Electrolytes Jameson

amandakzinn's version from 2015-04-30 21:58

Section 1

Question Answer
osmolality calculation2(na) + glucose/18 + BUN/2.8
sodium conc135-145
potassium conc3.5-5
magnesium conc1.7-2.1
chloride conc95-105
calcium conc8.5-10.5
osmolality number275-290
treat acidosis then potassium gonnago down! supplement potassium when treating acidosis. dont wait for it to go down
treat hyperglycemia then serum sodium...go up cuz water follow glucose into cell
first ruletotal body sodium rules volume
2nd rulefree water rules serum sodium
give diuretic and taking lots free water gethypnatremia
give diuretic and taking in NS gethypernatremia
hyponatremia, hypo-osmolar, low volume causediuretic and taking in lots free water
hyponatremia, hypo-osmolar, low volume treatmentNS and stop diuretic
hyponatremia, hyo-osmolar, normal volume causetoo much ADH....SSRI, TCA, carbamezapine
hyponatremia, hyo-osmolar, normal volume treatmentstop med, give NS, limit fluids, give loop
hyponatremia, hyo-osmolar, high volume causeheart failure
hyponatremia, hyo-osmolar, high volume treatmenttreat underlying cause, give loop, limit salt and water intake
hyponatremia, hyper-osmolar causeglucose (diabetes) elevated
hyponatremia, hyper-osmolar treatmentinsulin and NS
treating hyponatremia go slow otherwiseget central pontine myelonolysis (brain shrink like raisin). pull fluid out of brain. raise by 12 meq/L/day
treating hyperosmolar hyponatremia go slow otherwisecerebral edema
hypernatremia low volume causefree water low and total body sodium low
hypernatremia normal volume causediabetes insipidus (not enough ADH) free water. drugs lithium, demococyline
hypernatremia low volume treatmentNS then once BP stabilized 1/2 NS
hypernatremia normal volume treatmentloop and D5W
avoid rapid correction hypernatremia cuzotherwise cerebral edema

Section 2

Question Answer
causes of hypokalemiadecreased intake-rare, intracellular shifts(insulin/albuterol), increased excretoin due to gi loss, diuretics, hypomagnesium
must fix what first before fix hypokalemialow magnesium
low magnesium can affectmake potassium low
albuterol can cause low potassium
insulin can causelow potassium
diuretics can causelow potassium, low magnesium
hypokalemia presentationarrythmia
potassium treatment.KCL 40-100 meq divided per day or IV 10-20meq given over one hour
can give iv push potassium?no
hyperkalemia causesincreased intake or decreased excretion (potassium sparing, nsaids, ACI, ARB, acidosis)
renal failure can causehigh potassium and high magnesium
ACEiI and ARB casehigh potassium
nsaids can causehigh potassium
metabolic acidosis can causehyperkalemia. fix acidosis then get lower potassium
peak t waveshigh potassium
treatment hyperkalemiagive calcium chloride, give insulin, give albuterol, give kayexalate, give lasix, HD
magnesium low signsmakes you twitchy
low magnesium causesdecreased intake/absorption. drug induced or hormone induced= amp B, aminglycoside, diuretic, aldosterone
worst thing low magnesium can do istorsades
amph b can cayselow magnesium
amingolycoside can causelow magnesium
aldosterone can causelow magnesum
treatment low magnesium2 grams premixed over 1-2 hours.
hypermagnesium signsdecreased reflexes
high magnesium causesrenal failure
treatment high magnesiumavoid mag products, calcium chloride, loops+saline, supportive care