Im Renal Potassium Usmle 2

Front 1

Nomal range of Potassium

Back 1

3.3 - 5.5

(below is hypoK; above is hyperK)

Front 2

Difference b/t Periodic paralysis of HypoK vs. HyperK

Back 2

HypoK - presents in teens

HyperK - presents in infancy

Front 3

What heart drug causes a greater toxicity if patient goes into HypoK?

How is this avoided?

Back 3

Digitalis

- check K+ regularly

Front 4

(4)* general ways we can lose potassium (become HypoK)

Back 4

1. Cellular shift + undetermined mechanisms
2. Inc renal excretion
3. GI losses
4. Sweating

Hint 4

CIGS

Front 5

Cellular shift + undetermined mechanisms of HypoK
(5)*

Back 5

A Deadly VIBe:

1. Alkalosis
2. Digoxin toxicity correction (w/ digibind)
3. Vitamin B-12
4. Insulin
5. Beta-adrenergics

Hint 5

A Deadly VIBe

Front 6

in Alkalosis, how does each 0.1 increase in pH affect K+?

Back 6

decreases serum K+ by 0.5 mEq/L

Front 7

What does insulin do to K+?

Back 7

drives it into the cells

Front 8

Etiology of HypoK due to Increased renal excretion mechanisms
(6)*

Back 8

1. Cushings (Inc Mineralcorticoid activity)
2. HypoMagnesium
3. Bartter's syndrome
4. Osmotic diuresis (mannitol)
5. Renal tubular acidosis
6. Medications

Hint 8

Causes HypoK By Other Renal Methods

Front 9

Dx:
JG-cell hyperplasia causing increased renin/aldosterone, met alkalosis, HypoK, muscle weakness and tetany; seen in young adults

Back 9

Bartter's syndrome

Front 10

(3) GI loss causes of HypoK

Back 10

1. Vomiting; nasogastric suction

2. Diarrhea; laxative abuse

3. Inadequate dietary intake (anorexia)

Front 11

Dx:
Impaired gastric motility, nausea, vomiting, muscle weakness (to paralysis), rhabdomyolysis, atrial + ventricular arrhythmias

Back 11

HypoK

Front 12

What is the Tx for urgent HypoK? (2)

What works faster?

What type of patient must be monitored closely?

Back 12

give IV + oral potassium simultaneously

- oral works faster

- monitor pt w/ renal failure

Front 13

At what level should K+ be peri-MI to prevent arrhythmias?

Back 13

K+ > 4.0

Front 14

IV infusion of K+ should not exceed what number/hour?

How much does that raise serum K+?

Back 14

IV no more then 20 mEq/hr

Increases K+ by 0.25 mEq/L

Front 15

what diagnostic procedure should be performed on patients w/ moderate or severe HyperK?

Back 15

Stat EKG

Front 16

The only Tx of HyperK (aside from dialysis) that removes K from the body

Back 16

Kayexalate

Front 17

MCC of HyperK in lab results

What should be done?

Back 17

Pseudo-HyperK:
falsely elevated measurement due to hemolysis

Re-run lab test

Front 18

(4)* causes of ICF to ECF potassium shifting causing HyperK

Back 18

Heavy exercise

Acidosis

Insulin deficiency

Digitalis toxicity

Hint 18

AIDs HyperK

Front 19

(3) causes of an increased potassium load causing HyperK

Back 19

IV potassium supplements

K+ medications

Increased cellular breakdown

Front 20

Causes of decreased potassium excretion causing HyperK
(3 renal and 3 drugs)*

Back 20

ROB A K:
Renal failure;
Obstructive uropathies;
Beta-blockers;
Aldosterone deficiency / ACEi;
K-sparing diuretics

Hint 20

ROB A K

Front 21

Dx:
N/V/D; muscle cramps, weakness, areflexia, tetany, confusion; respiratory insufficiency; arrhythmias, cardiac arrest

Back 21

HyperK

Front 22

EKG changes when potassium equals:
1. 6.5 - 7.5 (3)
2. 7.5 - 8.0 (2)
3. 10 - 12

What does it lead to? (3)

Back 22

1. Tall, peaked T-waves; short QT; prolonged PR

2. QRS widening; Flat P-wave

3. QRS degrades into SIN wave

leads to: V-fib, complete heart block or asystole

Front 23

HyperK is most common with what (2) causes

Back 23

Renal failure

muscle breakdown

Front 24

What are the Tx of HyperK in order of Stabilize, Shift, Remove?*

Back 24

Can Get In A Bad K Day:

Stabilize - Calcium

Shift - Glucose + Insulin; Albuterol; Bicarbonate

Remove - Kayexalate; Dialysis

Hint 24

Can Get In A Bad K Day

Front 25

When is calcium contraindicated for HyperK?

Back 25

if patient is on Digoxin