Upgrade to remove ads
Only $35.99/year

Electrolyte imbalances (Part of AKI)

Terms in this set (50)

What are some s/s of hyperkalemia?
Muscle weakness, paresthesia, palpitations, ascending paralysis, EKG (high T waves)
What are some s/s of hypokalemia?
Often without s/s. Can have weakness, palpitations and EKG findings (U waves, flat T)
T/F: Often patient with hyperkalemia are asymptomatic
false, this is true for HYPO L
T/F: Patient with Hyper and hypokalemia can both present with weakness, palpitations, EKG findings and paralysis
false, paralysis is hyperkalemia! The rest are common s/s shared between both hyper and hypo
What are some causes of hypoK?
Abnormal losses: Diarrhea, Diuretics (HCTZ, Foresmide)

Inadequate intake
Pseudokypokelmeia
What 3 drugs/Hormones can cause K transcellular shifts?
Insulin
SABA (asthma pt)
Aldosterone
T/F: Insulin drives K out of cells
false, drives K into cells
T/F: SABA/neb drive K into cells
true
What should you do if your patient's 1st CMP comes back with hypoK?
Repeat it and confirm less than 3.6 meq/l
You get a low K level and have confirmed it. What labs do you want to check now
Check BMP/CMP: Look at kidneys for example
check Mg (remember if MG messed up, must fix first)
can also get a urine K excretion (Spot K: creatinine)
What is the most important goal in hypoK managment
prevent cardiac conduction dysfunction
Your patient in the ICU. They get a BMP back and their K levels are less than 3.6. You confirm it. You order an EKG and see U waves and flatten T waves. What should you do for treatment?
Urgent treatment: Give 20 to 40 mg K with 1 L normal saline
What is the side effect of IV K?
It burns, so dont use over 20 mEq/hr and give with saline
You get a patient with confirmed hypokalemia (3.2 mEq/L). You order an EKG and it comes back as normal sinus rhythm. You patient does have some weakness. How should you treat them?
Give 40-100 mEq/D of K over days to weeks, this can be PO
T/F: HyperK can be d/t impaired excretion, increased intake and pseudohyperkalemia
True
What are some causes of impaired excretion of K that leads to hyperK
Acute kidney injury, pt is on a spirolactone or ACE/ARB, patient has low alodsterone (driving K out of cells) or pt has adrenal insufficiency
What are some causes of increased intake that leads to hyper K?
Multivitamins, Bananas, Potatoes, KCl salt (sub in the HTN pt)
What can cause a pseudohyperkalemia?
Hypoglcyemia, lab error (blood that sits too long can cause cell lysis and K leak out of cells into serum), post chemo (tumor lysis) and hemolysis
You confirmed your patient has high K (5.2). What are some things you should consider in your patient in order to help lower this K level
1. Think of causes: HTN patient (did they start a new ACE, ARB, HCTZ?)
2. Diet/med modification (no more bananas and potato diet)
3. Consider Kayexalate (binds to K and helps you poop but this is rare)
You confirmed your patient has high K (over 6). They have high T waves on their EKG. How should you treat them?
Because they have EKG changes, give them IV calcium chloride 10 mL of 10% solution over 5 to 10 min to protect the heart and this patient should be put in the hospital
T/F: Any patient with a K level 6 or over should be admitted to the hospital
true
You confirmed your has high K (6.2). You do an EKG and it is normal. How should you treat them?
1. Admit
2. Give them insulin 10 units with glucose 25 g
Your patient has high K (8). You do an EKG and it is normal. They are not responding to insulin and glucose. What can you also try in your patient?
Give them albuterol 10-20 g nebulized
T/F: Insulin and Albuterol drive K into the cells
True
T/F: Aldosterone drives K into the cells
false, drives K out (Ie drives kidney to excrete K)
Hyponatremia is a very common problem. What is the most common cause of this?
medication, think nursing home pt or ICU
What are severe s/s of hyponatremia
confusion, ataxia, seizures, obtundation (not fully alert), coma, respiratory depression
What are mild s/s of hyponatremia
headache, lethargy, dizzy
T/F: if a pt is hyponatremia and has s/s, this generally indicates a severe infection
true
Your patient has a NA level of 120. You should now calculate _______________________.
Serum osmolaity
Your patient has a hyponatremia lab value. You calculate their serum Osm and find it to be 280-285 mOsm/Kg. What is the most likely cause
pseudohyponatremia; repeat lab
Your patient has a sodium level under 135. You calculate their serum Osm and find it to be less than 280 mOsm/Kg. What should you assess next?
assess volume stats
Your patient has a sodium level under 135. You calculate their serum Osm and find it to over 285 mOsm/Kg. What should you assess next?
You should consider hyperglycemia

did they have recent mannitol, sorbitol or radiocontrast media
Your patient has a low NA level, less than 280. What vital signs, labs or other s/s should you assess in your patient
orthostatics
JVP
Skin turgor
Mucus membranes
Peripheral edema
BUN
Uric Acid

checking volume status
Your patient has low NA level. They have edema and JVP and extra water weight. Their Urine sodium is less than 20, you consider what 3 causes and will do what for treatment?
3 causes: HR, cirrhosis, nephrotic syndrome

Tx: restrict water, loop diuretics
Your patient has low NA level. They have edema and JVP and extra water weight. Their Urine sodium is more than 20, you consider what is the cause and will do what for treatment?
Renal failure

Tx: restrict water
Your patient has low NA level. They have normal extracellular volume. Your urine sodium is over 20, how should you tx them?
Restrict water ...remember these pt are euvolemic but have increased total body water and normal total body sodium
Your patient has hyponatremia and normal extra cellular fluid volume, what can be the cause?
they can have a central issues (adrenal or thyroid hypofunction --- check thyroid and cortisol)
Your patient has hyponatremia and decreased volume and sodium. You order a urine sodium and their level is less than 20 mEq/L. What are some causes and how do you treat it?
causes: Diarrhea, vomit
Tx: Fluid restoring
Your patient has hyponatremia and decreased volume and sodium. You order a urine sodium and their level is more than 20 mEq/L. What are some causes and how do you treat it?
Causes: Think peeing out sodium so some renal issues
Tx: Replace fluids (isotonic)...hypertonic solution is rare
Fixing hyponatremia: You should use _______________ fluid -.5-2 mL/kg/hr until sx resolve. 4-6 mEq/L usually reduces s/s
Use 3% saline
T/F: You should use 12-24 mEq/L of saline in 24 hours to fix hyponatremia, any more than that can cause osmotic demyelination
false! no more than 6-12 mEq/L!!!
What is the concern of giving a patient too much saline while fixing hyponatremia
tooo fast can cause osmotic demyelination. Go slow and check the patient often
Your patient is on 4 mEq/L 3% saline to fix hyponatremia. WHen you last called the HO she said the patient was doing better. 1 hour later the HO calls and says the patient is beginning to decompensate neurologically, what are you concerned about
osmotic demyelination, check NA levels and make sure didnt fix the pt too fast
T/F: Hypernatremia is over 145 mEq/L
true
Your patient is hypernatremic, what should you check next? What 3rd?
Volume status

3rd: urine soidum
Your patient has high NA, they have increased total body water and increase total body sodium. They urine sodium is over 20 mmol/L, what are some causes
Hyperalosteronism, Cushings, NaCl tablets

Also: Hypertonic dialysis
Your patient has high NA and no edema (euvolemia). They have no change in total body Na. You know you need to evaluate what?
Kidney

call neprho
Your patient has high Na, Low total water volume and low total body sodium. Your Urine NA is less than 20, what are you thinking
extra renal losses: seat, burns, diarrhea, fistulawe
your patient has high Na and is hypovolemic, your urine Na is over 20 mmol/L. What are some causes
Renal loss: Diuretics, post obstruction, intrinsic renal dz
Other sets by this creator