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12 Cards in this Set
- Front
- Back
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______kalemia causes acidosis.
______kalemia causes alkalosis. What % of K+ is Intra Cellular? What amount of change causes dramatic change? Why is a change in K+ clinically important? insulin and B2 agonists cause K+ to move _____. |
hyper - acid
hypo - alka 98%- only 2-5mEq/L makes transmembrane potential, cardiac/neuro/muscular effects; small changes cause large effects intracellularly |
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what are the main physiological factors that regulate intra/extra cellular K levels?
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1. ingestion of potassium
2. renal filtration and secretion of potassium 3. serum pH 4. insulin (K into cells) 5. Beta-2 agonists (K into cells) |
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What causes extra cellular potassium changes with renal excretion?
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Sports Illustrated covered the UAA (aldosterone and acid/base main)
1. Sodium delivery to distal nephron 2. Intracellular potassium level 3. Urine flow rate 4. Aldosterone 5. Acid-base status |
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What are the main things that effect potassium intracellular balance?
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IC an ACE
1. Insulin 2. Catecholamines 3. Acid-base status 4. Cell integrity 5. Extracellular fluid osmolality |
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Case #1: 45 y/o m, c/o fatigue, N/V/D x 3 d, abd distension, constipation. Skin, mucus membranes dry, orthostatic hypotension.
Labs: Na 135, K 2.8, Cl 88, Urine K <20 EKG: ST-T changes, T inversion, U waves Cause? other causes?' What is considered "hypokalemia" found in blood levels? |
diarrhea - GI loss of K, vomiting, diarrhea
other causes: diuretics hypokalemia= <3.5mEq/L |
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1. How does Bartter's affect K+?
2. 4 things to evaluate for hypokalemia? 3. Neuromuscular effects of hypokalemia? 4. Cardiac effects? |
1. affects JGA - produces renin
2. Hx, BP acid-base status urine electrolytes - Cl, K 3. neuromuscular - ileus, cramps, rhabdomyolysis, respiratory paralysis 4. cardiac - ventricular arrhythmias |
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1. EKG changes with hypokalemia?
2. Tx? Which route is preferred? what else should you correct? 3. If pt has arrhythmias, what should you do? |
1. flat, inverted T waves, U waves
2. aggressive tx if <2.5mEq/L, preferably oral tx, correct Mg++ also, access renal function 3. give IV K+ |
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1. 5 causes of hyperkalemia?
2. Explain how renal failure effects K+. 3. decreased aldosterone action causes ____kalemia. |
1.a. loss of cell integrity - rhabdo, hemolysis
b. hyperosmolarity - hyperglycemia c. insulin deficiency d. beta blockade e. acidosis (increased Cl) 2. renal failure --> decreased urine flow rate, so less K+ excreted 3. hyperkalemia |
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1. 4 causes of RTA type 4?
2. 3 drugs that impair aldosterone production? 3. 2 drugs that inhibit K secretion? 4. Cyclosporine causes ____ RTA. 5. Why does constipation cause hyperkalemia? |
1. DM, sickle cell, obstruction, renal transplant
2. NSAIDs, ACE-Is, heparin, 3. K sparing diuretics, Bactrim 4. Cyclosporine - Type 4 5. normally K is secreted in feces |
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1. EKG changes in hyperkalemia?
2. Other effects of hyperkalemia? 3. Goal of tx for hyperkalemia? Give ___ IV. |
1. peaked T waves, flattened P waves, widened QRS
ventricular arrhythmias, conduction defects 2. tingling, paresthesia, skeletal muscle paralysis 3. shift K+ to normal places, antagonize cardiac effects - use IV Ca (Chloride or gluconate), insulin and glucose |
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only 2 tx options for hyperkalemia definitive options?
What are 3 other treatments? |
1. dialysis
2. cation exchange resin - Kayexalate - insulin and glucose B2 agonists NaHCO3 with furosemide, diet restriction |
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Case: 22 y/o m, coma post car accident.
Na 135, K 7.8, Cl 100, HCO3 15, UA brown, detectable myoglobin EKG: no P waves, peaked T, wide QRs. 1. What is the cause of the Hyperkalemia? 2. What is the most appropriate initial treatment? |
1. rhabdomyolysis from trauma --> ARF
2. Calcium gluconate IV (first) cardiac stabilization give CaCl, Ca gluconate then insulin, glucose, Kayexalate, albuterol, IVF |
