electrolytes 2 (K and Ca)

Created by jwells488 

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pH (acid/base balance of the body)

[K] is closely related to what?

kidneys

Potassium is mainly excreted how?

no (But [K] correlates to K disorders quite well)

Is [K] a good measure of TBK?

muscle weakness/cramps, nausea, vomiting, polyuria, EKG changes, cardiac arrhythmias, increased pH and bicarb levels

Signs and symptoms of hypokalemia

weakness/cramps

Hypokalemia causes muscle ____

increased (so does HYPER CAL cemia)

Hypokalemia causes ____ urine excretion

heart, cardiac arrhythmias (and EKG changes)

What organ does hypokalemia affect and how?

digoxin

Hypokalemia is associated with toxicity of what medication?

increase

Hypokalemia causes a ___ in pH

increase

Hypokalemia causes a ___ in bicarb levels

GI, renal (high aldosterone, low, Mg), inadequate intake of fluids, alkalosis, medications

What are the causes of hypokalemia?

diuretics, high dose antibiotics, corticosteroids, B2 agonists, insulin, aminoglycosides, amphotericin B, cisplatin, foscarnet

What medications cause K depletion?

K (potassium)

diuretics, high dose antibiotics, corticosteroids, B2 agonists, insulin, aminoglycosides, amphotericin B, cisplatin, foscarnet all cause depletion of what electrolyte?

B2 agonists and insulin

drug that causes hypokalemia through cellular redistribution

diuretics, high dose antibiotics, and corticosteroids

drugs that cause hypokalemia through renal potassium wasting

aminoglycosides, amphotericin B, cisplatin, foscarnet

drugs that cause hypokalemia secondary to Mg depletion

200 (mEq)

drop in [K] from 3 to 4 mEq/L indicates deficit of ____

200-400 (mEq)

drop in [K] from 3 to 2 mEq/L indicated deficit of ____

FALSE (use serum [K] and NOT a predetermined amount)

Potassium repletion should be guided by using a predetermined amount, rather than relying on serum [K]

KCl

What potassium salt should be used in hypokalemia/alkalosis?

anything but KCl (citrate, acetate, gluconate, or bicarbonate)

What potassium salt should be used in hypokalemia/acidosis?

KCl (except the effervescent tabs, which use KCl and Kbicarb)

What salt are oral K replacement products using?

acetate, Cl (usually saline solution; never concentrated potassium vials on patient units)

What salt are IV K replacement products using?

TRUE (oral route K sticks better)

Oral route is preferred mechanism of K replacement TRUE/FALSE

oral 40-120mEq daily

For moderate hypokalemia without EKG changes, what repletion strategy is indicated?

4-Kx100 (K range from 2.5-3.5, so 4-3 is 1, 100mEq per day)

Hypokalemia treatment rule of thumb

IV (replacement - usually 10-20mEq/hr of 40mEq/L conc. - max rate is 40, conc is 80)

For severe hypokalemia ( <2.5mEq/L) with or without EKG changes, what repletion strategy is indicated?

40 (mEq/hr - requires cardiac monitoring, when this fast)

What is the maximum infusion rate of potassium?

80 (mEq/L)

What is the maximum infusion concentration of potassium?

10 (mEq/hr)

What is the maximum K IV rate of infusion in a peripheral vein?

no (it augments K movement to ICF)

Can glucose be used for potassium infusion vehicle?

Mg

What electrolyte must be corrected along with K?

muscle weakness, parethesis(pins and needles), GI hypermotility, hypotension, EKG changes, decreased pH, increased potassium

What are the S/S of hyperkalemia?

hypermotility

How does kyperkalemia affect the GI tract?

peaked T-wave, shortened Q-T interval, widened QRS complex

How does hyperkalemia affect EKG?

cardiac arrhythmias, EKG changes

How does hyperkalemia affect the heart?

decreased pH

How does hyperkalemia affect pH?

increased intake, blood transfusions, rapid excessive IV administration, medications

What are the causes of hyperkalemia?

K supplements, K-sparing diuretics, ACE inhibitors, beta blockers, TMP/SMX, NSAIDs, digoxin, prograf, heparin, cyclosporin

What are medications that can cause hyperkalemia?

decreased excretion (renal failure, addison's disease - decreased ADH production), K release from cells (tissue breakdown - surgery, trauma, hemolysis and metabolic acidosis)

What are causes of hyperkalemia?

if [K] > 7

When is IV calcium indicated to oppose the effects of hyperkalemia?

oppose cardiac effects (IV Ca), promote K movement to ICF (using dex/insulin/bicarb)

What are 2 basic treatment strategies of hyperkalemia?

dextrose, insulin, bicarb (Acute) or beta agonists (non-acute, e.g., albuterol)

What solution can be used to promote the intracellular movement of potassium?

Kayexalate (sodium polystyrene sulfonate), loop diuretics, hemodialysis (only in CRF patients)

What drug can be used to remove potassium ions from the body?

Kayexalate, treats hyperkalemia (by removing K from the body)

What medication acts by exchanging Na for K in the gut and what is it used for?

CaCl2 injection (1mg or 13.5mEq - direct or diluted in D5W)

Treatment for hyperkalemia that works in 1-2mins and lasts only 30mins

yes (as often as needed)

Can CaCl2 injections be repeated to treat hyperkalemia?

50ml (25gm) IV over 5mins

How do you give dextrose 50% to treat hyperkalemia?

(give with) 20U insulin (over 1-2hrs .. starts working in 30mins and lasts 2-6 hours)

How do you give dextrose 10% to treat hyperkalemia?

15-60gm PO or PR

How should sodium polystyrene (KAYEXALATE) be given to treat hyperkalemia?

CaCl IV, dextrose50, dextrose10 with insulin, sodium polystyrene

What are 4 standard treatment strategies for hyperkalemia?

colonic necrosis and other GI effects (esp. when used with sorbitol)

Kayexalate is associated with what risks?

Vitamin D, calcitonin, PTH (parathyroid hormone)

[CA] and [phos] are regulated by a complex interaction between what 3 molecules?

bone

Where is 99/5% of the body's calcium found?

(enzyme) cofactor (in blood )clotting

What is the function of calcium?

it accounts for a decrease in percent of protein binding due to a decrease in serum albumin conc.

What is corrected calcium?

tetany, hypoactive (slow) reflex, CNS depression, hypotension, (trousseau's- hand and chvostek's - jaw signs)

What are the S/S of hypocalcemia?

hypoparathyroidism (low PTH), hypomagnesemia (causes low PTH secretion), hyperphosphatemia, chronic renal failure, vitamin D deficiency, acute pancreatitis, alkalosis, hypoalbuminemia, Mg depletion

What are the causes of hypocalcemia?

loop diuretics, corticosteroids, phenytoin, cisplatin, forcarnet, PO4 replacement products, pentamidine, alpha-interferon

What medications might cause hypocalcemia?

hypocalcemia

PIC TROUSSEA What does a positive sign indicate in this test?

hypocalcemia

PIC CHVOSTEK What does a positive sign indicate in this test?

calcium chloride

Which salt of calcium can only be given IV?

calcium acetate, carbonate, citrate

Which salt of calcium can only be given PO?

calcium gluconate

What salt of calcium can be given PO or IV?

gluconate (less irritating)

Preferred IV calcium product

chloride

This form of IV calcium can only be given through central line

carbonate (TUMS, OSCal and their generics)

Which PO salt of calcium gives more Ca per gram?

hypocalcemic symptoms present (paresthesia, tetany, Chvostek's sign), low serum [Ca], massive blood transfusion (esp with cardiac history), Ca chan blocker overdose, emergent hyperkalemia, receiving inotropic or vasopressor support

When is IV calcium appropriate?

magnesium

To effectively treat hypocalcemia, what body stores must be replete?

200-300mg elemental Ca IV (this means 1g of CaCl or 2-3g of Ca gluconate)

Treatment of acute symptomatic hypercalemia requires what?

30-60mg/min (ELEMENTAL CALCIUM - the salts will vary)

What is the maximum speed of elemental calcium?

oral calcium (supplementation of) 2-4g daily (of elemental calcium)

Treatment of chronic hypocalcemia requires what?

vitamin D

Many patients with chronic hypocalcemia must also receive _____

1gm CaCl or 2-3g CaGLU slow IV push

Suggested treatment for tetany (associated with hypocalcemia)

CNS depression, muscle weakness/pain, polyuria, kidney stone development, ECF depletion, heart failure, htn, constipation, increase digoxin toxicity

What are the signs and symptoms of hypercalcemia?

EKG (decreased QT interval), ventricular arrhythmias, htn, heart failure

Cardiac changes associated with hypercalcemia?

malignancy, hyperparathyroidism, thyrotoxicosis, TPN, immobilization, acidosis (decrease affinity of albumin for Ca - which causes more free calcium), milk, medications

What are the causes of hypercalcemia?

thiazide diuretics, estrogens and antiestrogens, lithium, vitamins A and D, calcium supplements

Which medications can cause hypercalcemia?

normal saline + furosemide (use only after ECF depletion is corrected, functioning kidneys necessary, monitoring K and Mg necessary)

Hypercalcemia treatment to enhance urinary calcium excretion

dialysis

Hypercalcemia treatment for patients with renal disease?

calcitonin, prostaglandin synthesis inhibitors, mithramycin, bisphosphonates, gallium, PTH antagonists

Hypercalcemia treatment to inhibit bone resorption

increases (serum calcium levels)

PTH hormone ____ calcium levels

PO/IV PO4

Hypercalemia treatment to increase calcium deposition

calcitonin (inhibits bone resorption)

What is a FAST treatment of hypercalcemia?

NS + furosemide or calcitonin (takes hours to correct)

Short term therapy for hypercalcemia

hydrocortisone or mithramycin (take days to correct)

Intermediate length therapy for hypercalcemia

zoledronic acid or pamidronate (takes weeks to correct)

Long term therapy for hypercalcemia

polyuria

Why are hypercalcemic patients usually dehydrated?

rehydrate with NS (monitoring for fluid overload), add furosemide (blocks Ca resorption), keep monitoring K and Mg

Steps to treat hypercalcemia

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