Electrolytes - Pharmacotherapy

Front 1

Na normal lab values

Back 1

135-145 mEq/L

Front 2

what is considered hyponatremia?

Back 2

<135 mEq/L

Front 3

what is considered hypernatremia?

Back 3

>145 mEq/L

Front 4

what Na levels are considered severe hypo?

Back 4

110-115 mEq/L

Front 5

what are some symptoms of severe hyponatremia?

Back 5

Modern sxs +- resp arrest, restlessness, seizure, coma, death

Front 6

what are the levels of moderate hyponatremia and the symptoms?

Back 6

115-125 mEq/L (moderate)

nausea, HA, malaise, lethargy

Front 7

what are the levels of mild hyponatremia? and symptoms

Back 7

125-130 mEq/L

usually asymptomatic

Front 8

what is the most common electroylyte abnormality in hospitalized patients?

Back 8

hyponatremia

Front 9

what are the three types of hyponatremia?

Back 9

1. isotonic
2.hypertonic
3.hypottonic

Front 10

what are the 5 most common electrolytes in the body?

Back 10

Na, K Ca, Mg, Phos

Front 11

what % of a 70kg male is water?

Back 11

Total body water (TBW) = 60%

Front 12

TBW :
2/3 of TBW is where?
1/3 of TBW is where?

Back 12

2/3 intracellular
1/3 extracellular

Front 13

what are the normal range of serum osmolality?

Back 13

280-290 mOsm/kg (isotonic)

Front 14

what values are considered elevated osmolality?

Back 14

>290 mOsm/Kg hypertonic

Front 15

what values are considered Low osmolality?

Back 15

<280 mOsmo/kg

Front 16

What are some some causes of hyponatremia?

Back 16

1. extra renal losses - diarrhea vomiting
2. renal losses - diuretics
3.edematous states - CHF, cirrhosis, renal failure
4. others - SIADH
-increase release of or increase sensitivity of ADH

-causes - disorders of CNS or lucgs and drugs

Front 17

what are some drugs that can cause hyponatremia

Back 17

ssri, antineoplastics, neuroleptics, nsaids

Front 18

what are some treatment methods of mild to moderate (125-130, 115-125) hypoantremia?

Back 18

water restriction (<1-1.2 L/day)

0.9% NaCl IV solution

Front 19

what treatment is most effective in patients with hypovolemic hypotonic hypoatremia?

Back 19

0.9% NaCl IV solution

Front 20

when giving NaCl IV, you do not want to increase Na by > than what value in 24 hrs?

Back 20

12 mEq/L

Front 21

what syndrome might occur if you increase the Na by >12 mEq/L in 24 Hrs?

Back 21

osmotic demyelination syndrome - loss of fluid from central nervous system

Front 22

t/f
recovery from hyponatremia will take 4 days?

Back 22

false, up to 48 hrs

Front 23

what is a common treatment of moderate to severe (115-125, 110-115) hyponatremia?

Back 23

0.9% or 3% NaCl IV +/- loop diuretic until severe symptoms resolved

Front 24

what % NaCl IV is preferred in SIADH?

Back 24

3%

Front 25

what % NaCl IV is preferred if the patient is hypervolemic, hypotonic, hypoatremia?

Back 25

3%

Front 26

what is the maintance dose for Demeclocycline?

Back 26

600-900 mg/day in divided doses

Front 27

what are some SE of demecocycline?

Back 27

nausea, photosensitivity, nephrotoxicity

Front 28

what is Demeclocycline used for?

Back 28

SIADH (a type of severe hyponatremia 110-115

Front 29

what is the MOA of Demeclocycline?

Back 29

inhibits tubulare effects of ADH

Front 30

NaCl tablets are also a form of treatment for hyponatremia, how many mmol of Na and Cl are in each tablet?

Back 30

17 mmol of Na and 17 mmol of CL

Front 31

t/f
Hypernatremia is usually a result of an intracellular H2O deficit relative to Na content

Back 31

false, f
Hypernatremia is usually a result of an extracellular H2O deficit relative to Na content

Front 32

what are the two main causes of hypernatremia?

Back 32

net water loss
-unreplaced insensible losses, diabetes, diuretics, vomiting , diarrhea, burns
and

hypertonic Na gain
-hypertonic sodium bicarbonate infusion, ingestion of NaCl, hypertonic dialysis

Front 33

what are some symptoms of hypernatremia?

Back 33

weakness, lethargy, thirst, irritability, hypereflexia, twitching, seizures, coma, death

Front 34

t/f
a treatment of hypernatremia would be to give a patient 0.9% NaCl and 0.45% NaCl


Hypotonic is relative to hypernatremic plasma so give 0.9% NaCl

treat hypernatremia with 0.9% NaCl, 0.45% NaCl, or 5% dextrose H2O

Back 34

true, used both for hypernatremia and hyponatremia

Front 35

what percent dextrose would you use to treat Hypernatremia?

Back 35

5% dextrose

Front 36

t/f when replacing fluid in hypernatremia, you should do it no faster than ___ hr period or ___ meq/per day

Back 36

48 hr period or 10 meq/per day

Front 37

t/f

Diabetes insipidis cause hypernatremia?

Back 37

trueeeeewwww

Front 38

what do you use to treat diabetes insipidis in?

Back 38

desmopressin (monitor for hyponatremia)

also might be able to treat with thiazide b/c paradoxal effect

Front 39

SIADH is caused by an increase in release or increase in sensitivity to ___


SIADH is a cause of hypo/hyper ??-natremia

Back 39

ADH

hypoatremia

Front 40

what diuretic should be used for hypernatremia if the pt suffers from Diabetes Insipidis

Back 40

thiazide diuretic

Front 41

t/f

NSAIDS and amiloride can be used to treat hypernatremia

Back 41

true

Front 42

t/f
Hypernatremia is always associated with hypotonicity?

Back 42

false,
hypertonicity

Front 43

what is the most abundant cation in the body?

Back 43

K

Front 44

t/f
98% of K is found in intracellularly

Back 44

true

Front 45

t/f

k is the most common electrolyte abnormality in hospitalized patients

Back 45

false

Na

Front 46

Na is a major osmotically active cation in the extracellular fluid?

Back 46

true

Front 47

what is the MOA of Demeclomycin (drug used to treat hyponatremia)

Back 47

inhibits ADH

Front 48

T/F
Serum K is an accurate reflection of total body K

Back 48

false, Serum K is NOT an accurate reflection of total body K

Front 49

General rule: 1 meq/L =/~ ______ meq total body K

Back 49

100-150

Front 50

what value is considered hypokalemia?

Back 50

<3.5 mEq/L

Front 51

what value is considered hyperkalemia?

Back 51

>5.0 mEq/L

Front 52

what is considered severe hyperkalemia?

Back 52

>7.0 mEq/L

Front 53

what is considered severe hypokalemia?

Back 53

<2.5 mEq/L

Front 54

what K range should be maintained in pts with HTN, CHF, or cardiac arrhythmias?

Back 54

4-5 mEq/L
-----------------------
normal values = 3.5-5

Front 55

what is considered an extra renal K loss?

Back 55

Vomiting, diarrhea, laxative abuse

Front 56

t/f
Mg depleting drugs cause hyperkalemia?

Back 56

false
hypokalemia

so increase loss of Mg , increase loss of K

Front 57

t/f
digoxin overdose causes hypokalemia?

Back 57

false, causes hyperkalemia

Front 58

t/f
hyperthyroid causes hypokalemia

Back 58

true

Front 59

what is the most common cause of hypokalemia?

a) inadquate PO intake
B)transcellular K shift
c)increased renal K loss
d)extra renal K loss

Back 59

D-extra renal K loss

Front 60

Drugs-diuretics , glucocorticoides , ATBs, Mg depleting drugs all cause hypokalemia by :

a) inadquate PO intake
B)transcellular K shift
c)increased renal K loss
d)extra renal K loss

Back 60

c) increased renal K loss

Front 61

drugs such as B-adrengeric agonists, catecholamines, decongestants, insuline cause hypokalemia how?
a) inadquate PO intake
B)transcellular K shift
c)increased renal K loss
d)extra renal K loss

Back 61

b) transcellular K shift

Front 62

cramping, weakness, malaise, myalgias are all symptoms of hyper or hypo kalemia?

Back 62

hypokalemia

Front 63

what level of K do symptoms usually appear in hypokalemia?

Back 63

<3 mEq/L

Normal value = 3.5-5 mEq/L

Front 64

cardiac arrhythmias can be seen in hypo or hyper kalemia?

Back 64

hypokalemia

Front 65

ACE and B-blockers and ARBs cause increase or decrease in K?

Back 65

increase

Front 66

at what level would you initiate replacement K therapy?

Back 66

<3 mEq/L

normal value- 3.5 - 5 mEq/L

Front 67

what are the three K supplements that are Rx?

Back 67

Chloride, bicarbonate, phosphate

Front 68

what is the dose of Rx K supplements?

Back 68

20mEq/day(preventative)

Front 69

what is the maintenance dose of Rx K supplements?

Back 69

Maintenance: 40-100 mEq/day tid/qid

preventative dose=20 mEq/day

Front 70

what is the one OTC salt substitute used to treat hypokalemia (yes, we use a salt substitute to treat hypokalemia) and how many mEq/G does it contain?

Back 70

choride salt - 12mEq/G

note: effective but increased risk of hyperkalemia due to improper management/followup

Front 71

when should parenteral replacement be used in hypokalemia?

Back 71

when levels are <2.5 meq or when intolerant to po Rx

normal levels= 3.5 -5

Front 72

t/f
when treating hypokalemia, saline admixture is preferred over dextrose in parentral replacement

Back 72

true

Front 73

what is the infusion rate for parenteral K replacement?

Back 73

10-20 meq/hr with constant ECG monitoring

Front 74

when treating hypokalemia you should ensure adequate ___ stores in all pts

Back 74

Mg

Front 75

saline admixture is preferred over dextrose in the treatment of what?

Back 75

parenteral replacement in hypokalemia

Front 76

what are the treatment strategies of electrolytes?
(4)

Back 76

1-correction of reversible factors
2-correct volume abnormalities
3-treatment of underlying associated disease states
4-correction of electrolyte abnormalities

Front 77

hyponatremia is largely a result of abnormalities of ___

Back 77

water disposition

treat with water restriction, 0.9% NaCl, 3% NaCl, Demeclocycline

Front 78

keep point**

keep potassium levels around what for pts with HTN, CHF, or cardiac arrhythmias

Back 78

4-5 meq/L

Front 79

*key point
never give an IV K ____

Back 79

undiluted or "push"