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Apex Review > Fluids, electrolytes, & acid-base 3 > Flashcards

Fluids, electrolytes, & acid-base 3 Flashcards

1
Q

Sodium osmolarity of 350-375 mEq/L can cause

A

headache
agitation
confusion

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2
Q

Sodium osmolarity of 376-400 mEq/L can cause

A

weakness
tremors
ataxia

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3
Q

Sodium osmolarity of 401-430 mEq/L can cause

A

hyperreflexia
muscle twitching

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4
Q

Sodium osmolarity of >430 mEq/L can cause

A

seizures
coma
death

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5
Q

Which statements represent the BEST understanding of the physiologic role of calcium? (Select 2).
a. Calcium is factor 6 in the coagulation cascade
b. albumin administration can cause hypocalcemia
c. it is responsible for phase 1 of the cardiac myocyte action potential
d. acidosis increases ionized calcium

A

b. albumin administration can cause hypocalcemia
d. acidosis increases ionized calcium

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6
Q

Normal plasma calcium is

A

8.5-10.5 mg/dL or 4.5-5.5 mEq/L

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7
Q

Normal ionized calcium is

A

4.65-5.28 mg/dL or 2.2-2.6 mEq/L

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8
Q

Parathyroid hormone ___________ serum calcium and calcitonin ___________- serum calcium

A

raises; lowers

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9
Q

Calcium plays a crucial role in ________ of the cardiac muscle cell action potential

A

phase 2

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10
Q

Important functions of calcium include

A

second messenger systems, neurotransmitter release, and muscular contraction (skeletal, cardiac vascular, bronchial, etc.)

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11
Q

The primary treatment for hypercalcemia includes

A

IV hydration (0.9% NaCl) & a loop diuretic (furosemide)

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12
Q

Calcium antagonizes the effects of _________ at the neuromuscular junction

A

magnesium

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13
Q

Calcium is factor ___ in the coagulation pathway.

A

4

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14
Q

Acidosis _________ionized calcium

A

increases

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15
Q

Alkalosis ___________- ionized calcium

A

decreases

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16
Q

What is the Chvostek sign?

A

tapping on the angle of the jaw–> facial contraction on the ipsilateral side

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17
Q

What is the Trousseau sign?

A

an upper extremity BP cuff is inflated above SBP for three minutes, decreased blood flow accentuates neuromuscular irritability–> muscle spasms of the hand and forearm

18
Q

Etiology of hypocalcemia includes

A

hypoparathyroidism
vitamin D deficiency
pancreatitis
sepsis
renal osteodystrophy

19
Q

Presentation of hypocalcemia includes

A

skeletal muscle cramps
nerve irritability
laryngospasm
mental status changes–> seizures
Chvostek sign
Trosseau sign

20
Q

What are the EKG findings of hypocalcemia

A

long QT interval

21
Q

What are the reasons for hypercalcemia?

A

hyperparathyroidism
cancer
thyrotoxicosis
thiazide diuretics
immobilization

22
Q

What is the presentation of hypercalcemia?

A

nausea
abdominal pain
hypertension
psychosis
mental status changes–> seizures

23
Q

What is the EKG findings of hypercalcemia?

A

short QT interval

24
Q

Loss of deep tendon reflexes is MOST likely a consequence of:
a. hypomagnesemia
b. hypermagnesemia
c. hypocalcemia
d. hypercalcemis

A

b. hypermagnesemia

25
Q

Normal plasma magnesium (total) is

A

1.7-2.4 mg/dL or 1.5-3 mEq/L

26
Q

Magnesium antagonizes the effects of

A

calcium

27
Q

Clinical uses of magnesium include

A

pre-eclampsia
opioid-sparing technique
acute bronchospasm
cardiac rhythm disturbances (symptomatic PVCs or torsades de points)

28
Q

Magnesium is required for normal ___________ function

A

cardiac

29
Q

What is the loading dose and dose of magnesium for pre-clampsia?

A

4 g load over 10-15 minutes then 1 g/hr for 24 hours

30
Q

Administration of magnesium for >48 hours increases the risk of

A

neonatal respiratory depression, hypotension, and lethargy

31
Q

Reasons for hypomagnesemia include

A

poor intake
alcohol abuse
diuretics
critical illness
common with hypokalemia

32
Q

Reasons for hypermagenesemia include

A

excessive administration
renal failure
adrenal insufficiency

33
Q

EKG findings of hypermagnesemia include

A

heart block

34
Q

EKG findings of hypomagnesemia include

A

long QT

35
Q

At a magnesium level of <1.2 mg/dL, you will see

A

tetany
seizures
dysrhythmias

36
Q

At a magnesium level of 1.2-1.8 mg/dL, you will see

A

neuromuscular irritability
hypokalemia
hypocalcemia

37
Q

At a magnesium level of 2.5-5 mg/dL, you will see

A

typically no symptoms

38
Q

At a magnesium level of 5-7 mg/dL, you will see

A

lethargy, drowsiness, flushing, N/V, diminished deep tendon reflexes

39
Q

At a magnesium level of 7-12 mg/dL, you will see

A

loss of deep tendon reflexes, hypotension, EKG changes, somnolence

40
Q

At a magnesium level of >12 mg/dL, you will see

A

respiratory depression–> apnea, complete heart block, cardiac arrest, coma, & paralysis

41
Q

How does magnesium work as an opioid-sparing drug?

A

it antagonizes NMDA receptors

42
Q

What classic sign should you assess in an OB patient receiving magnesium for preeclampsia?

A

loss of deep tendon reflexes

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