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61 Cards in this Set
- Front
- Back
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normal K range? |
3.5-5 mEq/L |
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what are the factors that cuase a shift in where K is? |
acid base balance- k exchange with h na k atpase pump-k in adrenergic activity- b2 stimulation insulin- stimulates atpase osmolality- draws k out cellular disruption- k out |
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what is excretion of k dependent on? what hormone plays a role? |
secretion from distal tubule and collecting duct aldosterone- usually removes K |
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define severe hypokalemia |
K less than 2.5 or ecg with changes |
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what are the signs and symptoms of hypokalemia? why does hypokelmia cause tox with digoxin? |
muscle weakness, bradyarrhythmias, heart block, st depression, u wave, atrial flutter, psvt binds atpase better and increases efficacy |
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1 meq/L K in serum equals how much in total body? |
100-200 meq |
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what can cause GI K loss? |
vomiting, ng suction, diarrhea, metabolic acidosis, high aldosterone |
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what reponse does the body have when diurects are used? what are the effects of high aldosterone? |
reflex hyperaldosteronsim increase na and k and h loss, increase atpase act |
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how does hypomagnemia cause hypokelmia? what about high steriods? |
increasing secretion of K into the DCT k wasting at the kidney |
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what drugs cause hypokalemia? |
high dose ticarcillin, corticosteriods, amphotericin, cisplatin, foscarnet, insulin |
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how do penicllins cause k wasting? |
penicillin has high na content, this gets reabsorbed and is exchanged with k, and thus gets secreted |
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how does beta 2 stimulation cause hypokalemia? what about insulins mechaninsm? |
releases catecholamine ( epi noriepi) which increases atpase, causes k influx increase atpase and increase k influx all these shift k from ecf to icf |
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what causes a cellular shift of K? |
insulin, b2 stim, alkalosis |
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how does amphotericin b, cisplatin, and foscarnet cause hypokalemia? |
by depleting mg |
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if you lose 1 meq/l of k, how much should be replaced? |
100 meq |
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why do hypokalemic patients become alkolatotic? |
there causes a loss of cl |
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what salt should you give to hypokalmeias that are alkolatoic? |
KCL because there is probably a loss of cl to be replaced |
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what salt should you give if you are hypokalemic and acidic? |
K acetate or KCl |
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when should you treat hypokelmia? |
once lab value is below 3.5 |
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what is the preffered route for treating hypokelmia? |
oral |
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why is iv k never given in dextrose? what are the side effects of this route? what is the max rate? |
dextrose spikes insulin and would shift k to ICF vein irritation and hyperkalemia 10 meq/hr |
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mild hyperkalemia? moderate? severe? |
mild- 5-6.5 moderate 6.5- 8 severe is greater than 8 |
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what are the sign and symptoms of hyperkalemia? |
weakness, paresthesisa paralysis bradycardia, wide qrs, no p wave, vfib, asytole |
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what patients are at risk for hyperkalemia? how is hyperkalemia prevented in the body? |
ckd and diabetes type 1 insulin release and renal k excretion |
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what are the 3 mechanism of hyperkalemia? |
increased intake cellular shift decreased excretoion |
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what is pseudohyperkalemia? |
blood sample sits, rbcs lyse, release a lot of k |
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decreased renal excretion of K can be caused by what? |
kidney failure, addisons, pentamidine, diabetes, hiv, hypoaldosteronism, decreased raas, ace, nsaid, cyclosporine, trimethoprim, heparin k sparking diuretic |
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what causes a shift of k from inside cell to ecf? |
metabolic acidosis- h moves in and k out insulin defiency- similar to no insulin so k leaks tissue damage hyperglycemia dig tox- keeps k on the outside since pump doesnt work b blocker- inhibit pump, k does not move in |
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therapy of hyperkalemia? when do you give urgent therapy? |
determine severity with ekg stop all medications that raise k use exchange resin k greater than 6.5, hyperkalmeia w ecg changes or symptoms, impaired renal function, acidosis |
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what do you give if hyperkalmic and arrhythmias? |
calcium 10 ml of 10% every 5 min |
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what can be used alone to decrease hyperkalemia? what else can be used, usually not monotherapy? |
dextrose and insulin sodium bicarb, B2 agonist, loop diuretic |
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what are the resin exchangers? |
sodium polystyrene, patiomerand zirconium |
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what is normal Ca? |
4.5-5.5 meq/l or 9-11 mg/dl |
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what can cause an increase in ca? why?
what causes ca to bind more albumin? |
hypoalbuminemia, because it is protein bound, and less albumin means more free ca
alkalosis |
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what hormones affect calcium? do they increase or decrease calcium? |
PTH- increase ca vitamin d- increase ca calcitonin- decreases |
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what should you assess when you are hypocalcemic? |
acid basic, and albumin status |
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what are the causes of hypocalcemia? |
hypoparathyroidism, vitamin d defiency, hyperphosphatemia |
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what level of hypocalcimia do you become symptomatic? what are the symptoms? |
6.5 mg/dl tetany, chvoseks sign, trousseaus sign, seizures, chf, ventriular arrythmia |
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how does CaCl compare to Ca Gluconate |
cacl has three times amount of ca compared to ca gluconate |
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when would you give iv ca? |
if syptomatic or unable to give oral |
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what is therpay for hypoparathyroidism? malabsorption of vitamin d or ckd? |
oral ca 1-3 g and vitamin d vitamin d |
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what compound is used in most otc calcium/vitamin d products? |
cholecalciferol |
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what calcium level is considered hypercalcemia? mild hypercalcemia? moderate hypercalcemia? severe? |
greater than 10.2 mg/dl mild- 10.2-12 mg/dl moderate- 12.1-13 severe- greater 13 |
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what are the causes of hypercalcemia? what medications cause hypercalcemia? |
hyperparathyroidism, malignancy, medications thiazides, vitamin d, calcium supplement od |
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signs and symptoms of of hypercalcemia what is hypercalcemic crisis? |
n/v/c, polyuria, decreased kidney function, muscle weakness, depression, arrhythmias, short qt, fatigue acute kidney injury and cns obtundation (less alert) |
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what non pharmacological ways can you treat hypercalcemia? |
surgery of parathyroid reduce tumor load remove offending drug hydration |
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how can volume depletion worsen hypercalcemia?q |
stimultes na and ca reabsorbption |
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pharmacolgoical treatments of hypercalcemia? |
hydrate with NS, then add loop bisphosphonates- for malignancy calcitionin- for fluid restricted patients |
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where is most phosphorous found? normal concentration? what causes a icf ecf shift? |
intracellular 3-4.5 mg/dl acidosis |
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what hormones are involved with phosphorus homeostatsis, and what are there effects? |
PTH- decrease P by decreaseing renal tubular reabsorption and stimulates vit d vit d- increases gi p absorption but inhibits renal tubular reabsorption |
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hypophosphatemia levels moderate? severe? |
1-2.5 mg/dl less than 1 mg/dl |
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what are some causes of hypophosphatemia? |
alcoholism, v/d, alkalosis, hyperparathyroid, burn |
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what are the signs and symptoms of hypophosphatemia? |
respiratory depression, hemolysis, cardiomyopathy, myalgias |
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how do you treat hypophosphatemia? when do you give IV? what is a possible s/e of iv phosphate? |
eggs, meat, milk, supplements if less than 1 mg/dl or symptomatic hypocalcemia |
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what amount of phosphate is considered hyperphossphatemia? what are the causes? |
greater than 4.5 mg/dl ckd, hypoparathyroid, phosphate enemas, rhabdo, cell lysis, dka |
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how do you treat hyperphoasphatemia? |
ca administration, gi binders |
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normal mg levels? is it protein bound? |
1.5-2.5 mg/dl yes 20-30% |
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what causes hypomagnemsemia? |
decreased intake- alchoholics poor nutrion decresed gi absorption- resection, pancreatic insuf increased gi loss- laxative, diarrhea renal- hypercalcemia, hyperaldosteronis, hyperparathyroidism, drugs- gminoglycosides, ampho b, cisplatin, cyclosporine |
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what are the signs and symptoms of hypomagnesemia? |
n/v, tremor, chvosteks, trouseaus, depression, refactory hypokalemia, and hypocalcemia, flat t, prolonged qt |
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treatment of hypomagnesemia? if amount is greater than 1meq/l less than that? |
magnesium oxide 300 mg qid IM |
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what level is considered hypermagnesmia? how do you treat hypermagnesemia |
greater than 2-2.5 dc source, NS, furosemide, HD, calcium for cv effects |
