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111 Cards in this Set
- Front
- Back
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treatment of SIADH
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water restriction
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signs/symptoms of hyponatremia
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confusion, lethargy, MS changes, anorexia, seizures, disorientation, cramps, coma
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If refractory to conservative management, SIADH can be treated with what?
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demeclocycline (tetracycline that causes renal DI)
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how do you treat hypovolemic hyponatremia?
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saline
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how do you treat euvolemic and hypervolemic hyponatremia?
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free water restriction and possibly diuretics for hypervolemia
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what can happen if you treat hyponatremia too rapidly?
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brainstem damage - central pontine myelinolysis
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causes of hypovolemic hyponatremia
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dehydration, diuretics, DKA or DM, Addison's disease, hypoaldosteronism
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K level in Addison's and hypoaldosteronism
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elevated
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causes of euvolemic hyponatremia
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SIADH, psychogenic polydipsia, oxytocin use
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causes of hypervolemic hyponatremia
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CHF, nephrotic syndrome, cirrhosis, toxemia, renal failure
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once glucose exceeds 200, what happens to sodium?
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decreases by 1.6 for each increase of 100 in glucose
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what is the most common cause of hyponatremia in a surgical patient?
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inappropriate or excessive fluid administration
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what can cause hyponatremia in a pregnant woman?
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oxytocin (acts like ADH)
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common causes of hypernatremia
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dehydration, inability to drink (paralysis, dementia), diuretics, DI, diarrhea, renal disease (e.g. isothenuria from sickle cell trait), iatrogenic administration of excessive salt
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treatment of hypernatremia?
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water replacement - often the patient is so dehydrated that NS is used until patient is hydrated and HD stable, then pt. can be switched to 1/2 NS
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treatment for nephrogenic DI?
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thiazide
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medications that can cause nephrogenic DI?
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lithium, demeclocycline, methoxyflurane, ampho B
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does nephrogenic DI respond to vasopressin?
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no
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symptoms of hypokalemia?
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muscle weakness, including weakness of smooth muscles (ileus, hypotension)
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EKG findings in hypokalemia?
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U wave, loss of T wave, PVCs, PACs, ventricular and atrial tachyarrhythmias
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alkalosis causes what change in K+?
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hypokalemia
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acidosis is related to what change in K+?
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hyperkalemia
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what should be given to severely hyperkalemic patients?
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bicarbonate
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heart is particularly sensitive to hypokalemia when a patient is taking what cardiac med?
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digitalis
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if K has to be given IV, don't exceed how much per hour?
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20 mEq
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what other electrolyte must also be corrected with hypokalemia
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Mg - have to correct hypomagnesemia in order to correct hypokalemia
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what causes a false hyperkalemia?
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hemolysis
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EKG changes in hyperkalemia?
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peaked T waves, widening of QRS, PR prolongation, loss of P waves, sine wave pattern; asystole and vfib
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common causes of hyperkalemia?
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renal failure, severe tissue destruction, hypoaldosteronism, drugs, adrenal insufficiency
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drugs that can cause hyperkalemia
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K-sparing diuretics, beta-blockers, NSAIDS, ACE-Is
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treatment for symptomatic hyperkalemia?
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calcium gluconate (cardioprotective, but does not change K levels), sodium bicarbonate, glucose with insulin; if treatment ineffective or if pt has renal failure immediate dialysis
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EKG findings in hypocalcemia
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QT prolongation
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common causes of hypocalcemia
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DiGeorges, renal failure, hypoparathyroidism, vit. D deficiency, pseudohypoparathyroidism, acute pancreatitis
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tentany shortly after birth, absent thymic shadow
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DiGeorge's syndrome
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characteristics of pseudohypoparathyroidism
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short fingers, short stature, MR, normal PTH levels with end-organ unresponsiveness to PTH
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what electrolyte must be corrected along with low Ca
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low Mg
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vitamin D deficiency in children/adults
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Rickets/osteomalacia
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in renal failure you should do what to Ca2+ and phos?
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raise Ca, restrict phos
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EKG changes in hypercalcemia
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QT shortening
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symptoms of hypercalcemia
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bones, stones, groans, psychiatric overtones
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most common cause of hypercalcemia in outpatients
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hyperparathyroidism
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most common cause of hypercalcemia in inpatients
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malignancy
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vitiman A or D intoxication can cause what to happen to Ca2+
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too high
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what class of diuretics can cause hypercalcemia
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thiazides
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treatment for hypercalcemia
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IV fluids, furosoemide; oral phos, calcitonin, diphophonates (e.g. etidronate - Paget's), plicamycin can also be used
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what can be used in malignancy-induced hypercalcemia?
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prednisone
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what do you check in patients treated with magnesium sulfate?
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decreased DTRs, hypotension, respiratory depression
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treatment for hypermagnesemia
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stop mag sulfate, intubate if necessary, IV fluids, lasix, dialysis as last resort
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hypomagnesemia seen most often in what patients?
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alcoholics
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treatment for hypomagnesemia?
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oral replacement
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hypophosphatemia seen primarily in what patients?
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DKA, alcoholics
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hyperphosphatemia seen almost always in which patients
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those with renal failure
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treatment for hyperphosphatemia?
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phosphate restriction, dialysis, possibly phosphate-binding resins (CaCO3)
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most common cause of B12 deficiency
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pernicious anemia
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pathophysiology of pernicious anemia?
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anti-parietal cell antibodies destroy ability to secrete intrinsic factor
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conditions associated with pernicious anemia?
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hypothyroidism and vitiligo
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test used to diagnose the cause of B12 deficiency
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Schilling's
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isoniazid causes what deficiency
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B6/pyridoxine
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anticonvulsants can cause what vitamin deficiency
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folate
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where do bone changes first appear in rickets?
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lower ends of radius and ulna
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what is given to all newborns as prophylaxis against hemorrhagic disease of the newborn?
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vitamin K
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vitamin A deficiency
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night blindness, scaly rash, dry eyes, Bitot's spots (debris on conjunctiva), increased infections
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vitamin A toxicity
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pseudotumor cerebri, bone thickening, teratogenicity
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vitamin D deficiency
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rickets, osteomalacia, hypocalcemia
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vitamin D toxicity
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hypercalcemia, N&V, renal effects
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vitamin E deficiency
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anemia, peripheral neuropathy, ataxia
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vitamin E toxicity
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necrotizing enterocolitis (infants)
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vitamin K deficiency
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hemorrhage, prolonged PT
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vitamin K toxicity
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hemolysis (kernicterus)
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vitamin B1 (thiamine) deficiency
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wet/dry beriberi, Wernicke's and Korsakoff's
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wet beriberi
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high-output cardiac failure
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dry beriberi
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peripheral neuropathy
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B2 (riboflavin) deficiency
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cheilosis, angular stomatitis, dermatitis
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B3 (niacin) deficiency
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Pellagra (dementia, dermatitis, diarrhea), stomatitis
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B6 (pyridoxine) deficiency
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peripheral neuropahty, cheilosis, stomatitis, convulsions in infants, microcytic anemia, seborrheic dermatitis
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only B vitamin with toxicity
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B6 (pyridoxine) - peripheral neuropathy
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B12 (cobalamin) deficiency
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megaloblastic anemia plus neurologic symptoms
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folic acid deficiency
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megaloblastic anemia without neurologic symptoms
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vitamin C deficiency
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scurvy (hemorrhages- skin petechiae, bone, gums; loose teeth; gingivitis), poor wound healing, hyperkeratotic hair follicles, bone pain (from periosteal hemorrhages)
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iron deficiency
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microcytic anemia, koilonychia (spoon-shaped nails)
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iron toxicity
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hemochromatosis
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iodine deficiency
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goiter, cretinism, hypothyroidism
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iodine toxicity
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can cause myxedema
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fluorine deficiency
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dental caries
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fluorine toxicity
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fluorosis with mottling of teeth and bone exostoses
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zinc deficiency
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hypogeusia (decreased taste), rash, slow wound healing
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copper deficiency
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menke's disease (x-linked, kinky hair, MR)
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copper toxicity
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Wilson's disease
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Selenium deficiency
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cardiomyopathy and muscle pain
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selenium toxicity
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loss of hair and nails
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chromium deficiency
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impaired glucose tolerance
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prolonged antibiotic therapy can cause what vitamin to become deficient?
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vitamin K - meds can eliminate normal gut bacteria that synthesize much of the daily requirement for vitamin K
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high CO2, pH <7.4
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respiratory acidosis
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low CO2, pH >7.4
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respiratory alkalosis
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high bicarb, pH>7.4
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metabolic alkalosis
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low bicarb, pH <7.4
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metabolic acidosis
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common causes of respiratory acidosis
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COPD, asthma, drugs (opiods, benzos, drugs that depress respiratory drive), chest wall problems, sleep apnea
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common causes of metabolic acidosis
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ethanol, DKA, uremia, lactic acidosis, methanol/ethylene glycol, ASA/salicylate OD, diarrhea, carbonic anhydrase inhibitors
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common causes of respiratory alkalosis
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anxiety/hyperventilation, ASA/salicylate OD
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common causes of metabolic alkalosis
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diuretics (except carbonic anhydrase inhibitors), vomiting, volume contraction, antacid abuse/milk-alkali syndrome, hyperaldosteronism
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what type of acid-base disturbance does aspirin overdose cause?
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respiratory alkalosis and metabolic acidosis
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tinntus, hypoglycemia, vomiting, hx of swallowing pills
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ASA overdose
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treatment of aspirin overdose?
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alkalinize urine with bicarb to speed excretion
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blood gas of people with chronic lung conditions?
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pH may be alkaline during the day because they breathe better when awake
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blood gas of patient with asthma changes from alkalotic to normal and patient appears to be sleeping...
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patient probably crashing
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hyponatremia, low BP, high potassium
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adrenal insufficiency
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hypercalcemia with low urinary calcium
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familial hypocalciuric hypercalcemia
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biotin deficiency
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dermatitis, enteritis
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how can biotin deficiency be caused?
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by ingestion of raw eggs
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magnesium deficiency
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weakness, muscle cramps, exacerbation of hypocalcemic tetany, CNS hyperirritability -> tremors, choreoathetoid movement
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Keshan disease
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selenium deficiency (cardiomyopathy)
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