ILE I U4 D4 Flashcards
Mild, asymptomatic treatment (Na)
Non-emergent, non-aggressive. Prevent symptoms through restriction of fluids, diuretics, etc
Moderate, symptomatic treatment (Na)
Use IV therapy to prevent seizures, coma, etc.
Asymptomatic hypokalemic levels and treatment
3-3.8, oral therapy (unless non-functioning GI)
Moderate hypokalemic levels and treatment
2.5-2.9, oral or IV (unless non-functioning GI (IVs))
Severe hypokalemic levels and treatment
<2.5, IV therapy
When do you use emergent hyperkalemic therapy?
ECG changes (PEAKED T waves!) and >5.5 OR >6.5 without changes
How do you treat emergent hyperkalemia?
Intracellular shift; IV Ca gluconate/chloride, insulin with dextrose, Na bicarb, albuterol,
Remove K; furosemide, Na polystyrene sulfonate, hemodialysis
Need to several of these - not just one
Hypomagnesia treatment emergent
IV (takes 3-5 days)
Hypomagnesia non-emergent treatment
IV preferred because PO causes strong GI upset
Hypermagnesia treatment (non-symptomatic)
D/C any current meds with mag
Hypermagnesia treatment (symptomatic
D/C any current meds with mag, then administer CaCl/gluconate, loop diuretics, hemodialysis
When should you check mag levels?
before administering mag, but afterwards it will seem high due to delayed distribution
Hypophosphatemia treatment (mild, asymptomatic) and levels
2.3-2.7 PO meds but unpredictable GI effects
Which muscle do you especially need phosphate for?
Diaphragm!
Hypophosphatemia treatment (moderate) and levels
1.5-2.2, can use oral, but may need IV
Hypophosphatemia treatment (severe) and levels
<1.5, IV
Hyperphosphatemia treatment (severe)
Need to increase renal excretion, administer NS, loop diuretics, hemodialysis
Chronic hyperphosphatemia treatment
Dietary restrictions, phosphate binders (only for asymptomatic)
Under which circumstances would a pt GI tract not work and you would need to administer IV therapy?
GI bleeds, nausea/vomiting, gut dysfunction, surgery, NPO
Which diagnostic would you use if you were concerned for pulmonary edema? What concern would this be? (safety/efficacy)
Xrays, safety
What are efficacy monitoring tools for electrolytes?
Vitals, physical exams, electrolyte levels (these overlap)
What are safety monitoring tools for electrolytes?
Vitals, diagnostic tests, electrolyte levels (these overlap)
Monitoring for asymptomatic Na problems
Serum levels 1-2 times daily
Monitoring for symptomatic Na problems
Serums at least Q4H, D/C hyper/hypotonic fluids if correction exceeds recommended rate
Monitoring for patients at risk for hypo/hypernatremia
Regular follow up with physician to monitor Na levels
Asymptomatic hypo-or hyperkalemia monitoring
SerumK+ level Q 24-48 hrs
Severe, symptomatic hypo-or hyperkalemia monitoring
-SerumK+Q 1-6 hrs during treatment-Admit to hospital in monitored bed
Hypo-or hyperkalemia, but symptoms have resolved monitoring
Serum K+Q 4-12 hrs until serum K+is in normal range
Critically ill patients monitoring (K)
Serum K+Q 24-48 hrs
At risk for hypo-or hyperkalemia monitoring
Regular follow up with physician to monitor serum K+ levels
When taking serum K for patients, one must also check for
serum mag!
Asymptomatic, mild to moderate hypo-or hyper-magnesemia monitoring
Serummagnesium levels at least daily (inpatient)
Symptomatic hypo-or hyper-magnesemia, aggressive treatment monitoring
Serum magnesium levels Q 1-6 hrs (inpatient)
Once levels have normalized,Q 1-3 days while hospitalized
Asymptomatic hypophosphatemia, conservative management (oral or IV therapy) monitoring
Serumphosphorus level daily (inpatient)
Symptomatic hypophosphatemia, aggressive management (IV therapy) monitoring
Serumphosphorus level 2-4 hrs after end of infusion to ensure response and assist with additional supplementation (inpatient)
At risk for hypophosphatemia (critically ill, malnourished, alcoholics) monitoring
Serumphosphorus level Q 12-24 hrs (inpatient)
Chronic hypophosphatemia monitoring
Serum phosphorouslevel monthly untilstable, then Q 3 months
Acute hyperphosphatemia due to excessive phosphorus load or acutekidney injury monitoring
Serum phosphorus level Q 24-48 hrs (inpatient)
Before starting parental nutrition (PN), one must always
check electrolyte levels; Recheck labs daily for at least first few days of therapy (until stable and PN at goal), then a few times weekly (can extend to longer durations if a long-term PN)
