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Pathophysiology > McCarthy: K+, Ca+, Mg > Flashcards

McCarthy: K+, Ca+, Mg Flashcards

1
Q

Albumin is __ grams in reference to calculating the corrected calcium

A

4g

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2
Q

normal lab value: total Ca+, ionized Ca+

A

total: 8.5 – 10.5 mg/dl
ionized: 4.6-5.1 mg/dl

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3
Q

normal lab value: phosphorous

A

2.5-4.5 mg/dl.

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4
Q

what kind of Ca is biologically active?

A

only free (ionized) is biologically active

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5
Q

effect on/from Ca and/or K balance? D50

A

aka glucose(dextrose + H2O)

  • used to txt hyperKalemia, can cause hypoKalemia
  • increase blood sugar (given with insulin)- if hyperkalemia is bad enough, very acidodic
  • give w/out insulin, the body would produce insulin and drive K+ into cells
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6
Q

effect on/from Ca and/or K balance? insulin

A

txt hyperKalemia

- helps drive K+ into cells

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7
Q

effect on/from Ca and/or K balance? Kayexelate

A
  • used to txt hyperKalemia
    -binds K+ in GI and excretes it in feces
    Removal of K+ takes time, so short term tx strategies involve temporary shifts of K+ from extracellular to intracellular compartment
    (kayexalate = cation exchange resin)
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8
Q

effect on/from Ca and/or K balance? albuterol

A
  • used to txt hyperKalemia
    -drives K+ into the cells
    (via increasing activity of Na/K-ATPase pump)
    ( B2 agonist )
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9
Q

effect on/from Ca and/or K balance? calcitonin

A

txt hyperCalcemia by inhibiting bone resorption

osteoclast inhibitor

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10
Q

effect on/from Ca and/or K balance? bicarbonate

A

txts hyperKalemia
(when caused by acidosis)
-Acidosis: H+ in ECF, it enters cell to buffer, K+ leaves cell to balance. there is then DECREASED driving force for K+ secretion = hyperkalemia
*can cause slight alkalosis

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11
Q

effect on/from Ca and/or K balance? CCBs

A

if you see on test, this is a WRONG answer

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12
Q

effect on/from Ca and/or K balance? ARBs

A

txt hypoKalemia

-raises blood potassium

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13
Q

effect on/from Ca and/or K balance? ACE-Is (lisinopril)

A

txt hypoKalemia

-raises blood potassium

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14
Q

effect on/from Ca and/or K balance? prednisone

A

increases urinary losses of potassium (hypokalemia)

-manifests in people with too much cortisol (cushing’s- causes hypokalemia)

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15
Q

effect on/from Ca and/or K balance? Digoxin

A

worry about increased digoxin toxicity with hypoKalemia (when on diuretic and digoxin- can get hypoKalemia and a fatal arrhythmia)
-WONT drive K in or out of cell specifically. it inhibits the Na/K atpase pump- inhibiting K from going into the extracellular space
(not used much anymore)

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16
Q

effect on/from Ca and/or K balance? TZD (hydrochlorothiazide)

A

can CAUSE hypokalemia
-acts on the early distal tubule cells (upstream of principle cells) = increase Na+ delivery to principle cells= more Na+ reabs. here and more K+ secreted.

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17
Q

effect on/from Ca and/or K balance? K+-sparing diuretics

spironolactone/triamterene

A
  • can CAUSE hyperkalemia
  • Acts on early distal tubule cells and collecting duct principal cells.
  • Should be avoided in renal dysfunction patients.
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18
Q

effect on/from Ca and/or K balance? loop diuretics (lasix/furosemide)

A
  • can CAUSE hypokalemia

- Acts on thick ascending loop of Henle

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19
Q

effect on/from Ca and/or K balance? loop diuretics (lasix/furosemide)

A
  • can CAUSE hypokalemia

- Acts on thick ascending loop of Henle

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20
Q

normal lab values: Mg

A

1.8 – 2.7 mg/dl

21
Q

overall: increased Na+ delivery to principle cells causes what effect on K+?

A

increased K+ excretion

22
Q

*With the exception of metolozone, thiazide diuretics are not effective in what pts?

A

pt w/ renal insufficiency (GFR < 30)

23
Q

what disorders can cause increased PTH?

A
  • primary hyperparathyroidism
  • pseudohypo-parathyroidism
  • chronic renal failure
  • vit D deficiency
24
Q

what disorders can cause decreased PTH?

A
  • surgical hypo-parathyroidism

- humoral hypercalcemia of malignancy

25
Q

what disorders can cause increased serum Ca+ ?

A
  • primary hyperparathyroidism

- humoral hypercalcemia or malignancy

26
Q

what disorders can cause increased serum Ca+, and decreased serum phosphate ?

A
  • primary hyperparathyroidism

- humoral hypercalcemia or malignancy

27
Q

what disorders can cause decreased serum Ca+, and increased serum phosphate?

A
  • surgical hypo-parathyroidism
  • pseudohypo-parathyroidism
  • chronic renal failure
28
Q

how can you tell the difference between chronic renal failure and vit D deficiency?

A

BOTH: increased PTH, low Ca+
chronic renal failure: high phosphate
vit D def.: low phosphate

29
Q

what disorders have increased urine cAMP?

A
  • primary hyperparathyroidism
  • humoral hypercalcemia or malignancy
    (same as those with increased Ca+ and decreased phosphate)
30
Q

what disorders have decreased urine cAMP?

A
  • surgical hypo-parathyroidism
  • pseudohypo-parathyroidism
    (same as those with decreased Ca+ and increased phosphate - except renal failure)
31
Q

what is primary hyperparathyroidism?

A

is a disorder of one or more of the parathyroid glands
- The parathyroid gland(s) becomes overactive and secretes excess amounts of parathyroid hormone (PTH).
= blood Ca+ rises to a level that is higher than normal (called hypercalcemia).

32
Q

what is surgical hypoparathyroidism? symptoms?

A

symptoms post-neck surgery: check symtpoms of hypoparathyroidism (may be sign of destruction of parathyroid)
-neural irritability : tingling, numbness, parasthesias (b/c easier to depolarize).

33
Q

hyperventilation (maybe weeds)

-how does it effect Ca+ and PTH

A

blowing off CO2 = alkalotic … leads to tingling, numbness, parasthesias (from decr. ionized Ca+)
when pH normal- there is competition between neg. charges, H+ and Ca+. but if you dec. H+ ion conc, theres a greater chance for Ca+ to bind vacant albumin- then you DO have decr. ionized Ca+ (serum)
—> but PTH should respond and correct this.

34
Q

txt for decreased ionized Ca+ from hyperventilation (if PTH doesn’t respond and correct it) ?

A

TXT with Calcium and active form of vit D (1,25 dihydroxycholecalciferol)

35
Q

what is pseudohypoparathyroidism?

A

parathyroid is normal
looks like surgical hypoparathyroid except PTH also high
receptors on the bones and kidney in target tissue.
-you have normal/high PTH but its not working on the receptors of target tissue

36
Q

what is humoral hypercalcemia of malignancy?

A

humoral hypercalcemia of malignancy- most common kind of hypercalcemia- lung cancer (squamous cell carcinoma)
tumor acts just like PTH - activates receptors in bone and kidney - hyperCa and decr. phos
increased urine cAMP

37
Q

chronic renal failure

A

decrease GFR = incr. serum phosphorous ( and inverse relationship with calcium so you get hypocalcemia)
-naturally stimulate PTH

38
Q

txt for primary hyperparathyroidism

A

txt with surgery (remove parathyroid glands)
medical txt: txt underlying disease. hyperCa+ makes them volumed depleted so txt with saline to restore volume, txt with lasix (block Na+ reabs so you dont get Ca+ reabs. = calcium diuersis to lower Ca+)- once they are hydrated, then give IV bisphosphonates.
goal to prevent initial hyperphosphatemia- give calcium carbonate (binder) - so complex is not absorbed.

39
Q

txt for surgical hypoparathyroidism

A

calcium and activated form vitamin D (1,25)

40
Q

txt for humoral hypercalcemia of malignancy

A

hyperCa+ makes them volumed depleted so…

  • txt with saline to restore volume
  • txt with lasix (block Na+ reabs so you dont get Ca+ reabs. = calcium diuersis to lower Ca+)
  • once hydrated, txt w/ IV bisphosphonates.
41
Q

txt chronic renal failure

A

goal: prevent initial hyperphosphatemia

- give calcium carbonate (binder) - so complex is not absorbed.

42
Q

Urinary potassium excretion, is primarily determined by secretion where?

A

in the principal cells in the cortical collecting tubule

43
Q

how does aldosterone effect K+ excretion?

A

increases K + excretion

44
Q

metabolic acidosis (and hyperosmolarity) cause of K+ shifts into or out of cells?

A

shifts K OUT of cell, causing hyperkalemia

45
Q

alkalosis and (hypo-osmolarity) both cause K+ to go into or out of the cell?

A

shifts K+ INTO cell , causing hypokalemia

46
Q

insulin deficiency causes what change to K+?

A

hyperkalemia (b/c can’t be driven into cells)

47
Q

decrease in GFR causes what change in K+? how does this happen? what are two causes of this?

A

hyperkalemia
- b/c diminished Na+ and H2O delivery to distal tubule (principal cells)
(decrease GFR causes- renal failure or severe CHF - w/ volume depletions)

48
Q

low aldosterone (hypoaldosteronism) has what effect on K+? what drugs may cause this?

A

hyperkalemia
(NSAIDs, ACEs, spironolactone, etc.)
- also primary adrenal insufficiency

Pathophysiology (28 decks)

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