ILE I U4 D4

Question 1

Mild, asymptomatic treatment (Na)

Answer 1

Non-emergent, non-aggressive. Prevent symptoms through restriction of fluids, diuretics, etc

Question 2

Moderate, symptomatic treatment (Na)

Answer 2

Use IV therapy to prevent seizures, coma, etc.

Question 3

Asymptomatic hypokalemic levels and treatment

Answer 3

3-3.8, oral therapy (unless non-functioning GI)

Question 4

Moderate hypokalemic levels and treatment

Answer 4

2.5-2.9, oral or IV (unless non-functioning GI (IVs))

Question 5

Severe hypokalemic levels and treatment

Answer 5

<2.5, IV therapy

Question 6

When do you use emergent hyperkalemic therapy?

Answer 6

ECG changes (PEAKED T waves!) and >5.5
OR >6.5 without changes

Question 7

How do you treat emergent hyperkalemia?

Answer 7

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

Question 8

Hypomagnesia treatment emergent

Answer 8

IV (takes 3-5 days)

Question 9

Hypomagnesia non-emergent treatment

Answer 9

IV preferred because PO causes strong GI upset

Question 10

Hypermagnesia treatment (non-symptomatic)

Answer 10

D/C any current meds with mag

Question 11

Hypermagnesia treatment (symptomatic

Answer 11

D/C any current meds with mag, then administer CaCl/gluconate, loop diuretics, hemodialysis

Question 12

When should you check mag levels?

Answer 12

before administering mag, but afterwards it will seem high due to delayed distribution

Question 13

Hypophosphatemia treatment (mild, asymptomatic) and levels

Answer 13

2.3-2.7 PO meds but unpredictable GI effects

Question 14

Which muscle do you especially need phosphate for?

Answer 14

Diaphragm!

Question 15

Hypophosphatemia treatment (moderate) and levels

Answer 15

1.5-2.2, can use oral, but may need IV

Question 16

Hypophosphatemia treatment (severe) and levels

Answer 16

<1.5, IV

Question 17

Hyperphosphatemia treatment (severe)

Answer 17

Need to increase renal excretion, administer NS, loop diuretics, hemodialysis

Question 18

Chronic hyperphosphatemia treatment

Answer 18

Dietary restrictions, phosphate binders (only for asymptomatic)

Question 19

Under which circumstances would a pt GI tract not work and you would need to administer IV therapy?

Answer 19

GI bleeds, nausea/vomiting, gut dysfunction, surgery, NPO

Question 20

Which diagnostic would you use if you were concerned for pulmonary edema? What concern would this be? (safety/efficacy)

Answer 20

Xrays, safety

Question 21

What are efficacy monitoring tools for electrolytes?

Answer 21

Vitals, physical exams, electrolyte levels (these overlap)

Question 22

What are safety monitoring tools for electrolytes?

Answer 22

Vitals, diagnostic tests, electrolyte levels (these overlap)

Question 23

Monitoring for asymptomatic Na problems

Answer 23

Serum levels 1-2 times daily

Question 24

Monitoring for symptomatic Na problems

Answer 24

Serums at least Q4H, D/C hyper/hypotonic fluids if correction exceeds recommended rate

Question 25

Monitoring for patients at risk for hypo/hypernatremia

Answer 25

Regular follow up with physician to monitor Na levels

Question 26

Asymptomatic hypo-or hyperkalemia monitoring

Answer 26

SerumK+ level Q 24-48 hrs

Question 27

Severe, symptomatic hypo-or hyperkalemia monitoring

Answer 27

-SerumK+Q 1-6 hrs during treatment-Admit to hospital in monitored bed

Question 28

Hypo-or hyperkalemia, but symptoms have resolved monitoring

Answer 28

Serum K+Q 4-12 hrs until serum K+is in normal range

Question 29

Critically ill patients monitoring (K)

Answer 29

Serum K+Q 24-48 hrs

Question 30

At risk for hypo-or hyperkalemia monitoring

Answer 30

Regular follow up with physician to monitor serum K+ levels

Question 31

When taking serum K for patients, one must also check for

Answer 31

serum mag!

Question 32

Asymptomatic, mild to moderate hypo-or hyper-magnesemia monitoring

Answer 32

Serummagnesium levels at least daily (inpatient)

Question 33

Symptomatic hypo-or hyper-magnesemia, aggressive treatment monitoring

Answer 33

Serum magnesium levels Q 1-6 hrs (inpatient)

Once levels have normalized,Q 1-3 days while hospitalized

Question 34

Asymptomatic hypophosphatemia, conservative management (oral or IV therapy) monitoring

Answer 34

Serumphosphorus level daily (inpatient)

Question 35

Symptomatic hypophosphatemia, aggressive management (IV therapy) monitoring

Answer 35

Serumphosphorus level 2-4 hrs after end of infusion to ensure response and assist with additional supplementation (inpatient)

Question 36

At risk for hypophosphatemia (critically ill, malnourished, alcoholics) monitoring

Answer 36

Serumphosphorus level Q 12-24 hrs (inpatient)

Question 37

Chronic hypophosphatemia monitoring

Answer 37

Serum phosphorouslevel monthly untilstable, then Q 3 months

Question 38

Acute hyperphosphatemia due to excessive phosphorus load or acutekidney injury monitoring

Answer 38

Serum phosphorus level Q 24-48 hrs (inpatient)

Question 39

Before starting parental nutrition (PN), one must always

Answer 39

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)