Lecture 4 Electrolyte Imbalance - Thompson

Question 1

Top three reasons for confusion in the elderly?

Answer 1

Medications
UTI
Electrolyte imbalance

Question 2

Most common cause of hypokalemia?

Answer 2

Diuretics.

Diarrhea also plays a large role.

Question 3

What are the signs and symptoms of hypokalemia?

Answer 3

Flat t waves with ST depression.

Will present with belly ache, cramps and nausea.

Question 4

Tx for hypokalemia?

Answer 4

Replace potassium very slowly.

Make sure to admit if levels are below 2.5!

Question 5

When should a patient be admitted for hypokalemia?

Answer 5

If the levels are below 2.5.

3.5-5 is considered normal.

Question 6

What is the number one cause of hyperkalemia?

Answer 6

Hemolysis.

Metabolc acidosis can cause it too, as the acidosis is corrected the potassium shifts back into cells leading to hypokalemia.

Question 7

What must be taken into consideration when treating a hyperkalemic patient that is experiencing hyperkalemia?

Answer 7

when the acid inbalance is fixed, the potassium moves back into the cells and hypokalemia can occur.

Question 8

What are the signs and symptoms of hyperkalemia?

Answer 8

Tented T waves.

Hyperreflexia, parasthesia, and weakness.

Question 9

What are the treatment choices for hyperkalemia?

Answer 9

Albuterol
Lasix
Insuling with glucose.

Question 10

If ECG changes are present in a hyperkalemic pt what should be administered to protect the heart?

Answer 10

Calcium gluconate and calcium chloride.

Question 11

What blood sugar levels correlate to low bs?

Answer 11

<50-60

Question 12

How will hypoglycemia present?

Answer 12

Sweaty, confused agitated.

Wish time diabetics lose this sensation.

Question 13

Which type of diabetes is DKA most often associated with?

Answer 13

Type 1 diabetes

Question 14

How do you treat DKA?

Answer 14

Lots of fluids
Give insulin when BS hits 250 give sugar.

Add potassium.

Question 15

What is hyperosmotic hyperglycemic states?

Answer 15

This is type II diabetes equivalent to DKA.

Glucose >600!

Question 16

Calcium is inversely related to which substance?

Answer 16

Phosphorous

Question 17

What are the signs and symptoms of hypocalcemia?

Answer 17

Tetany/muscle spasm
Chvostek sign = Facial nerve
Trousseau sign (Arm BP)

Question 18

Chvostek vs trousseaus sign

Answer 18

Chvotsek = Cheek!

Trousseaus = Arm!

Question 19

What should you always check before stating a patient is hypocalcemic?

Answer 19

Albumin!

Question 20

Two most common causes of hypercalcemia?

Answer 20

Cancer

Excessive PTH

Question 21

What are the signs and symptoms of hyponatremia?

Answer 21

Confusion
Nausea/Vomiting
Crams
Often no signs and symptoms tho.

Question 22

Hypovolemic hyponatremia

Answer 22

Pt is dehydrated but has lost more salt than water.

Give isotonic saline.

Question 23

Euvolemic hyponatremia

Answer 23

Volume is ok but sodium is low.

Very common with SIADH

Question 24

Pseudohyponatremia?

Answer 24

Low sodium secondary to an increase in lipids!!

Question 25

Transitional hyponatremia?

Answer 25

Secondary to hyperglycemia.

Sodium decreases for every 100 mg/dl increase in glucose.

Question 26

Prozac can cause which issue?

Answer 26

SIADH

Question 27

What happens if you replace sodum too quicky?

Answer 27

Central pontine myelinolysis which is an irreversable damage to the brain.

Question 28

What happens if you replace fluids too quickly with hypernatremia?

Answer 28

If you replace fluids too quickly it can cause brain swelling.

Question 29

How big is a bolus in children?

Answer 29

20 ml/kg

Adults more eyeball the volume.

Question 30

Describe the maitenance of fluid needs over hours?

Answer 30

1st 10 kg = 4ml/kg/hr
2nd 10 kg = 2ml/kg/hr

Any above that = 1ml/kg/hr

Question 31

What should the urine output be in children?

Answer 31

1-2 ml/kg/hr

Question 32

What should the urine output be in adults?

Answer 32

.5-1 ml/kg/hr <30 ml/hr is very concerning.