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111 Cards in this Set

  • Front
  • Back
treatment of SIADH
water restriction
signs/symptoms of hyponatremia
confusion, lethargy, MS changes, anorexia, seizures, disorientation, cramps, coma
If refractory to conservative management, SIADH can be treated with what?
demeclocycline (tetracycline that causes renal DI)
how do you treat hypovolemic hyponatremia?
how do you treat euvolemic and hypervolemic hyponatremia?
free water restriction and possibly diuretics for hypervolemia
what can happen if you treat hyponatremia too rapidly?
brainstem damage - central pontine myelinolysis
causes of hypovolemic hyponatremia
dehydration, diuretics, DKA or DM, Addison's disease, hypoaldosteronism
K level in Addison's and hypoaldosteronism
causes of euvolemic hyponatremia
SIADH, psychogenic polydipsia, oxytocin use
causes of hypervolemic hyponatremia
CHF, nephrotic syndrome, cirrhosis, toxemia, renal failure
once glucose exceeds 200, what happens to sodium?
decreases by 1.6 for each increase of 100 in glucose
what is the most common cause of hyponatremia in a surgical patient?
inappropriate or excessive fluid administration
what can cause hyponatremia in a pregnant woman?
oxytocin (acts like ADH)
common causes of hypernatremia
dehydration, inability to drink (paralysis, dementia), diuretics, DI, diarrhea, renal disease (e.g. isothenuria from sickle cell trait), iatrogenic administration of excessive salt
treatment of hypernatremia?
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
treatment for nephrogenic DI?
medications that can cause nephrogenic DI?
lithium, demeclocycline, methoxyflurane, ampho B
does nephrogenic DI respond to vasopressin?
symptoms of hypokalemia?
muscle weakness, including weakness of smooth muscles (ileus, hypotension)
EKG findings in hypokalemia?
U wave, loss of T wave, PVCs, PACs, ventricular and atrial tachyarrhythmias
alkalosis causes what change in K+?
acidosis is related to what change in K+?
what should be given to severely hyperkalemic patients?
heart is particularly sensitive to hypokalemia when a patient is taking what cardiac med?
if K has to be given IV, don't exceed how much per hour?
20 mEq
what other electrolyte must also be corrected with hypokalemia
Mg - have to correct hypomagnesemia in order to correct hypokalemia
what causes a false hyperkalemia?
EKG changes in hyperkalemia?
peaked T waves, widening of QRS, PR prolongation, loss of P waves, sine wave pattern; asystole and vfib
common causes of hyperkalemia?
renal failure, severe tissue destruction, hypoaldosteronism, drugs, adrenal insufficiency
drugs that can cause hyperkalemia
K-sparing diuretics, beta-blockers, NSAIDS, ACE-Is
treatment for symptomatic hyperkalemia?
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
EKG findings in hypocalcemia
QT prolongation
common causes of hypocalcemia
DiGeorges, renal failure, hypoparathyroidism, vit. D deficiency, pseudohypoparathyroidism, acute pancreatitis
tentany shortly after birth, absent thymic shadow
DiGeorge's syndrome
characteristics of pseudohypoparathyroidism
short fingers, short stature, MR, normal PTH levels with end-organ unresponsiveness to PTH
what electrolyte must be corrected along with low Ca
low Mg
vitamin D deficiency in children/adults
in renal failure you should do what to Ca2+ and phos?
raise Ca, restrict phos
EKG changes in hypercalcemia
QT shortening
symptoms of hypercalcemia
bones, stones, groans, psychiatric overtones
most common cause of hypercalcemia in outpatients
most common cause of hypercalcemia in inpatients
vitiman A or D intoxication can cause what to happen to Ca2+
too high
what class of diuretics can cause hypercalcemia
treatment for hypercalcemia
IV fluids, furosoemide; oral phos, calcitonin, diphophonates (e.g. etidronate - Paget's), plicamycin can also be used
what can be used in malignancy-induced hypercalcemia?
what do you check in patients treated with magnesium sulfate?
decreased DTRs, hypotension, respiratory depression
treatment for hypermagnesemia
stop mag sulfate, intubate if necessary, IV fluids, lasix, dialysis as last resort
hypomagnesemia seen most often in what patients?
treatment for hypomagnesemia?
oral replacement
hypophosphatemia seen primarily in what patients?
DKA, alcoholics
hyperphosphatemia seen almost always in which patients
those with renal failure
treatment for hyperphosphatemia?
phosphate restriction, dialysis, possibly phosphate-binding resins (CaCO3)
most common cause of B12 deficiency
pernicious anemia
pathophysiology of pernicious anemia?
anti-parietal cell antibodies destroy ability to secrete intrinsic factor
conditions associated with pernicious anemia?
hypothyroidism and vitiligo
test used to diagnose the cause of B12 deficiency
isoniazid causes what deficiency
anticonvulsants can cause what vitamin deficiency
where do bone changes first appear in rickets?
lower ends of radius and ulna
what is given to all newborns as prophylaxis against hemorrhagic disease of the newborn?
vitamin K
vitamin A deficiency
night blindness, scaly rash, dry eyes, Bitot's spots (debris on conjunctiva), increased infections
vitamin A toxicity
pseudotumor cerebri, bone thickening, teratogenicity
vitamin D deficiency
rickets, osteomalacia, hypocalcemia
vitamin D toxicity
hypercalcemia, N&V, renal effects
vitamin E deficiency
anemia, peripheral neuropathy, ataxia
vitamin E toxicity
necrotizing enterocolitis (infants)
vitamin K deficiency
hemorrhage, prolonged PT
vitamin K toxicity
hemolysis (kernicterus)
vitamin B1 (thiamine) deficiency
wet/dry beriberi, Wernicke's and Korsakoff's
wet beriberi
high-output cardiac failure
dry beriberi
peripheral neuropathy
B2 (riboflavin) deficiency
cheilosis, angular stomatitis, dermatitis
B3 (niacin) deficiency
Pellagra (dementia, dermatitis, diarrhea), stomatitis
B6 (pyridoxine) deficiency
peripheral neuropahty, cheilosis, stomatitis, convulsions in infants, microcytic anemia, seborrheic dermatitis
only B vitamin with toxicity
B6 (pyridoxine) - peripheral neuropathy
B12 (cobalamin) deficiency
megaloblastic anemia plus neurologic symptoms
folic acid deficiency
megaloblastic anemia without neurologic symptoms
vitamin C deficiency
scurvy (hemorrhages- skin petechiae, bone, gums; loose teeth; gingivitis), poor wound healing, hyperkeratotic hair follicles, bone pain (from periosteal hemorrhages)
iron deficiency
microcytic anemia, koilonychia (spoon-shaped nails)
iron toxicity
iodine deficiency
goiter, cretinism, hypothyroidism
iodine toxicity
can cause myxedema
fluorine deficiency
dental caries
fluorine toxicity
fluorosis with mottling of teeth and bone exostoses
zinc deficiency
hypogeusia (decreased taste), rash, slow wound healing
copper deficiency
menke's disease (x-linked, kinky hair, MR)
copper toxicity
Wilson's disease
Selenium deficiency
cardiomyopathy and muscle pain
selenium toxicity
loss of hair and nails
chromium deficiency
impaired glucose tolerance
prolonged antibiotic therapy can cause what vitamin to become deficient?
vitamin K - meds can eliminate normal gut bacteria that synthesize much of the daily requirement for vitamin K
high CO2, pH <7.4
respiratory acidosis
low CO2, pH >7.4
respiratory alkalosis
high bicarb, pH>7.4
metabolic alkalosis
low bicarb, pH <7.4
metabolic acidosis
common causes of respiratory acidosis
COPD, asthma, drugs (opiods, benzos, drugs that depress respiratory drive), chest wall problems, sleep apnea
common causes of metabolic acidosis
ethanol, DKA, uremia, lactic acidosis, methanol/ethylene glycol, ASA/salicylate OD, diarrhea, carbonic anhydrase inhibitors
common causes of respiratory alkalosis
anxiety/hyperventilation, ASA/salicylate OD
common causes of metabolic alkalosis
diuretics (except carbonic anhydrase inhibitors), vomiting, volume contraction, antacid abuse/milk-alkali syndrome, hyperaldosteronism
what type of acid-base disturbance does aspirin overdose cause?
respiratory alkalosis and metabolic acidosis
tinntus, hypoglycemia, vomiting, hx of swallowing pills
ASA overdose
treatment of aspirin overdose?
alkalinize urine with bicarb to speed excretion
blood gas of people with chronic lung conditions?
pH may be alkaline during the day because they breathe better when awake
blood gas of patient with asthma changes from alkalotic to normal and patient appears to be sleeping...
patient probably crashing
hyponatremia, low BP, high potassium
adrenal insufficiency
hypercalcemia with low urinary calcium
familial hypocalciuric hypercalcemia
biotin deficiency
dermatitis, enteritis
how can biotin deficiency be caused?
by ingestion of raw eggs
magnesium deficiency
weakness, muscle cramps, exacerbation of hypocalcemic tetany, CNS hyperirritability -> tremors, choreoathetoid movement
Keshan disease
selenium deficiency (cardiomyopathy)