Metabolic Emergencies Flashcards
Osmolarity =
2*NA + glucose/20 + BUN/3
In true hyponatremia the osmolality is
decreased
hyponatremia with an osmotic pressure >295
Hypertonic hyponatremia
MCC is hyperglycemia
hyponatremia with an osmotic pressure 275-295
Isotonic hyponatremia
hyponatremia with an osmotic pressure <275
Hypotonic Hyponatremia
Causes of hypovolemic hyponatremia
Renal: urinary sodium >20
Extrarental: urinary sodium <20
SIADH causes what kind of hyponatremia typically
euvolemic hyponatremia
= hypotonic
during treatment of hyponatremia, do not raise the sodium more than ______mEq/L/hr
2
What sodium level is hypernatremia
> 150
What sodium level is hyponatremia
<135
hypervolemic hyponatremia with urinary sodium >20
renal failure
MC lyte abnormality
Hypokalemia
ECG –T wave flattening or inversion, U waves, ST depression, PVC’s, wide QRS, tachyarrhythmias
Hypokalemia
When K is <___ you should use IV replacement
2.5
admit
K>2.5 and no ECG findings significant symptoms treatment is
PO K replacement and discharge home
MCC of hyperkalemia
factitious
dt hemolysis during phlebotomy
Treatment of severe/emergent hyperkalemia
Albuterol Calcium chloride & gluconate Sodium bicarb Insulin & glucose Furosemid ~Dialysis Sodium polystyrene sulfonate
Cushings disease could be implicated in what lyte abnormality commonly
hypernatremia
EKG changes seen with hyperkalemia
prolonged PR tall peaked T waves short QT flat p waves, QRS wide become sinusoidal pattern
hypocalcemia reflexes
hyperreflexia
=Trouseeau’s sign
carpopedal spasm
Chvostek’s sign
Chovostek’s sign
contraction of the facial muscles after percussion over the facial nerve
=HYPOcalcemia
what EKG changes are seen with hypocalcemia
prolonged QT
sinus brady
heart block
VT/VF
acutely symptomatic or severe hypocalcemia treatment
IV calcium gluconated 10ml over 10-15min
hypercalcemia usually caused by
malignancy or hyperparathyroidism
stones bones moans and groans
hypercalcemia
EKG of hypercalcemia
shortened QT
widened t waves
bradys, BBB, AV blocks
Hypocalcemia treatment
Volume replacement Mithramycin- decreases levels Pamidronate- inhibits bone resorption Calcitonin Hydrocortisone ~furosemide ~dialysis if severe
what is seen on EKG with hypomagnesemia
tachys
torsades
prolonged PR and QT
tx for hypermagnesemia
calcium gluconate/chloride (antagonizes)
Furosemide + IV NS
Dialysis if very high or renal failure
pH down
HC03- down
CO2 down
Metabolic acidosis
pH up
HCO3 up
CO2 up
Metabolic alkalosis
pH down
HCO3 up
CO2 up
Respiratory acidosis
pH up
HCO3 down
CO2 down
Respiratory alkalosis
COPD likely to cause what acid base imbalance
respiratory acidosis
Asthma likely to cause what acid base imbalance
resp alkalosis
salicylate toxicity
likely to cause what acid base imbalance
Normal anion gap
10-12
causes of anion gap acidosis
Alcohol Methanol Uremia Diabetic ketoacidosis Paraldehyde Iron, Isoniazid Lactic acidosis Ethylene glycol Carbon monoxide Aspirin Toluene
MCC anion gap metabolic acidosis
lactic acidosis dt decreased oxygen to tissues
sepsis, shock
diarrhea associated with what acid base imbalance
losing bicarb
=non AG metabolic acidosis
osmolar gap
difference between measured and calculated – normal < 10
Bicarb is given in metabolic acidosis if
<7.2
not responding to measures and myocardial irritability
if alcoholic and hypoglycemic
give thiamine IV before dextrose to prevent Wernicke-Korsakoff syndrome
if pt isn’t awake and cant establish IV with hypoglycemia
glucagon IM
effective in 10min
tx in sulfonylurea induced hypoglycemia
octreotide SQ
DKA labs
can do venous BG (vs ABG)
venous is 0.03 less than arterial
order or priorities in treatment of DKA
Volume NS, glucose to 250 then D% Potassium correction replace if <5.3 follow q2hrs Insulin drip follow q1hr
hyperosmolar hyperglycemic state seen in
DMII (most commonly)
glucose >600 Osmolality >315 bicarb >15 pH >7.3 ketones neg- few
hyperosmolar hyperglycemic state
thyrotoxicosis is
excess circulating hormone from any cause
AMS
ophthalmoplegia
gait ataxia
Wernicke-Korsakoff syn
