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72 Cards in this Set
- Front
- Back
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What is the order of correction when electrolytes and body fluids are abnormal?
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Volume
pH Potassium, Calcium, Magnesium Sodium and Chloride - Tissue perfusion often corrects the imbalance |
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Fluid that contains NaCl, has the same osmolarity as the serum, is the only fluid that can be given in same line as blood components?
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Normal Saline
BEST for volume replacement |
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Components of Lactated Ringer's?
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Na, Cl, K, Ca, lactate
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Characteristics of D5W
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Contains 5% Dextrose
Is hypotonic - NEVER can be used to replace volume |
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D51/2NS is for?
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Maintenance
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Classic components of a typical Pt history with dehydration
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V/D, fever
↓ intake Chronic disease |
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What are the early physical exam findings of dehydration?
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Dry MM, ↓ skin turgor
Decreased capillary refill Shrunken tongue Tachycardia and hypotension (late findings) Lethargy and coma (omnious signs and red flag for a significant comorbid condition) |
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What are the common lab findings in dehydration?
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Lab values are NOT reliable
Plasma and serum osmolarity are the BEST |
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What changes in BUN/Cr and H/H do you expect to see in a pt with dehydration?
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BUN/Cr > 20:1 indicates severe hydration and is a sign of azotemia
H/H increases |
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Most common presentations of volume overload?
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Edema: central or peripheral
Respiratory distress: from pulmonary edema JVD: secondary to CHF |
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What are the risk factors for volume overload?
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Renal disease
Cardiovascular disease Liver disease |
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T or F: Volume overload Pt's are always hypertensive.
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False - Pts can be hypotensive or hypertensive, This is due the third space effect.
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What are the components of the calculated osmolarity? How is this number used?
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Na
Glucose BUN EtOH Compare calculated and measured osmolarity to determine the osmolar gap |
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What does a value that falls outside the normal range of the calculated osmolarity indicate?
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Indicative that something other than Na, glucose, BUN, and EtOH are in the serum that are producing the osmol gap (big clue for your DDx)
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What does a osmol gap that falls within the normal range indicate?
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That indeed Na, glucose, BUN and EtOH are the major dissolved ions in the serum
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At what Na+ concentration do the symptoms of hyponatremia arise?
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Around 120 or less
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What is the diagnostic value of hyponatremia?
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<135
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SxS of hyponatremia?
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HA, agitation, confusion, seizures
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What is the most important issue to address in a Pt with hyponatremia?
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Correcting the volume deficit SLOWLY with NS
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When would Hypertonic saline (3%) be appropriate in the treatment of hyponatremia and how would it be given?
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Severe CNS changes
Given with furosemide to reduce CPM |
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What are the consequences of rapid correction in a Pt with hyponatremia?
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Central Pontine Myelinolysis (CPM)
CHF |
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What is the MCC of hyponatremia
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Dilutional
ex: Baby comes into ER having seizures - formula was diluted with water |
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What happens to the osmolarity in true hyponatremia?
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True Hyponatremia ↓ osmolarity
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Diagnostic value of hypernatremia
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>150
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When do Sxs of hypernatremia present?
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>350
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What is the MCC of hypernatremia
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Loss of total body water from decreased intake or increased loss (vomiting, diarrhea, fever, diabetes insipitus).
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1 liter deficit of the total body water causes
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increase of 3 - 5 mEq/L
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Irritability, ataxia, seizures and coma are the progression of symptoms in a Pt with
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Hypernatremia
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What is the treatment for hypernatremia?
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1. NS or Lactate Ringer
2. 1/2 NS plus furosemide to unload the body of the extra Na |
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At what rate should you correct hypernatremia?
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Very slowly: Avoid lowering Na more than 10mEq/L per day
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What is the K concentration in Hypokalemia?
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< 3.5
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When do Sxs of hypokalemia present?
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< 2.5
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What is the MCC of hypokalemia?
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Loop diuretics (lasix)
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What are the CNS, GI, cardiac, and renal sxs of hypokalemia?
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Weakness, hyporeflexia
Ileus Dysrhythmias, U waves Metabolic Alkalosis |
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95% of the K in our body is INSIDE the cells. What implication does this have on lab values?
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The measured value is only a small fraction of the true concentration.
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What is the treatment for Hypokalemia?
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Oral replacement is the BEST and faster than IV.
K is hard to replace intravascularly because at high concentration it burns the vessels. KCl in D5W at a rate of 10mEq/hour |
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Hyperkalemia
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> 5.5 mEq/L
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K > 6.5
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Peaked T waves
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K > 7.5
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Widened QRS
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K > 8.0
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Sine wave
VF Complete blocks |
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What is the most common and most deadly imbalance?
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Hyperkalemia
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What is a common cause of hyperkalemia?
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Renal failure with oliguria.
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What determines the severity of the ECG changes in hyperkalemia?
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The rate of rise
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What are the common sxs of hyperkalemia?
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Weakness, paralysis, NVD
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How should you work up a pt with suspected hyperkalemia?
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ECG
Electrolytes Ca, Mg ABG's (looking for acidosis) UA Dig level in appropriate pts |
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What are the temporary treatment measures that should be done immediately in a pt with hyperkalemia?
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Ca gluconate
Insulin and glucose Sodium and bicarb Albuterol |
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What is the definitive treatment of hyperkalemia?
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Kayexalate - binds to the K+ and drives it out via the stool
Furosemide - help ↑ secretion of K Digi-bind Hemodialysis - Needed in pts are are severely ill since the other measures take time. |
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What can cause false elevation of K?
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Cell lysis from the lab draw.
Always order labs again after an abnormal value is found. Can NOT wait until labs are confirmed to treat hyperkalemia |
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Define hypocalcemia in terms of Ca++ concentration and ionized Ca.
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Ca++ < 8.5
Ionized Ca < 2.0 Measures Ca is bound so must order ionzied Ca (physiologically active form) to determine the need for treatment. |
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What are the causes of hypocalcemia?
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Shock, sepsis, ARF, Pancreatitis, Drugs (cimetidine), Vit D deficiency
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What are they Sxs of hypocalcemia and at what concentration do they usually present?
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Paresthesias
Increased DTR (chvostek, and Trousseau signs) Weakness Seizures |
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What is the ECG finding associated with hypocalcemia?
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Prolonged QT
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What is the treatment for asymptomatic hypocalcemia vs. symptomatic?
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No sxs: Calcium gluconate and vitamin D
Sxs: Calcium chloride IV |
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Define hypercalcemia
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Ca > 10.5
Ionized Ca > 2.7 |
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PTH ____________ Ca and _________ PO4.
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PTH ↑ calcium and ↓ Po4.
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Calcitonin ________ calcium
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↓ calcium
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MCC of hypercalcemia?
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Hyperparathyroidism
Malignancies |
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PAM P. SCHMIDT - causes of hypercalcemia?
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PTH
Addisons MM Paget's Sarcoid Cancer Milk alkali syndrome Immobilization Increased vit D Thiazides |
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What are the signs of hypercalcemia?
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Stones: renal calculi
Bones: bone destruction secondary to malignancy Psychic moans: lethargy, weakness, fatigue, confusion Abdominal groans: abd pain, constipation, polyuria and polydyspia? |
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When is treatment indicated for hypercalcemia?
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Ca > 12
Symptomatic ARF |
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First line treatment in hypercalcemia?
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IVF! this is often all you need
Furosemide |
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What should be considered in a pt with an underlying endocrine disorder that is being treated for hypercalcemia?
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Calcitonin and hydrocortisone
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Lab diagnosis of hypomagnesemia?
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Can NOT be made on labs - total depletion of Mg can occur before any abnormalities appear
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When should you suspect hypomagnesemia?
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*ALCOHOLICS
poor nutrition pancreatitis |
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What are the Sxs of hypomagnesemia?
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Depression, vertigo, ataxia, increased DTR, Dyshythmias
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What ECG findings are associated with hypomagnesemia?
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QT prolongation
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What is the first step in the assessment/treatment of hypomagnesemia?
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Correct volumume
Correct potassium or Ca |
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An alcoholic experiencing DT's and hypomagnesemia should be treated with
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Mg 2 mg
MONITOR DTR's Stop treatment once DTR's are gone |
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What are the causes of hypermagnesemia?
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ARF with antacids or lithium
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Progressive Sxs of hypermagnesemia?
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Absent DTR's (>3.5)
Muscle weakness (>4) Hypotension (>5) Respiratory paralysis (>8) |
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what is the treatment for hypermagnesemia?
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NS and furosemide
If acidotic: corret with ventilation and sodium bicarb Tx symptoms with CaCl |
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What co-existing abnormalities should be suspected with hypermagnesemia?
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Co - existing ↑ in K and phosphate
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