potassium disorders and acid-base

Question 1

pt treated with furosemide has K = 2.4

Answer 1

Hypokalemia -

Question 2

causes of hypokalemia

Answer 2

shift into cells
decreased intake
excess loss - renal or GI

Question 3

majority of potassium excreted through

Answer 3

kidney

Question 4

what can cause potassium to shift into cells

Answer 4

Insulin

and beta 2 agonists like salbutamol

Question 5

2 causes of potassium loss in the urine

Answer 5

• High aldo

- High flow to ccd

Question 6

2 stimuli for aldo release

Answer 6

• increase in ECF K+ concentration

- Angiotensin 2

Question 7

clinical signs for hypokalemia

Answer 7

• weakness

- arrythmias- Vfib, Vtach

Question 8

acute management of hypokalemia

Answer 8

Give oral KCL, or IV -

Question 9

chronic management of hypokalemia

Answer 9

diet
K+ sparing diuretics
consider ACEi

Question 10

pt presents with progressive kidney disease on an ACEi, stops taking insulin, ends up

Answer 10

Hyperkalemic

Question 11

3 causes of hyperkalemia

Answer 11

shift out of cells -
increased intake
failure of kidney excretion

Question 12

what can cause K+ to shift out of cells

Answer 12

insulin deficiency
muscle necrosis
Hemolysis

Question 13

Impaired K+ excretion can be due to

Answer 13

Low flow to ccd

- Low aldo (ace i)

Question 14

ECG changes for hyperkalemia

Answer 14

small or absent P waves
Broad QRS
tall peaked T-waves

Question 15

4 principles of management of hyperkalemia

Answer 15

• stabilize myocardium
• shift K into cells
• excrete potassium
• hemodialysis

Question 16

what must you avoid in post-op and in patients with bowel obstruction or ileus

Answer 16

do not give Cation exchange resins like sodium polystyrene sulfonate
which can cause intestinal necrosis

Question 17

what acid base problem will you have in hypokalemia

Answer 17

metabolic alkalosis

Question 18

Patient with CHF, on a diuretic and hypokalemic why does he have a metabolic alkalosis

Answer 18

• acidified kidney cells
• increased excretion of NH4 - if on a diuretic
• reduced ECFV increased aldo
• high flow due to diuretic

Question 19

non- anion gap MET acidosis is often due to

Answer 19

bicarb loss - GI or renal

Question 20

osmolar gap =

Answer 20

osm (measured)- osm (calculated)

Question 21

2 causes of a high osmolar gap

Answer 21

methanol

ethylene glycol

Question 22

if you only have an AGMA

Answer 22

change in AG = change in bicarb