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18 Cards in this Set
- Front
- Back
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Na 126
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- does patient look euvolemic, hyper/hypo-volemic?
- calculate plasma osmolality: 2 x serum Na + glucose/18 + BUN/2.8 |
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etiology of euvolemic hypovolemic hyponatremia
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- hypoTH, adrenal insufficiency, SIADH
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tx of asymptomatic pts with chronic, mild hyponatremia?
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- 125-135 mEq/L - correct the underlying cause
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tx of mild or moderate SIADH
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- 115-124 mEq/L: water restriction
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pt with severe hyponatremia?
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- <115 mEq/L at rate of 1.5 to 2meq/L/hour for first 3-4 hours, avoid raising more than 12 meq/l in first 24 hours
- sodium replacement with hypertonic saline |
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tx of chronic, persistent cases of SIADH or antipsychotic-induced hyponatremia
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- demeclocycline
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Chvostek's sign
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- feature of hypocalcemia- contraction of facial muscles when facial nerve is tapped.
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sx of hypocalcemia
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- chvostek's or trousseau's, hyperpigmentation, seizures, muscular weakness, hypotension
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SIADH etiology
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- CNS disorder, tumors (especially small cell lung cancer,) drugs (SSRIs, carbamazepine), pulmonary disease, HIV, pos-op pts, thoracic surgery
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electrolyte abnormality associated with hyperactive deep tendon reflexes
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- hypocalcemia and hypomagnesemia
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leading cause of hypophos in hospitalized patients?
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- continuous glucose infusions
- pts are usually alcoholic or debilitated - can cause muscle weakness severe enough to prevent weaning from mechanical ventilation |
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hypocalcemia clinical manifestations and etiology
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- neuromuscular excitability: hyperreflexia, tetany, seizures
- cardiac effects: vasodilation, hypotension, prolonged QT - etiology: sepsis and hypomg and hypoparathyroidism |
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zing deficiency
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- common in ICU
- causes infections, skin rash - need plasma zinc levels for dx |
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complications of rapid correction of hyponatremia?
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- pontine myelinolysis: permanent neurological deficits that can be fatal
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EKG changes in hyperkalemia
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1. tall peaked T waves --> 2. loss of P wave --> 3. widened QRS with 'sine wave' pattern
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lab findings in SIADH
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- decreased plasma or serum osmolality, elevatd urinary osmolality (due to excessive fluid retention), urinary sodium concentration of more than 40mEq/L and normal adrenal, renal, thyroid fuctions
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labs in primary polydipsia
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- very dilute urine and urine osmolality of <100 millimoles/kg
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refeeding syndrome
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- hypophos
- phosphate depletion secondary to decreased vit D and phosphate intake but serum phosphate levels are maintained until pt received IV fluids and glucose --> insulin secretion --> phosphate shifts intercellularly --> unmasks phosphate depletion - muscle weakness, rhabdomyolysis as many have an underlying myopathy |
