Medicine (Electrolyte/Acid-Base)

Question 1

What happens if acidosis and alkalosis?

Answer 1

-Acidosis: Hypotension, hypoxia, hyperkalemia, CNS depression

-Alkalosis: Hypoxia, hypokalemia, hypocalcemia

Question 2

What are causes of ion gap metabolic acidosis?

Answer 2

-MUDPILERS

-Methanol ingestion
-Uremia
-Diabetic ketoacidosis
-Paraldehyde
-Iron
-Lactic acidosis
-Ethanol
-Rhabdomyolysis
-Salicylate/aspirin ingestion

Question 3

What are causes of non-ion gap metabolic acidosis?

Answer 3

-GI losses of HCO3 (diarrhea)
-Dilutional (NaCl overload fluids)

Question 4

What are causes of metabolic alkalosis?

Answer 4

-Increase in bicarbonate
-Diuretics
-GI (vomiting)

Question 5

How do you manage a patient with acid-base disorders?

Answer 5

-Correct underlying cause if possible
-Avoid succinylcholine (in hyperkalemia)
-Increased bleeding

Question 6

How is hyponatremia corrected?

Answer 6

-Slowly
-8 mEq/L in a 24h period
-Otherwise can have osmotic demyelination syndrome

Question 7

How is hypernatremia corrected?

Answer 7

-Correct hypovolemia first with normal saline, then 5% dextrose in 0.45% saline.
-Do this slowly to prevent cerebral edema

Question 8

How is hypokalemia treated?

Answer 8

-Treat magnesium at same time
-Oral potassium or IV potassium
-Monitor EKG during

Question 9

How is hyperkalemia treated?

Answer 9

-Calcium gluconate
-10U insulin with D50
-Bicarb

Question 10

What are SSRIs?

Answer 10

-Selective serotonin reuptake inhibitors
-More serotonin/neurotransmission
-Citalopram, escitalopram, paroxetine, setraline

Question 11

What are SNRI’s?

Answer 11

-Selective serotonin-norepinephrine reuptake inhibitors
-Duloxetine, venlafaxine

Question 12

What are TCAs?

Answer 12

-Tricyclic antidepressants
-Prevent reuptake of serotonin and norepinephrine
-Amitriptyline

Question 13

What is lithium?

Answer 13

-Mood stabilizer
-Narrow therapeutic index
-Pt can have cardiotoxicity

Question 14

What is seratonin syndrome?

Answer 14

-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

Question 15

How are depression patients managed?

Answer 15

-Avoid fentanyl, tramadol, odansetron
-EKG
-Caution with ketamine

Question 16

How are anorexia/bulemia patients managed?

Answer 16

-EKG, CBC, BMP, LFTs
-Increase NPO period
-Pt more susceptible to anesthesia, titrate slowly

Question 17

What is neuroleptic malignant syndrome?

Answer 17

-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

Question 18

How is NMS treated?

Answer 18

-Withdrawal of the dopamine antagonist offending agent
-Support
-Replenish electrolytes
-Control BP
-Benzo for agitation
-Bromocriptine

Question 19

How is a schizophrenia patient managed?

Answer 19

-EKG to assess QT interval
-Assess for substance abuse
-Avoid ketamine