Renal #4 (Na, K, Ca, Mg) Flashcards
What is the definition of hyponatremia?
What are some symptoms?
-Serum sodium < 135 due to increased free water
-Neuro symptoms (due to cerebral edema): confusion, lethargy, fatigue, seizures, coma, muscle cramps
Clinically significant hyponatremia is hypotonic hyponatremia. There are three types and it is determined by volume status. Explain the following etiologies of…
-Hypovolemic
-Isovolemic
-Hypervolemic
-Hypovolemic: Diuretics, ACEi, GI loss, burns, fever
-Isovolemic: SIADH, hypothyroidism MDMA
-Hypervolemic: Edematous states (CHF, Cirrhosis, Nephrotic Syndrome)
Correction of serum sodium > 0.5 mEg/L/hour can lead to _____________ leading to permanent neurologic damage.
Central pontine myelinolysis (demyelination)
What treatments should you give in the following instances for hyponatremia?
1) Isolvolemic:
2) Hypovolemic:
3) Hypervolemic:
4) Severe (seizures, coma):
1) Isovolemic: water restriction
2) Hypovolemic: volume replacement with Normal (0.9%) Saline
3) Hypervolemic: Volum removal with Diuretics, Sodium restriction, water restriction
4) Severe: IV hypertonic saline + Furosemide
On the other hand, hypernatremia, which is defined as ________________, has etiologies such as
Serum sodium > 145 due to increased free water loss
etiologies: diarrhea, diuretics, sweating, diabetes insipidus, burns, fever
Symptoms of hypernatremia
-Neuro symptoms: thirst, confusion, lethargy, disorientation, vomiting, weakness, seizures, coma, brain damage
From brain cell shrinkage
What else is seen on physical exam in a patient with hypernatremia?
Dehydration: dry mouth, decreased skin turgor, tachycardia, hypotension
Hypernatremia is almost always associated with ______ in lab studies. What does this mean?
Hyperosmolality (blood is drawing water out of other organs) = high concentration of salt and glucose
Treatment for hypernatremia
-Hypotonic fluids (pure water, D5W, NS, 0.2% saline) Oral
Again, what can rapid correction of serum sodium (>0.5 mEq/L/hr) lead to?
Cerebral edema (central pontine myelinolysis)
Normal K+ intracellular is _______
3.5 - 5
Etiologies of hypokalemia
-Urinary or GI losses: diarrhea, vomiting, diuretic therapy
-Increased K shift: Metabolic alkalosis, insulin, Hypothermia
-Hypomagnesemia: spills K into urine
-Hyperthyroidism
Symptoms of hypokalemia (what does it do)
-Affects cardiac conduction and muscle contraction
–Severe muscular weakness, decreased DTR’s, ileus, n/v
-Polyuria
-Palpitations, arrythmias
What does hypokalemia do to an ECG?
T wave flattening and prominent U wave
Treatment for hypokalemia
-Oral potassium chloride
-May need to replete magnesium as well
Etiologies of hyperkalemia
-Pseudohyperkalemia: hemolysis, venipuncture
-Acute or Chronic Renal Failure
-ACE, ARBs, Spironolactone, Eplerenone
-K+ Supplementation, NSAIDs
-Metabolic Acidosis (DKA)
-Rhabdomyolysis
The symptoms for hyperkalemia and hypokalemia are the same. It affects cardiac conduction and muscle contraction. However, what does hyperkalemia do to an ECG?
-Tall, peaked T waves, wide QRS, P wave flattening, sine wave
Management for hyperkalemia if significantly elevated or ECG Changes
-IV Calcium gluconate to stabilize myocardium
-K+ Lowering Agents: Parenteral insulin with glucose, Beta-2 agonists (Terbutaline, Albuterol)
-IV saline with loop diuretic
-Patiromer (oral potassium binder)
Hypocalcemia MCC
Normal Calcium levels are ______
Hypoparathyroidism
9 - 10.5
Symptoms of hypocalcemia
-Increased muscle contraction, cramps, tetany
-Chvostek Sign: tapping cheek causes spasm
-Trousseau’s Sign: inflation of BP cuff causes carpal spasm
-Increased DTR’s, Seizures
What does hypocalcemia do to an ECG
Prolonged QT interval
Treatment for hypocalcemia
-Mild: Oral Calcium + Vitamin D
-Severe or Symptomatic: IV Calcium gluconate or IV Calcium Carbonate
On the other hand, hypercalcemia is a malignancy of hyperparathyroidism. What can also cause this (medications).
Name the symptoms of this condition (there is a saying)
-Thiazide diuretics (this is why this is used for osteoporosis in hypertension)
Stones (Nephrolithiasis), Bones (bone pain and fractures), Groans (ileus, constipation), Psych Moans (Depression, Anxiety)
-Hypertension, Decreased DTR’s
What happens to the ECG in hypercalcemia?
Shortened QT interval
Treatment for hypercalcemia
-Mild: increase water intake
-Moderate (12-14): IVF, IV Loop Diuretics, Calcitonin + Bisphosphonates if malignancy
Hypermagnesemia is are in the absence of _______.
However, what are other causes of this…
-Renal insufficiency
Others: Lithium, Excess IV Magnesium Administration (Torsades, Eclampsia, Asthma, etc.)
Symptoms of hypermagnesemia
-Decreased DTR’s
-Weakness
-Respiratory depression
-Bradycardia and hypotension: increased Mg has CCB effects and decreases conduction of the heart
Treatment for hypermagnesemia:
-Mild: cessation of Mg+ sources will correct itself
-Severe:________
IV Calcium gluconate stabilizes the cardiac membranes
IVF + Furosemide to enhance Mg+ excretion in the kidneys
Dialysis if severe or refractory
On the other hand, hypomagnesemia has etiologies such as
-GI loss: malabsorption, chronic Alcoholism, Celiac, Prolonged diarrhea
-Thiazide and Loop Diuretics
-PPI (Omeprazole), Amphotericin B
Symptoms of hypomagnesemia
-Similar to hypocalcemia: tetany, increased DTR’s, Trousseau, Chvostek, Tremor, Cramps, AMS
-Palpitations, Dementia
Treatment for hypomagnesemia
-Mild:
-Severe:
Mild: Oral Magnesium Oxide
Severe: IV Mag Sulfate
True or False: Hypocalcemia or Hypokalemia may be indued by hypomagnesemia and may be refractory to correction until magnesium is repleted.
True
