Medicine (Electrolyte/Acid-Base) Flashcards
What happens if acidosis and alkalosis?
-Acidosis: Hypotension, hypoxia, hyperkalemia, CNS depression
-Alkalosis: Hypoxia, hypokalemia, hypocalcemia
What are causes of ion gap metabolic acidosis?
-MUDPILERS
-Methanol ingestion
-Uremia
-Diabetic ketoacidosis
-Paraldehyde
-Iron
-Lactic acidosis
-Ethanol
-Rhabdomyolysis
-Salicylate/aspirin ingestion
What are causes of non-ion gap metabolic acidosis?
-GI losses of HCO3 (diarrhea)
-Dilutional (NaCl overload fluids)
What are causes of metabolic alkalosis?
-Increase in bicarbonate
-Diuretics
-GI (vomiting)
How do you manage a patient with acid-base disorders?
-Correct underlying cause if possible
-Avoid succinylcholine (in hyperkalemia)
-Increased bleeding
How is hyponatremia corrected?
-Slowly
-8 mEq/L in a 24h period
-Otherwise can have osmotic demyelination syndrome
How is hypernatremia corrected?
-Correct hypovolemia first with normal saline, then 5% dextrose in 0.45% saline.
-Do this slowly to prevent cerebral edema
How is hypokalemia treated?
-Treat magnesium at same time
-Oral potassium or IV potassium
-Monitor EKG during
How is hyperkalemia treated?
-Calcium gluconate
-10U insulin with D50
-Bicarb
What are SSRIs?
-Selective serotonin reuptake inhibitors
-More serotonin/neurotransmission
-Citalopram, escitalopram, paroxetine, setraline
What are SNRI’s?
-Selective serotonin-norepinephrine reuptake inhibitors
-Duloxetine, venlafaxine
What are TCAs?
-Tricyclic antidepressants
-Prevent reuptake of serotonin and norepinephrine
-Amitriptyline
What is lithium?
-Mood stabilizer
-Narrow therapeutic index
-Pt can have cardiotoxicity
What is seratonin syndrome?
-Adverse drug reaction producing excess serotonergic effects of the CNS
-Mental status, neuromuscular activity, autonomic function
-HTN, diarrhea, tachycardia, hyperthermia, diaphoresis
-Treat with lorazepam for agitation, methysergide to counteract seratonin, labetalol, cyproheptadine
How are depression patients managed?
-Avoid fentanyl, tramadol, odansetron
-EKG
-Caution with ketamine
How are anorexia/bulemia patients managed?
-EKG, CBC, BMP, LFTs
-Increase NPO period
-Pt more susceptible to anesthesia, titrate slowly
What is neuroleptic malignant syndrome?
-Potentially fatal complication of dopamine agonist due to depletion of dopamine in the CNS
-Rigidity, altered mental status, pyrexia, elevated creat kinase, DIC, respiratory failure
How is NMS treated?
-Withdrawal of the dopamine antagonist offending agent
-Support
-Replenish electrolytes
-Control BP
-Benzo for agitation
-Bromocriptine
How is a schizophrenia patient managed?
-EKG to assess QT interval
-Assess for substance abuse
-Avoid ketamine
