M2 Day 1 Flashcards
Sodium
what is it for, what are the normal levels
Sodium (Na+)
- 136 to 145 mEq/L
Major ECF Cation
90% of ECF
Main factor in determining ECF volume
Only small amt in ICF
Water magnet
Necessary for
- maintain fluid levels
- prevents low blood pressure
- Helps muscles contract
- Sends nerve impulses throughout the body
hyperNatremia
what is the value
causes, manifestations (moderate + severe), treatment
Hypernatremia: Serum Sodium Levels > 145 mEq/L
Caused
- Excessive Na intake,
- Diabetes insipidus, Renal Failure, Cushing Syndrome
- Causes hyperosmolality leading to cellular dehydration
Manifestations
Moderate
- Confusion, thirst, low urinary output
Severe
- HTN, tachycardia, flushed skin
- seizures, coma
- Hyper-reflexia, muscle twitching
- Nausea, vomiting
Treatment
- Correct fluid deficit (hypo or iso)
- Diuretics
- Monitor fluid balance
HypoNatremia
causes, manifestations, treatment
<136
Caused by
-Excessive Na loss by Sweat, emesis, diarrhea,
- Renal dysfunction, Diuretics, GI loss
- H20 gain (dilution effect), Inappropriate use of hypotonic IV fluids
Manifestations
- Hypotension
- confusion, headache, lethargy, seizures
- decreased muscle tone, twitching, tremors
- weakness
Treatment
- Hypertonic IVF
- Fluid restriction
- Diet
potassium
what is it necessary for, how much in muscle
Potassium (3.5 to 5.1 mmol/L)
- Major ICF cation
- Potassium in muscle cells 140 mmol/L
- Potassium in ECF 3.5 to 5.1 mmol/L
Necessary for
- Transmission and conduction of nerve and muscle impulses
- Maintenance of cardiac rhythms
- Depolarizes and generates action potentials
- Low K is shown as a flat T wave in cardiac rhythm
- Regulates protein synthesis, and glucose use and storage
Hyperkalemia
causes, menifestations, treatment
Hyperkalemia – Serum levels > 5.1 mmol/L
Causes
- Massive cell destruction (burns, tumour, severe infections)
- Shift from ICF to ECF
- Most common cause of renal failure
Manifestations
- Oliguria (UO less than 400mL/day)
- Renal failure
- Addison disease
- Bradycardia, irregular heart rhythm
- Cramping leg pain
- Abdominal cramping or diarrhea
Treatment
- Hold K intake (ie meds)
- Loop diuretics, Kayexalate)
- Force K from ECF to ICF by IV insulin or sodium bicarbonate.
- Reverse membrane effects of elevated ECF potassium by administering calcium gluconate IV.
Dialysis
hypokalemia
causes, manifestations, treatment
<3.5
Caused by
Abnormal losses of K+ via the kidneys or gastrointestinal tract
Magnesium deficiency
Metabolic alkalosis
Manifestations
- Most serious are cardiac.
- Skeletal muscle weakness (legs)
- Oliguria
- Weakness of respiratory muscles
- Decreased gastrointestinal motility
- Impaired regulation of arteriolar blood flow
Treatment
- Diet – potassium-rich foods
- KCl supplements orally or IV
calcium
normal levels, functions
Calcium (2.10 to 2.75 mmol/L)
More than 99% combined with phosphorus and concentrated in skeletal system
Only about 30% of the calcium from foods is absorbed in the GI tract.
Functions:
Strong bones and teeth
Blood clotting
Muscle contraction
(even keeping a normal heartbeat)
Nerve function
hypercalcemia
causes, menifestations, treatment
Hypercalcemia (>2.75 mmol/L)
Caused by
- Hyperparathyroidism (two-thirds of cases)
- Cancer and malignant bone disease
- Vitamin D overdose
Manifestations
- Muscle weakness, decreased reflexes
- Decreased memory
- Behavioural changes: confusion, disorientation,
- Constipation, nausea and vomiting
Treatment
- Calcitonin
- Excretion of Ca with loop diuretic
- Oral fluids (3-4L per day)
- Hydration with isotonic saline infusion
- Dialysis
hypocalcemia
causes, manifestations, treatment
Hypocalcemia (< 2.10 mmol/L)
Caused by
- Renal failure
- Hypothyroidism
- Acute pancreatitis
- Alkalosis
Manifestations
- Positive Trousseau’s or Chvostek’s sign
- Laryngeal stridor
- Dysphagia
- Tingling around the mouth or in the extremities
- Diarrhea
- Muscle numbness
Treatment
- Oral or IV calcium supplements
- Diet (calcium, vitamin D, protein)
- Anticipate tracheostomy (laryngeal spams)
magnesium
normal level, whats it used for
Magnesium (serum 0.65 to 1.05 mmol/L)
50% to 60% contained in bone.
Regulated by GI absorption and renal excretion
Kidneys conserve magnesium in times of need and excrete excess
metabolism of protein and carbohydrates
Manifestations often mistaken for calcium imbalances
Related to calcium and potassium balance
Important for normal cardiac function
hypermagnesemia
causes, manifestations, treatment
Hypermagnesemia (>1.05 mmol/L)
Caused by
- Increased intake or ingestion of products containing magnesium when renal insufficiency or failure is present
- Renal failure
- Adrenal insufficiency
Manifestations
- Lethargy or drowsiness
- Nausea/vomiting
- Bradycardia, hypotension
- Impaired reflexes
- Respiratory and cardiac arrest
Treatment
- IV CaCl or calcium gluconate
- Fluids to promote urinary excretion
hypomagnesemia
causes, manifestations, treatment
Hypomagnesemia (< 0.65 mmol/L)
Caused by
- alcoholism
- Fluid loss from gastrointestinal tract
- Prolonged parenteral nutrition without supplementation
- Diuretics
- DKA
Manifestations
- Skeletal muscle weakness
- Hyperactive deep tendon reflexes
- Numbness and tingling
- Painful muscle contractions
- Decreased GI motility and nausea
Treatment
- Diet
- Oral supplements
- Parenteral IV magnesium when severe
phorphorus
Phosphorus (serum 1.0 to 1.5 mmol/L)
Activates vitamins and enzymes
Forms ATP for energy supplies
Assists in cell growth and metabolism
Maintains acid-base balance
Maintains calcium homeostasis
hyperphosphatemia
Hyperphosphatemia (>1.5 mmol/L)
Caused by
- Renal failure
Manifestations
- Same as hypocalcemia
- Muscle cramps
- Tetany
- Perioral numbness and tingling
- Bone and joint pain
Treatment
- Phosphate binders (e.g. calcium acetate)
- Diet low in phosphorus
hypophophatemia
Hypophosphatemia (<1.0 mmol/L)
Caused by
- Alcohol withdrawal
- Recovery from diabetic ketoacidosis
- TPN
- Glucose administration
- Malabsorption syndrome
Manifestations
- Decreased cardiac output
- Weak peripheral pulses
- Skeletal muscle weakness
Treatment
- Diet high in phosphorus
- Vitamin D Supplements
- Oral or IV calcium (e.g. calcium carbonate)
- Sodium phosphate
