Renal #4 (Na, K, Ca, Mg)

Question 1

What is the definition of hyponatremia?

What are some symptoms?

Answer 1

-Serum sodium < 135 due to increased free water

-Neuro symptoms (due to cerebral edema): confusion, lethargy, fatigue, seizures, coma, muscle cramps

Question 2

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

Answer 2

-Hypovolemic: Diuretics, ACEi, GI loss, burns, fever

-Isovolemic: SIADH, hypothyroidism MDMA

-Hypervolemic: Edematous states (CHF, Cirrhosis, Nephrotic Syndrome)

Question 3

Correction of serum sodium > 0.5 mEg/L/hour can lead to _____________ leading to permanent neurologic damage.

Answer 3

Central pontine myelinolysis (demyelination)

Question 4

What treatments should you give in the following instances for hyponatremia?
1) Isolvolemic:
2) Hypovolemic:
3) Hypervolemic:
4) Severe (seizures, coma):

Answer 4

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

Question 5

On the other hand, hypernatremia, which is defined as ________________, has etiologies such as

Answer 5

Serum sodium > 145 due to increased free water loss

etiologies: diarrhea, diuretics, sweating, diabetes insipidus, burns, fever

Question 6

Symptoms of hypernatremia

Answer 6

-Neuro symptoms: thirst, confusion, lethargy, disorientation, vomiting, weakness, seizures, coma, brain damage

From brain cell shrinkage

Question 7

What else is seen on physical exam in a patient with hypernatremia?

Answer 7

Dehydration: dry mouth, decreased skin turgor, tachycardia, hypotension

Question 8

Hypernatremia is almost always associated with ______ in lab studies. What does this mean?

Answer 8

Hyperosmolality (blood is drawing water out of other organs) = high concentration of salt and glucose

Question 9

Treatment for hypernatremia

Answer 9

-Hypotonic fluids (pure water, D5W, NS, 0.2% saline) Oral

Question 10

Again, what can rapid correction of serum sodium (>0.5 mEq/L/hr) lead to?

Answer 10

Cerebral edema (central pontine myelinolysis)

Question 11

Normal K+ intracellular is _______

Answer 11

3.5 - 5

Question 12

Etiologies of hypokalemia

Answer 12

-Urinary or GI losses: diarrhea, vomiting, diuretic therapy
-Increased K shift: Metabolic alkalosis, insulin, Hypothermia
-Hypomagnesemia: spills K into urine
-Hyperthyroidism

Question 13

Symptoms of hypokalemia (what does it do)

Answer 13

-Affects cardiac conduction and muscle contraction
–Severe muscular weakness, decreased DTR’s, ileus, n/v
-Polyuria
-Palpitations, arrythmias

Question 14

What does hypokalemia do to an ECG?

Answer 14

T wave flattening and prominent U wave

Question 15

Treatment for hypokalemia

Answer 15

-Oral potassium chloride

-May need to replete magnesium as well

Question 16

Etiologies of hyperkalemia

Answer 16

-Pseudohyperkalemia: hemolysis, venipuncture
-Acute or Chronic Renal Failure
-ACE, ARBs, Spironolactone, Eplerenone
-K+ Supplementation, NSAIDs
-Metabolic Acidosis (DKA)
-Rhabdomyolysis

Question 17

The symptoms for hyperkalemia and hypokalemia are the same. It affects cardiac conduction and muscle contraction. However, what does hyperkalemia do to an ECG?

Answer 17

-Tall, peaked T waves, wide QRS, P wave flattening, sine wave

Question 18

Management for hyperkalemia if significantly elevated or ECG Changes

Answer 18

-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)

Question 19

Hypocalcemia MCC

Normal Calcium levels are ______

Answer 19

Hypoparathyroidism

9 - 10.5

Question 20

Symptoms of hypocalcemia

Answer 20

-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

Question 21

What does hypocalcemia do to an ECG

Answer 21

Prolonged QT interval

Question 22

Treatment for hypocalcemia

Answer 22

-Mild: Oral Calcium + Vitamin D
-Severe or Symptomatic: IV Calcium gluconate or IV Calcium Carbonate

Question 23

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)

Answer 23

-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

Question 24

What happens to the ECG in hypercalcemia?

Answer 24

Shortened QT interval

Question 25

Treatment for hypercalcemia

Answer 25

-Mild: increase water intake
-Moderate (12-14): IVF, IV Loop Diuretics, Calcitonin + Bisphosphonates if malignancy

Question 26

Hypermagnesemia is are in the absence of _______.

However, what are other causes of this…

Answer 26

-Renal insufficiency

Others: Lithium, Excess IV Magnesium Administration (Torsades, Eclampsia, Asthma, etc.)

Question 27

Symptoms of hypermagnesemia

Answer 27

-Decreased DTR’s
-Weakness
-Respiratory depression
-Bradycardia and hypotension: increased Mg has CCB effects and decreases conduction of the heart

Question 28

Treatment for hypermagnesemia:

-Mild: cessation of Mg+ sources will correct itself
-Severe:________

Answer 28

IV Calcium gluconate stabilizes the cardiac membranes

IVF + Furosemide to enhance Mg+ excretion in the kidneys

Dialysis if severe or refractory

Question 29

On the other hand, hypomagnesemia has etiologies such as

Answer 29

-GI loss: malabsorption, chronic Alcoholism, Celiac, Prolonged diarrhea
-Thiazide and Loop Diuretics
-PPI (Omeprazole), Amphotericin B

Question 30

Symptoms of hypomagnesemia

Answer 30

-Similar to hypocalcemia: tetany, increased DTR’s, Trousseau, Chvostek, Tremor, Cramps, AMS
-Palpitations, Dementia

Question 31

Treatment for hypomagnesemia
-Mild:
-Severe:

Answer 31

Mild: Oral Magnesium Oxide

Severe: IV Mag Sulfate

Question 32

True or False: Hypocalcemia or Hypokalemia may be indued by hypomagnesemia and may be refractory to correction until magnesium is repleted.

Answer 32

True