

it lowers free calcium by increasing the amount bound to albumin

Question 22

how does carpal pedal spasms occur

Answer 22

alkalosis from hyperventilation, resulting in hypocalcemia

Question 23

what are some causes of hypoparathyroidsim

Answer 23

surgical removal, autoimmune disorder effecting gland, or radiation destruction, others.

Question 24

in a pt with normal PTH, albumin, and no acid-base disorders… what are some other causes of hypocalcemia

Answer 24

Vitamin D deficiency, hyperphosphatemia (renal failure can’t rid Phosphate, hence binds to free Ca), massive transfusions, hypomagnesium

Question 25

signs/sx of hypocalcemia

Answer 25

tetany, Trosseaus sign, Chvostek’s sign, seizures, myocardial dysfunction

Question 26

Tx hypocalcemia

Answer 26

correct cause: renal dialysis, Vit D or Ca supp. Mg. supp. correct ventilation

Question 27

what are two primary causes of hypercalcemia

Answer 27

hyperPTH, and malignancy

Question 28

how does milk alkali syndrome manifest itself with calcium levels..

Answer 28

causes hypercalcemia; too much dietary intake or Ca supp. for osteoporosis

Question 29

signs/sx of hypercalcemia

Answer 29

constipation, polydipsia, polyuria, lethargy, coma, anorexia, nausea, muscle weakness, recurrent stones, renal failure

Question 30

tx hypercalcemia

Answer 30

mild none, moderate- Aggressive saline hydration, Calcitonin (counteracts PTH, decreases bone resorption, increase renal excretion) **Bisphophonates **dialysis

Question 31

causes of hypermg

Answer 31

meds, renal insufficiency (urine 20-50)

Question 32

this method is used to monitor Mg levels in an eclamptic pt on a drip to ensure they don’t develop hypermg

Answer 32

hyporeflexia

Question 33

what most often associated with hypomg

Answer 33

alcoholics