Lecture 4 Electrolyte Imbalance - Thompson Flashcards
Top three reasons for confusion in the elderly?
Medications
UTI
Electrolyte imbalance
Most common cause of hypokalemia?
Diuretics.
Diarrhea also plays a large role.
What are the signs and symptoms of hypokalemia?
Flat t waves with ST depression.
Will present with belly ache, cramps and nausea.
Tx for hypokalemia?
Replace potassium very slowly.
Make sure to admit if levels are below 2.5!
When should a patient be admitted for hypokalemia?
If the levels are below 2.5.
3.5-5 is considered normal.
What is the number one cause of hyperkalemia?
Hemolysis.
Metabolc acidosis can cause it too, as the acidosis is corrected the potassium shifts back into cells leading to hypokalemia.
What must be taken into consideration when treating a hyperkalemic patient that is experiencing hyperkalemia?
when the acid inbalance is fixed, the potassium moves back into the cells and hypokalemia can occur.
What are the signs and symptoms of hyperkalemia?
Tented T waves.
Hyperreflexia, parasthesia, and weakness.
What are the treatment choices for hyperkalemia?
Albuterol
Lasix
Insuling with glucose.
If ECG changes are present in a hyperkalemic pt what should be administered to protect the heart?
Calcium gluconate and calcium chloride.
What blood sugar levels correlate to low bs?
<50-60
How will hypoglycemia present?
Sweaty, confused agitated.
Wish time diabetics lose this sensation.
Which type of diabetes is DKA most often associated with?
Type 1 diabetes
How do you treat DKA?
Lots of fluids
Give insulin when BS hits 250 give sugar.
Add potassium.
What is hyperosmotic hyperglycemic states?
This is type II diabetes equivalent to DKA.
Glucose >600!
Calcium is inversely related to which substance?
Phosphorous
What are the signs and symptoms of hypocalcemia?
Tetany/muscle spasm Chvostek sign = Facial nerve Trousseau sign (Arm BP)
Chvostek vs trousseaus sign
Chvotsek = Cheek!
Trousseaus = Arm!
What should you always check before stating a patient is hypocalcemic?
Albumin!
Two most common causes of hypercalcemia?
Cancer
Excessive PTH
What are the signs and symptoms of hyponatremia?
Confusion
Nausea/Vomiting
Crams
Often no signs and symptoms tho.
Hypovolemic hyponatremia
Pt is dehydrated but has lost more salt than water.
Give isotonic saline.
Euvolemic hyponatremia
Volume is ok but sodium is low.
Very common with SIADH
Pseudohyponatremia?
Low sodium secondary to an increase in lipids!!
Transitional hyponatremia?
Secondary to hyperglycemia.
Sodium decreases for every 100 mg/dl increase in glucose.
Prozac can cause which issue?
SIADH
What happens if you replace sodum too quicky?
Central pontine myelinolysis which is an irreversable damage to the brain.
What happens if you replace fluids too quickly with hypernatremia?
If you replace fluids too quickly it can cause brain swelling.
How big is a bolus in children?
20 ml/kg
Adults more eyeball the volume.
Describe the maitenance of fluid needs over hours?
1st 10 kg = 4ml/kg/hr
2nd 10 kg = 2ml/kg/hr
Any above that = 1ml/kg/hr
What should the urine output be in children?
1-2 ml/kg/hr
What should the urine output be in adults?
.5-1 ml/kg/hr <30 ml/hr is very concerning.
