Lytes Simplified

Question 1

anorexia

n/v

AMS

twitching/ataxia/tremor

lethargy → stupor/coma

Answer 1

hypernatremia

Question 2

dx for hypernatremia

Answer 2

1. bmp → > 145
2. urine and plasma osmolality

Question 3

fluid tx for chronic hypernatremia

Answer 3

D5½NS 1.35 ml/kg/hr

Question 4

amount to lower Na for chronic hypernatremia

Answer 4

no more than 10 mEq/L x 24 hr

Question 5

fluid tx for acute hypernatremia

Answer 5

1. D5½NS 3-6 mL/kg/hr

OR

½ NS

2. maintain until Na < 145
3. then switch to D5½NS 1 mL/kg/hr until Na < 140

Question 6

anorexia

n/v

lethargy

disorientation

sz

ha

orthostatic hypotn

delirium

Answer 6

sx of hyponatremia

Question 7

dx for hyponatremia

Answer 7

1. bmp + serum osmolality

Question 8

emergency tx for hyponatremia → any pt w. sx

Answer 8

hypertonic saline

→ raise Na 4-6 mEq over a couple hr

Question 9

tx for hypovolemic hyponatremia

Answer 9

isotonic saline

Question 10

tx for hypervolemic hyponatremia: CHF, cirrhosis

Answer 10

diuresis

fluid restriction

Na restriction

Question 11

tx for hypervolemic hyponatremia: renal failure

Answer 11

fluid restriction

dialysis

Na restriction

Question 12

tx for euvolemic hyponatremia

Answer 12

fluid restriction

Question 13

tx for SIADH (euvolemic hyponatremia)

Answer 13

salt tabs

+/- loop diuretic

demecocycline

Question 14

n/v

palpitations

lethargy

confusion

paresthesias

Answer 14

hyperkalemia

Question 15

dx for hyperkalemia

Answer 15

check/recheck K+

BMP

EKG

Question 16

hyperkalemia ekg

Answer 16

peaked T waves

prolonged PR

wide QRS

sine wave

Question 17

tx for hyperkalemia

Answer 17

insulin + glucose

IV calcium gluconate

Lasix + saline

Kayexalate/Veltassa

SABA

IV sodium bicarb

Question 18

muscle fatigue/weakness

cramps/rhabdo

resp muscle weakness

ileus/constipation

Answer 18

hypokalemia

Question 19

dx for hypokalemia

Answer 19

bmp

Mg → separate test

ekg

Question 20

ekg: hypokalemia

Answer 20

flattened/inverted T waves

U wave in V4-V6

Question 21

tx for emergent hypokalemia

Answer 21

IV K+

Question 22

tx for non emergent hypokalemia

Answer 22

oral KCl

Question 23

neuromuscular toxicity

nausea

flushing

lethargy

drowsy

hypocalcemia

absent DTRs

bradycardia

muscle paralysis

Answer 23

hypermagnesemia

Question 23

neuromuscular toxicity

nausea

flushing

lethargy

drowsy

hypocalcemia

absent DTRs

bradycardia

muscle paralysis

Answer 23

hypermagnesemia

Question 24

dx for hypermagnesemia

Answer 24

serum Mg → separate lab bmp ekg 24 hr urine OR random urine (fraction excretion)

Question 25

ekg: hypermagnesemia

Answer 25

widened qrs prolonged pq

Question 26

tx for hypermagnesemia

Answer 26

stop offending agent +/- diuretics IV calcium gluconate

Question 27

tetany → trousseau/chovstek tetany arrhythmias sz

Answer 27

hypomagnesemia

Question 28

ekg: hypomagnesemia

Answer 28

wide QRS peaked T waves

Question 29

tx for severe hypomagnesemia

Answer 29

IV Mg sulfate → renal dosing!

Question 30

stones bones moans thrones abd groans psychiatric overtones

Answer 30

hypercalcemia

Question 31

dx for hyperclacemia

Answer 31

1. check Ca 2. recheck Ca 3. if low → confirmed 4. check PTH 5. if low → check via D and PTHrP

Question 32

ekg: hypercalcemia

Answer 32

shortened QT

Question 33

tx for hypercalcemic crisis

Answer 33

NS wide open cardiac monitoring bisphosphonates/calcitonin/glucocorticoids

Question 34

Chvostek trudeau muscle cramps/spasms tetany paresthesias

Answer 34

hypocalcemia

Question 35

ekg: hypocalcemia

Answer 35

prolonged at

Question 36

dx for hypocalcemia

Answer 36

total serum serum phos vit D PTH bmp Mg → hypomagnesemia

Question 37

tx for severe hypocalcemia

Answer 37

replete Mg first IV calcium gluconate

Question 38

tetany muscle cramps perioral numbness/tingling sz uremia pruritis sob sleep disturbance painful joint masses

Answer 38

hyperphosphatemia

Question 39

dx for hyperphosphatemia

Answer 39

serum phos → separate lab pth serum Ca vit D +/- renal bx

Question 40

tx for acute hyperphosphatemia w. normal renal fxn

Answer 40

saline PLUS PLUS loop diuretics

Question 41

tx for hyperphosphatemia: hypoparathyroidism

Answer 41

Ca Vit D

Question 42

tx for hyperphosphatemia rt aki

Answer 42

phosphate binders

Question 43

metabolic encephalopathy proximal myopathy rhabdo dysphagia hemolysis

Answer 43

hypophosphatemia

Question 44

dx for hypophosphatemia

Answer 44

serum phos urinary phos: 24 hr vs random → FEPO4

Question 45

tx for hypophosphatemia

Answer 45

IV phos dipyridamole did → if urinary phos wasting