Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
138 Cards in this Set
- Front
- Back
|
Normal Potassium?
|
3.5-5meq/L
|
|
|
Functions of Potassium
|
intracellular cation, protein and glycogen synthesis, cellular metabolism and growth, membrane potential, maintained by Na/K/ATPase pump
|
|
|
Causes of hypokalemia (10)
|
HF, cirrhosis, nephrotic syndrome, dehydration, insulin, beta agonists, diuretics (loop and TZD), bicarbonates, vomiting, diarrhea, malabsorption
|
|
|
Oral Potassium salts: Use, Names, ADR's, Efficacy
|
Used to replace K.
KCL - several forms (microencapsulated, wax matrix, powder, liquid), KPhos (Neutraphos, neutraphos K), Kbicarb, Kcitrate. ADR's Gi Irritation/ulceration. Effective. KCl most often used. |
|
|
IV potassium: use, Names, ADRs, efficacy
|
use for symptomatic hypoK+, if rate is >10meq/hr EKG required, no IV push, ADRs pain and burning at injection site. Prepare in NaCl because dextrose stimulates insulin release.
|
|
|
Administration of K above what rate requires an EKG?
|
10meq/hr
|
|
|
What oral fomulation of potassium should be used for a patient in metabolic acidosis?
|
Kbicarb, KCitrate
|
|
|
Causes of hyperkalemia
|
Hemolysis of sample, AKI/CKD, NSAIDS, ACE-I, Aldosterone receptor agonists, Beta-blockers, Digitalis toxicity, acidosis
|
|
|
What is hyperkalemia commonly associated with?
|
acidosis - low HCO3
AKI/CKD - high BUN and SCr |
|
|
What are manifestations of Hyperkalemia?
|
arrhythmias, neuromuscular symptoms
|
|
|
Furosemide (as Tx for Hyperkalemia)
|
Loop diuretic, K-wasting, PO or IV, onset within minutes
|
|
|
SPS or Kayexelate
|
Cation exchange resin with Na and K.
|
|
|
What can you not use to mix SPS?
|
OJ
|
|
|
Calcium gluconate
|
Used to antagonize cardiac membrane in patients with hyperkalemia. IV bolus. Reverses abnormal EKG within minutes.
|
|
|
Calcium Chloride
|
Antagonizes cardiac membrane in patients with hyperkalemia - only administer through central line due to tissue necrosis.
|
|
|
Dextrose/insulin is used for what electrolyte imbalance and how does it work?
|
Hyperkalemia - shifts K into cells. Watch for hypo/hyperglycemia. Don't use dextrose if glucose >250.
|
|
|
What electrolyte imbalance is albuterol used for? How does it work?
|
Hyperkalemia - it stimulates the na/k/atpase pump and stimulates insulin release. May cause tachycardia.
|
|
|
What is a drug to use to remove calcium from the body?
|
SPS (kayexelate)
|
|
|
What monitoring parameters are required for a patient with K > 5meq/L?
|
Continuous EKG, K+ hourly
|
|
|
When using dextrose and insulin therapy how often should you check glucose?
|
Every hour
|
|
|
How often do you reassess the need for SPS?
|
Every 4 hours
|
|
|
Involving Calcium, albuterol, and SPS what is the order of the rate at which they decrease potassium from fastest to slowest?
|
Calcium, albuterol, SPS
|
|
|
Normal Magnesium
|
1.5-2.2 meq/L
|
|
|
What are the causes of hypomagnesemia?
|
Alcoholism, TZD and loop diuretics, chronic diarrhea, malnutrition
|
|
|
Why is Magnesium important?
|
It is a cofactor for many reactions, involved in ATP synthesis, and regulates cardiac ion channels
|
|
|
What electrolyte imbalances are commonly seen together?
|
Hypo K, Mg, Ca
|
|
|
What are two outcomes of low Mg levels?
|
lower threshold for nerve stimulation, reduced PTH
|
|
|
How will hypomagnesium present?
|
tetany, seizures, arrhythmias
|
|
|
What is used to treat severe hypoMg?
|
Magnesium Sulfate IV.
|
|
|
What ADR's are present with MgSO4 IV therapy?
|
hypotension, vasodilation
|
|
|
How long does it take to replace Mg stores?
|
3-5 days
|
|
|
What are the names of two oral magnesium products?
|
Milk of Magnesia and MagOx
|
|
|
What is the most common ADR associated with oral magnesium replacements?
|
Diarrhea
|
|
|
What monitoring is required until Mg is at LEAST 1.8meq/l?
|
Continuous EKG, hourly MG levels
|
|
|
What are the causes of hypermagnesiemia?
|
AKI/CKD, Antacids/laxatives
|
|
|
What are the early signs of hypermagnesemia?
|
N/V, weakness, cutaneous flushing
|
|
|
What is seen as Mg levels rise above 4mg/dL?
|
Loss of reflexes
|
|
|
What is seen as Mg levels rise above 5 or 6?
|
hypotension, EKG changes
|
|
|
What is seen as Mg levels rise above 9?
|
respiratory depression, coma, complete heart block
|
|
|
What is seen as Mg levels raise above 10?
|
asystole, cardiac arrest, death
|
|
|
What product is used to reverse hyperMg?
|
IV Calcium products - antagonize NM and cardiac effects of Mg
|
|
|
Tonicity
|
Ability to draw water across a membrane (effective osmolality)
|
|
|
Osmolality
|
Total solute concentration
|
|
|
ECF consists of:
|
interstitial fluid and IVF
|
|
|
ECV
|
effective circulating volume - unmeasureable
|
|
|
plasma
|
liquid portion of blood with dissolved solutes
|
|
|
serum
|
plasma without clotting factors
|
|
|
The majority of fluids in the body is
|
intracellular fluid
|
|
|
What is D5W considered?
|
Free water
|
|
|
What is D5W used for?
|
Hypernatremia - water loss
|
|
|
Normal saline is _____ and mostly stays _____
|
isotonic, intravascular
|
|
|
What is normal saline used for?
|
Expands volume - hypotension or blood loss
|
|
|
3% NaCl does what to fluids?
|
Decreases ICF, increases ECF
|
|
|
What are lactated ringers used for?
|
acidosis, fluid loss from pancreas or small bowel, pregnant patients.
|
|
|
What fluids remains in IVF best?
|
Plasma Expanders
|
|
|
What are examples of plasma expanders?
|
Albumin, hetastarch, dextrans, Packed RBCs, Plasma
|
|
|
What is the most common electrolyte imbalance?
|
hyponatremia
|
|
|
What is happening in hyponatremia with increased osmolality?
|
ADH released and thirst stimulated
|
|
|
What causes hyponatremia with elevated-normal osmolality?
|
Another effective osmole - glucose.
|
|
|
What must be evaluated when a patient has low osmolality and hyponatremia?
|
fluid status
|
|
|
What are the causes of hypovolemic hypotonic hyponatremia?
|
Diarrhea, TZD diuretics
|
|
|
What is generally the cause of euvolemic hypotonic hyponatremia?
|
SIADH
|
|
|
What drugs induce SIADH?
|
carbamazepine, SSRIs
|
|
|
What is SIADH (2 possible)
|
inappropriate secretion of ADH or exaggerated response to normal ADH levels
|
|
|
What are 2 causes besides SIADH of euvolemic hypotonic hyponatremia?
|
Renal failure, hypothyroidism
|
|
|
What is hypervolemic hypotonic hyponatremia?
|
Increased ECF with DECREASED effective circulating volume; kidneys react to perceived hypovolemia and retain more water than Na
|
|
|
What are 3 causes of hypervolemic hypotonic hyponatremia?
|
CHF, cirrhosis, nephrosis
|
|
|
What do hyponatremic patients present with?
|
headache, lethargy, seizures, brain damage
|
|
|
What do hypovolemic hyponatremic patients present with?
|
Dry mucus membranes, orthostatic hypotension
|
|
|
What do hypervolemic hyponatremic patients present with?
|
Edema
|
|
|
What causes osmotic demyelination syndrome?
|
Overly rapid correction of hyponatremia (>12meq/L/day)
|
|
|
What is used to treat hypovolemic hyponatremia?
|
0.9% Nacl (3% temp. if very severe)
|
|
|
What is used to treat euvolemic patients? (3 drugs)
|
demeclocycline, Conivaptan, Tolvaptan
|
|
|
What fluids (if any) are used to euvolemic or hypervolemia natremia?
|
Fluid restriction is first line, 3% NaCl for hypervolemic can be used
|
|
|
What are the six steps to treating SIADH?
|
1. Remove offending drug
2. treat underlying condition 3. Restrict fluids 4. Target Na: 125meq 5. increase Na intake and add loop diuretics 6. Use medication |
|
|
What is demeclocycline used to treat? Common ADR? When is it effective?
|
- SIADH
- nephrotoxicity - several days |
|
|
What is Conivaptan (Vaprisol) used to treat? Common ADR? Contraindication?
|
- SIADH
- Infusion site rxns (IV) - Not for use in hypovolemic patients - Costly |
|
|
What is Tolvaptan (Samsca) used to treat? What is the boxed warning? Who can it not be used for?
|
- SIADH (oral med)
- Only start in hospital setting - not for use in hypovolemic patients - pts should be allowed to drink if thirsty |
|
|
What measures are taken to treat hypervolemic hyponatremia?
|
Fluid restriction, Na restriction, ACE-I may cause or contribute in heart failure patients
|
|
|
How often do you monitor hyponatremic patients?
|
Several times a day
|
|
|
What are three causes of hypernatremia?
|
Pure water loss, hypotonic sodium loss, hypertonic sodium gain
|
|
|
What is diabetes insipidus?
|
decreased ADH secretion (central) or decreased ADH activity at kidneys (nephrogenic)
|
|
|
What 2 drugs can cause diabetes insipidus?
|
Lithium, demeclocycline
|
|
|
What will a hypernatremic patient present with?
|
Muscle weakness, lethargy, coma, brain shrinkage (permanent neurological damage)
|
|
|
How much should you reduce Na by when hypernatremia develops over a few hours?
|
1meq/L/hr
|
|
|
What is a concern of overly rapid administration of hypotonic fluids
|
Cerebral Edema
|
|
|
What should be used IV to treat hypernatremia?
|
hypotonic fluids
|
|
|
What fluids should be used for a patient with hypernatremia from pure fluid loss or hypotonic sodium loss?
|
D5W and 0.45 NaCl
|
|
|
What is desmopressin used for? ADRs? Who is contraindicated?
|
Central Diabetes insipidus.
- severe hyponatremia pts with ClCr <50ml/min contraindicated |
|
|
What should you avoid while give desmopressin?
|
Excessive fluids
|
|
|
What drug is used to treat nephrogenic diabetes insipidus?
|
TZD diuretics
|
|
|
What fluids are used for hypertonic sodium gain?
|
D5W with furosemide
|
|
|
What are the causes of Hypocalcemia?
|
Pancreatitis, GI surgery, malnutrition/absorption, AKI/CKD, Nephrotic syndrome, Alkalosis, furosemide, calcoitonin, bisphosphanates, cinacalcet
|
|
|
What should be considering when evaluating calcium lab results?
|
Albumin level
|
|
|
What will a patient with low calcium present with?
|
tetany, prolonged QT interval
|
|
|
What should be used to treat acute hypocalcemia?
|
IV calcium Products
|
|
|
What are 2 IV Calcium products? What are the ADRs? Efficacy?
|
Calcium Chloride, Calcium gluconate. ADRs severe cardiac dysfunction if infused at >60mg elemental Ca/min
They are effective. |
|
|
How much elemental Calcium is in 1 gram of Calcium Chloride?
|
9270mg
|
|
|
How much elemental calcium is in 1 gram of calcium gluconate?
|
90mg
|
|
|
What are 3 oral calcium agents?
|
CaCO3, CaCitrate, CaLactate
|
|
|
What patient population should use Cacitrate?
|
Elderly
|
|
|
How often should you monitor calcium if using IV therapy?
|
Several times a day
|
|
|
How often should you monitor calcium using oral therapy?
|
1-2 days
|
|
|
What are the two most common causes of hypercalcemia?
|
Primary hyperparathyroidism, malignancy
|
|
|
What are the causes of hypercalcemia?
|
Primary hyperPTH, malignancy, thiazides, lithium, hyperthyroidism
|
|
|
What do patients with hyperCa malignancy present with?
|
Rapid onset of anorexia, N/V
|
|
|
What do patients in a hyperCa crisis present with?
|
ARF, obtundation, arrhythmias
|
|
|
What do CaPhos deposits contribute to?
|
Cardiac disease
|
|
|
How do you treat hyperCa patients with EKG changes?
|
Expand fluid volume and increase Ca excretion with diuretics if fluid overloaded
|
|
|
What are possible ADR's with furosemide?
|
ototoxicity, hypokalemia
|
|
|
When should you use furosemide when trying to correct hypercalcemia?
|
AFTER administration of normal saline
|
|
|
What is Calcitonin used for? ADRs? Efficacy?
|
HyperCa in CKD or HF. injected subq or IM. IV would cause irritation. Effective rapidly but with unpredictable changes.
|
|
|
What are bisphosphanates used for? ADR's? Efficacy?
|
Hypercalcemia of malignancy. ADrs osteonecrosis of jaw or ARF. Reduces Ca within 48 hours when combined with fluids and calcitonin
|
|
|
What are glucocorticoids used for?
|
Hypercalcemia in patients with chronic granulomatous disease.
|
|
|
What are 3 examples of bisphosphonates?
|
Pamidronate - Aredia
Zoledronic Acid - Zometa Ibandronate - Boniva |
|
|
What drug is an example of a glucocorticoid?
|
Prednisone
|
|
|
How often do you monitor hypercalcemic patients
|
everyday
|
|
|
What are the causes of hypophosphatemia?
|
Refeeding, insulin, resp alkalosis, CaCO3, Sevelamer, diarrhea
|
|
|
What electrolyte has an inverse relationship with phosphate?
|
Calcium
|
|
|
How will a hypophos patient present?
|
seizures, rhabdomyolysis, hemolysis
|
|
|
How much Na and Phos does NaPhos contain?
|
Na - 4meq 3mmol Phos
|
|
|
How much K and Phos does KPhos contain?
|
K 4.4meq 3mmol phos
|
|
|
How soon do you see results with IV therapy for hypophos?
|
within 24 hours, but patients commonly revert
|
|
|
What are 4 oral therapies for hypophos?
|
neutra phos, neutraphos K, K-phos neutral, Fleets phospho soda
|
|
|
What are the relative proportions of Na/K/Phos in phos oral products?
|
Neutra Phos - equivalent. Around 8meq/8mmol each.
Neutra-Phos K - K is high, Na + phos equiv. K-Phos neutral - high Na, K low, phos 8mmol Fleets - 4mmol phos |
|
|
What are the causes of hyperphos?
|
Laxatives/antacids containing phos, renal failure
|
|
|
What is the most common cause of hyperphos?
|
CKD
|
|
|
How do hyperphos patients present?
|
Obstructive uropathy
|
|
|
What does chronic hyperphos cause?
|
Brain damage, osteodystrophy
|
|
|
What are normal phos levels?
|
2.7-4.6mg/dL
|
|
|
What are normal calcium levels?
|
8.5-10.8mg/dL
|
|
|
What are KDOQI guidelines for phos and calcium?
|
Ca x Phos < 55mg/DL
|
|
|
What type of drugs are used to treat hyperphos?
|
Phosphate binders
|
|
|
What is Calcium Acetate used for? ADRS? Efficacy?
|
- hyperphos
- hypercalcemia - binds more efficiently to phos than other salts |
|
|
What is Sevelamer (Renvela) used for? ADRS? Efficacy?
|
- hyperphos
- N/V/D, arthralgias - effective at lowering phos and beneficial effects on LDL and HDL |
|
|
What is Lanthanum (fosrenol) used for? How is is taken? ADR's? Efficacy?
|
- hyperphos
-CHEWED - N/V/D - Effective for CKD, cost is an issue |
|
|
What are ADR's of aluminum hydroxide?
|
Anemia, CNS disorders, Bone disease
|
|
|
What are ADRs of magnesium hydroxide?
|
increased magnesium
|
