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152 Cards in this Set
- Front
- Back
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What is the normal sodium range?
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135-145 mEq/L
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What is the normal range of serum osmolality?
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275-295 mOsmol/L
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What hormone is sodium regulated by?
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ADH
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What are the 3 order of priorities of the kidney?
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1. maintain perfusion
2. maintain osmolality 3. maintain pH |
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Fluids of any kind that does not contain sodium is the definition of?
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free water
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Which of the following has symptoms that include poor skin turgor, orthostatic hypotension, increased thirst, hypotension, tachycardia, and decreased urine ourput?
a. hypovolemic hypotonic hyponatremia b. isovolemic hypotonic hyponatremia c. hypervolemic hypotonic hyponatremia |
a. hypovolemic hypotonic hyponatremia
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Which of the following have signs/symptoms that include normal physical exam, usually normal HR, normal BP, normal skin turgor
a. hypovolemic hypotonic hyponatremia b. isovolemic hypotonic hyponatremia c. hypervolemic hypotonic hyponatremia |
b. isovolemic hypertonic hyponatremia
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Which of the following have signs/symptoms that include generalized edema, possible pulmonary edema, normal or slightly increased HR, and normal BP
a. hypovolemic hypotonic hyponatremia b. isovolemic hypotonic hyponatremia c. hypervolemic hypotonic hyponatremia |
c. hypervolemic hypotonic hyponatremia
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What kind of hypotonic hyponatremia have a decreased in total body fluid status?
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hypovolemic hypotonic hyponatremia
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What kind of hypotonic hyponatremia have an increased in totat body fluid status?
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isovolemic and hypervolemic hypotonic hypovolemia
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What type of hypotonic hyponatremia have a decreased or normal total body sodium status?
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hypovolemic hypotonic hyponatremia
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What type of hypotonic hyponatremia have normal total body sodium status?
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isovolemic hypotonic hyponatremia
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What type of hypotonic hyponatremia have increased total body sodium status?
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hypervolemic hypotonic hyponatremia
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Which of the following is commonly caused by dehydration, vomiting, diarrhea, NG suctioning, diuretics, and severe bleeding?
a. hypovolemic hypotonic hyponatremia b. isovolemic hypotonic hyponatremia c. hypervolemic hypotonic hyponatremia |
a. hypovolemic hypotonic hyponatremia
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Which of the following is commonly caused by free water overload, IVF, TF, IV meds, and SIADH?
a. hypovolemic hypotonic hyponatremia b. isovolemic hypotonic hyponatremia c. hypervolemic hypotonic hyponatremia |
c. isovolemic hypotonic hyponatremia
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Which of the following is commonly caused by CHF, ESRD, cirrhosis, and hyperaldosterone states?
a. hypovolemic hypotonic hyponatremia b. isovolemic hypotonic hyponatremia c. hypervolemic hypotonic hyponatremia |
c. hypervolemic hypotonic hyponatremia
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What are the common clincal causes of hypovolemic hypotonic hyponatremia?
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dehydration, vomiting, diarrhea, NG suctioning, diuretics,and sever bleeding
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What are the common clincal causes of isovolemic hypotonic hyponatremia?
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free water overload, IVF, TF, IV meds, SIADH
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What are the common clinical causes of hypervolemic hypotonic hyponatremia?
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CHF, ESRD, cirrhosis, hyperaldosterone states
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What are the general treatments for hypovolemic hypotonic hyponatremia?
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volume replacement with NS or D5WNS
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What are the general treatments for isovolemic hypotonic hyponatremia?
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restrict all free water
diuretics if fluid needed use only NS |
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What are the general treatments of hypervolemic hypotonic hyponatremia?
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fluid restriction
diuretics |
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What can cause hypertonic hyponatremia?
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hyperglycemia
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What is the normal value for potassium?
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3.5-5 meq/L
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What is the critical values for potassium?
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< 2.5 meq/L
>7 meq/L |
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For every 0.1 increase in serum pH, measured potassium will decrease by how much?
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0.6
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For every 0.1 decrease in serum pH, potassium will increase by how much?
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0.6
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If serum pH increase, does potassium levels increase or decrease?
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decrease
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If serum pH decreases, does potassium levels increase or decrease?
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increase
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Under hypokalemic conditions, if potassium levels are greater than 3 meq/L how much potassium replacement need to be given to increase potassium levels by 0.1?
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10 meq/L
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When potassium is less than 3 meq/L, how much potassium needs to be given to increase potassium levels by 0.1?
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20 meq
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What are the side effects of administering potassium by IV route?
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hyperkalemia
peripheral venous thrombosis/thrombophlebitis IV infusion tract/IV site pain and burning |
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What type of fluid is prefered when replacing potassium by IV route?
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NS or 1/2 NS
avoid dextrose solution |
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How often do you need to recheck potassium levels when using IV replacement therapy?
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after each 40 meq is administered
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what is the maximun rate of KCL IV infusion without monitoring ECG?
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10 meq/hr
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What is the maximum rate of KCL IV infusion for a central line while monitoring ECG?
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20-40 meq/hr
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What is the maximun rate of KCL IV infusion for peripheral line while monitoring ECG?
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10 meq/hr
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What type of IV line can administer KCl 20 meq/hr?
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central line
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If a patient has serum potassium level of 2.5 and has ECG changes, what type of treatment should be given?
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KCl 20meq/50ml by IV central line at a rate of 20-40 meq/hr
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If a patient has a serum potasium level of less than 3 and no ECG changes, what type of treatment should you give?
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KCl 10 meq/50ml via IV by peripheral line at a rate of 10 meq/hr
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What are the available oral therapy options to treat asymptomatic hypokalemia? There are 4
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KCl elixir
KCl effervescent tabs for soln Wax-matrix ER tabs (Klor-con) CR-microencapsulated tablet/capsule (K-Dur) |
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True or False: Oral therapy can be used to treat patient's whose potassium level is less than 3 meq/L
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False
potassium levels must be at 3 or higher to use oral therapy |
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What is the usual dosage of potassium oral replacement therapy?
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20 meq PO now, then q2hr
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What class of drugs can be used as an adjucntive or atypical treatment for asymptomatic hypokalemia?
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potassium sparing diuretics
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At what dose is triamterene (Dyrenium) used for treatment of hypokalemia?
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50mg - 100mg BID
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At what dosage can amiloride be used to treat hypokalemia?
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5mg Daily
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At what dose can spironolactone be used to treat hypokalemia?
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25-50mg daily
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At what dosage can eplernone be used to treat hypokalemia?
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50mg daily or BID
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What are the oral therapies used to treat chronic hypokalemia?
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eating high potassium food
daily oral replacement doses with concurrent diuretic therapy (10-40 meq/day) |
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What should you always rule out when you have a critically high potassium level?
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hemolysis
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If a patient has potassium levels above 7 meq and have ECG changes, what should you give immediately?
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Calcium
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What dose of calcium should be given to treat hyperkalemia?
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1gm IV bolus. If ECG changes, IV push over 1-2min. Otherwise IV push over 5-10 minutes
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What is the prefered form of calcium in treating hyperkalemia?
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calcium gluconate
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If the patient is in cardiac arrest, what form of calcium should be used and why?
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Calcium chloride because it has 3x more calcium than calcium gluconate
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What is the acute goal in treating asymptomatic hyperkalemia?
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intracellular shift of potassium
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What are the therapeutic options for intracelluar shift of potassium?
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insulin, sodium bicarb, albuterol
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How long does an intracellular shift last?
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1-2 hours
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What treatment would you give a patient who has asymptomatic hyperkalemia and is hyperglycemic (BS > 250 mg/dL)?
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Insulin 5-10 units IV push
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How do you treat a patient who has asymptomatic hyperkalemia and whose BS < 250 mg/dL?
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Insulin 5-10 units IV push with dextrose (50mL of 50% prefilled syringe IV push or 500-1000ml of 10% IV infusion)
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What is the onset of action of insulin?
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30 min for regular insulin
5 min for rapid |
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What is the duration of action of insulin?
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regular = 2-4 hours
rapid = 1-2 hours |
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How often should you monitor blood sugar when using insulin to treat hyperkalemia?
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every hour
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What should you use to treat hyperkalemia in the presence of metabolic acidosis?
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sodium bicarb
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At what dose should you give sodium bicarb to treat hyperkalemia?
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50-500 meq
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What is the onset of action of sodium bicarb?
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5-30 minutes
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What is the duration of action of sodium bicarb?
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2-6 hours
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what is the onset of action of calcium per IV administration in treating hyperkalemia?
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1-2 minutes
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what is the duration of action of calcium per IV administration in treating hyperkalemia?
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10-30 minutes
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What do you need to monitor when using sodium bicarb to treat hyperkalemia?
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total sodium delivered to patients
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True or False: Albuterol is a first line of treatment for hyperkalemia?
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False
It is adjunctive to insulin/D50 |
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What do you need to monitor when using sodium bicarb to treat hyperkalemia?
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total sodium delivered to patients
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At what dose should you give albuterol to treat hyperkalemia?
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10-20 mg by neb or 1200 mcg by inhalation
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What is the duration of action of albuterol in treating hyperkalemia?
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up to 5 hours
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What is the onset of action of albuterol in treating hyperkalemia?
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30min
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What are the problems with using albuterol to treat hyperkalemia?
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underdosing
ineffective in some patients tachycardia |
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What is the end goal of treating hyperkalemia?
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removal of potassium
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What non-pharmacological therapy is used to treat hyperkalemia?
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hemodialysis
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What are the pharmacological options to remove potassium?
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diuretic therapy
resin-binding therapy (K-exilate) |
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Under what circumstances can you use diuretics to treat hyperkalemia?
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healthy kidney function
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What is the normal range of magnesium?
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1.5-2.2 meq/L
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What is the critical value of magnesium?
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<1
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When mag-K exchange is saturated, how much IV magnesium replacement is excreted in the urine?
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50%
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To maximize dose retention, what rate should IV magnesium be administered?
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max of 1gm/hour
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50% of patient who have hypomagnesemia also have what?
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hypokalemia
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IV magnesium sulfate are availabe in what concentrations?
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1gm/2ml vials
40mg/ml bottles of 100ml, 500ml, and 1000ml |
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What is the most common diuretic used to remove potassium in treating hyperkalemia?
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Furosemide
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At what dose should you give furosemide to treat hyperkalemia?
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20-40 mg IV or PO
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What is the onset of action of furosemide IV
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1-2 minutes
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What is the onset of action of furosemide PO
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30 minutes
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What is the duration of action of furosemide?
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6 hours
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How often should you monitor potassium levels when treating hyperkalemia with furosemide?
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every hour
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At what dose should you give sodium polystyrene sulfonate (kayexalate) to treat hyperkalemia?
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15-60 gm with a laxative, may repeat q4hrs
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what is the exchange rate of sodium for potassium when 1gm of SPS is given?
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1 sodium for 1 potassium
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What is the most effective route of administration of SPS for the treatment of hyperkalemia?
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oral suspension
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What is the onset of action of SPS for the treatment of hyperkalemia?
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1 hour
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In treating symptomatic acute hypomagnesemia, what dose of intravenous magnesium sulfate should be used?
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2 gm diluted in 10ml syringe with NS by IV pust over 1 min
Then 1 meq/kg IV infusion over 24 hours then 0.5 meq/kg/day daily on days 2-5 |
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In treating acute asymptomatic hypomagnesemia, what dose of IV magnesium sulfate should be used?
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1 meq/kg IV infusion in MIVF over 24 hours
then 0.5 meq/kg/day in MIVF over 24 hours on days 2-5 |
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When can you use oral replacement therapy to treat hypomagnesemia?
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magnesium level is 1-1.5 meq/L and asymptomatic
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What oral replacement therapy for hypomagnesium are there?
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magnesium containing antacids or laxatives
milk of mag, mag oxide, mylanta/maalox |
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what dose should be used when milk of mag is used to treat hypomagnesemia?
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5 ml QID as tolerated
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what dose should be given when using mag oxide to treat hypomagnesemia?
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300mg - 600mg QID
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What dose should be given when treating hypomagnesemia with mylanta/maalox?
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15ml TID
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What is the dose limiting effect of using oral replacement therapy to treat hypomagnesemia?
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diarrhea
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How long will it take to see the effects of oral replacement therapy?
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3-5 days
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What can you use to treat asymptomatic hypomagnesemia with mag levels of 1-1.5 meq/L
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IV mag sulfate or oral replacement therapy
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If you have a patient who has acute hypermagnesemia with ECG changes or evidence of neuromuscular damage, what should you give immediately?
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Cacium gluconate: 2-3gm (20-30ml of 10% soln) IV bolus push over 5-10 minutes. Repeat PRN
or Calcium chloride: 1gm (10ml of 10% soln) IV bolus Then start IV calcium infusion at rate of 0.5-2 mg/kg/hr of elemental calcium |
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True or False: you can use diuretics to treat acute symptomatic hypermagnesemia
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true
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at what dose should furosemide be given to treat hypermagnesemia?
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40mg IV
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What should be monitored when furosemide is given to treat hypermagnesemia?
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mag and potassium levels every hour
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What is the normal range for phosphat?
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2.6-4.5 mg/dL
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What are the common causes of hypophosphatemia?
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"refeeding syndrome" of malnourished patients
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What is the concentration of phosphate in sodium phosphate?
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3 mmol/ml
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What is the concentration of phosphate in potassium phosphate?
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3 mmol/ml
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What is the concentration of sodium in sodium phosphate?
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4 meq/ml
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wha tis the concentration of potassium in potassium phosphate?
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4.4 meq/ml
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If a patient has hypophosphatemia and low potassium levels, what salt form of phosphate should be used?
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potassium phosphate
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If a patient has hypophosphatemia and high potassium levels, what salt form of phosphate should be used?
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sodium phosphate
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How often should you monitor phosphate levels when treating hypophosphatemia?
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every 6 hours
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At what rate is phosphorus generally infused in patients with hypophosphatemia?
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3-6 hours
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What should you monitor when treating hypophosphatemia?
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phosphate levels and potassium levels if potassium salt form is used
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If a patient has severe (< 1mg/dL) symptomatic hypophosphatemia, what should be given to treat the patient?
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15-30 mmol phosphorus in 250ml D5W or NS infused over 3 hours
or 0.5 mmol/kg IBW over 3 hours |
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What IV dose would you use to treat asymptomatic hypophosphatemia?
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9-15 mmol phosphorus in 250ml D5W or NS infused over 3 hours
or 0.24 mmol/kg IBW over 3 hours |
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When can you use oral replacement therapy to treat hypophosphatemia?
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when phosphorus levels are > 2 mg/dL
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What are the 3 oral replacement therapies for hypophosphatemia?
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Neutra-Phos
Neutra-Phos K K-Phos Neutral |
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Which oral replacement therapy for the treatment of hypophosphatemia have equal amounts of potassium and sodium salts in addition to phosphorus?
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Neutra-Phos
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Which oral replacement therapy in the treatment of hypophosphatemia have potassium but no sodium in addition to phosphorus?
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Neutra-Phos K
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Which oral replacement therapy for the treatment of hypophosphatemia have significantly more sodium than potassium in addition to phosphorus?
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K-Phos Neutral
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What dose of oral replacement therapy should be given to treat hypophosphatemia?
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2 capsules PO QID with full glass of water x 8 doses
Recheck phosphorus after 24 hours from last dose, repeat PRN |
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At what level do you have severe hypophosphatemia?
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< 1mg/dL
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At what level do you have moderate hypophosphatemia?
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< 2mg/dL
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What is the immediate goal of treating hyperphosphatemia?
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treat hypocalcemia
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What is the underlying cause of hyperphosphatemia?
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renal dysfunction
rhabdomyolysis increased phosphate intake |
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If a patient has symptomatic hyperphosphatemia, how should you treat the patient?
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Calcium gluconate: 2-3gm IV push over 5-10 min, repeat PRN
or Calcium chloride: 1gm IV bolus then start IV calcium infusion at 0.5-2mg/kg/hr of elemental calcium |
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What should be monitored when administering elemental calcium to treat hypophosphatemia? Be specific and include time
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ionized calcium every 4 hours
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If a patient has asymptomatic hyperphosphatemia, how should you treat the patient?
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Oral phosphate binders
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Antacids, Calcium acetate (Phos-Lo), Lanthanum carbonate (Fosrenol), and Seveamer (Renagel) are what type of drugs?
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phosphate binders
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What is the normal range for total calcium?
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8.5-10.5
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True or False: Hypoalbuminemia results from a decrease in ionized calcium
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False
hypoalbuminemai results in a decrease in TOTAL calcium |
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True or False: Only ionized (free) calcium in physiologically active
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True
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What is the reference range of ionized calcium?
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4.6-5.2 mg/dL
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What is the critical values for total calcium?
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< 7 mg/dL
> 14 mg/dL |
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What can cause calcium levels to appear low when actual body values may be normal?
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blood transfusions
hypoalbuminemia |
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If a patient has symptomatic hypocalcemia, how should you treat the patient?
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calcium gluconate: 2-3gm IV push over 5-10 minutes, repeat PRN
or calcium chloride: 1gm IV bolus then start calcium IV infusion at 0.5-2 mg/kg/hr of elemental calcium |
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If you are treating symptomatic hypocalcemia, what should you monitor? be specific and include time
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ionized calcium every 4 hours
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For a patient with chronic hypocalcemia who have hypoparathyroidism and vit D deficiency, how should you treat the patient?
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Oral calcium and vit D supplementation
2-8gm elemental calcium daily in divided doses |
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How should you treat a patient with chronic hypocalcemia, and vitamin D deficiency?
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Ergocalciferol 50,000U daily or weeky or monthly
or Calcitriol (1,25-dihydroxyvitamin D3) 0.5-3 mcg daily |
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What should you use to treat patients with hypercalcemia and normal to moderate kidney function? There is 7
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saline rehydration
loop diuretics IV Bisphosphonates Calcitonin Glucocorticoids IV phosphorus Dialysis |
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what dose of normal saline should be used to treat patients with hypercalcemia?
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200-300 ml/hr depending on patient
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What should you monitor when using loop diuretics to treat hypercalcemia?
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potassium levels
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If using Calcitonin to treat hypercalcemia, what dose should be given?
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4 U/kg q12h SQ, IM, or IV infusion at a rate of 10-12 U/hr
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What can be used to treat patients with hypercalcemia and limited or severe kidney function?
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Dialysis
Calcitonin and Glucocorticoid with low functioning kidneys |
