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25 Cards in this Set

  • Front
  • Back

What is the primary IC cation?

K

What is the primary EC cation?

Na

What can cause hypokalema?

1. rarely reduced intake since K is reabsorbed in the kidneys




2. increase in K shift into cells


-alkalosis


-insulin or carbohydrate load


-Breceptor stimulation caused by stress induced epinephrine release or admin of Bagonist (albuterol, dopamine)




3. Increased GI loses, vomiting, diarrhea, fistula, chronic laxative use, etc




4. increased urinary losses, HCTZ, aldosterone (mineralcorticoid excess)




5. hypomagnesemia

When do symptoms present w/ hypokalema?




What symptoms?

K < 3.0




muscle weakness in lower extremities and will progress upward




ECG changes: flattened Twaves or elevated Uwaves)




Cardiac arrhythmias




digoxin toxicity if pt taking dig




rhabdomyolysis because hypokalemia can cause reduced blood flow to skeletal muscles

How can the K deficit be estimated?

200-400 mEq of K for every 1 mEq of K loss




20 mEq = 0.1 reduction

What is the best potassium form for metabolic alkalosis?

KCl; these pts typically lose Cl through diuretics or GI loss. This is the most common form of hypokalemia

What drugs can cause hyperkalemia?

ACEI/ARB
Ksparing diuretics


At what level can one expect to see EKG changes?

K > 6.0 mEq/L




Consider medical treatment even if pt isn't showing cardiac abnormalities

What is a good drug for asymptomatic hyperkalemia?

sodium polystyrene sulfonate (kayexelate)

What should be used to lower K in pts w/ symptomatic hyperkalemia?

10 ml Ca gluconate 1-% IV peripherally over 2-10 minutes


-may repeat after 5 mins if no EKG improvement




onset w/in minutes, but duration is short




it does not reduce K conc but antagonizes the effect of K in cardiac conduction cells




Give prior to other interventions such as insulin and glucose sodium bicarb, albuterol







Patients taking what drug should Ca gluconate be avoided in?

Digoxin; hypercalcemia canprecipitate digoxin tox




There have been reports of sudden death

What drugs can be given after Ca gluconate has corrected EKG changes?

1. Insulin and glucose


-10 units IV plus 25-50 gm of 50% glucose IVpush


-if pt hyperglycemic no need for glucose IVPush




2. Sodium bicarbonate


-50 mEq infused over 5 minutes


-most effective if pt has underlying metabolic acidosis




3. B adrenergic agonists (ex: albuterol)


-10-20 mg neb over 10 mins


-not recommended as a single agent since up to 40% of pts dont respond

What agents can be used to remove excess K from the body?

1. loop or thiazide diuretics


-ineffective if pt has advanced renal disease




2. Kayexalate (sodium polystyrene sulfonate)


-onset is slow, ~2 hours


-not for emergencies


-considered a cation exchange resin, it exchanges Na for K resulting in GI excretion of K




3. Hemodialysis


-for when other measures aren't workin or hyperkalemia is severe



What usually causes hypomagnesemia?

impaired intestinal absorption (UC, diarrhea, pancreatitis, laxative abuse)




Often presents concurrently w/ hypokalemia and hypocalcemia

What are S/S of hypomagnesemia?

twitching, tetany, seizures, arrhythmias, sudden cardiac death, HTN

How should mag be administered IV?




Why?

Mag sulfate should be adminsted 1/gm per hour to increase absorption




About half of administered mag is excreted in the urine




Full mag replacement should occur over 3-5 days

How does hypermagnesemia occur?




S/S?




What level of mag is dangerous?

rarely; generally associated w/ CKD




N/V, bradycardia, hypotension, heart block, asystole, respiratory failure, death




symptoms rarely occur unless conc is > 4-5 mg/dL

How can hypermagnesemia be treated?

d/c all magnesium containing meds




asymptomatic pts can be given NS and loop diuretics




symptomatic pts should be given 100-200 mg elemental Ca IV for cardiac stability




HD will probably be necessary

What can cause hypophosphatemia?

increased renal elimination


refeeding syndrome


respiratory alkalosis


Diabetic Ketoacidosis treatment; as DKA is corrected phos moves IC

S/S of hypophosphatemia?

tissue hypoxia can occur due to decreased oxygen release in peripheral tissues




confusion, delirium, seizures, coma




pulmonary and cardiac symptoms





When does hyperphosphatemia occur?

usually in pts w/ CKD or hypoparathyroidism

S/S of hyperphosphatemia?

pts usually asymptomatic




could show hypocalcemia, ECG changes, parasthesias, vascular calcifications

How much elemental Ca is in 1 gm CaCl?




1 gm calcium gluconate?

1 gm CaCl - 273 mg elemental Ca




1 gm Ca gluconate - 90 mg elemental Ca





How much elemental Ca should be used for symptomatic hypocalcemia?

200-300 mg elemental Ca over 5-10 mins

When is hypercalcemia occur?




Treatement?

hypercalcemia of malignancy




zoledronic acid, pamidronate, calcitonin