Term
|
Definition
| impermeable solute concentration; ability to draw water across a membrane |
|
|
Term
|
Definition
| total solute concentration (impermeable + permeable); body fcns best between 280-300 mOsm/L |
|
|
Term
| Dextrose 5% in Water (D5W) |
|
Definition
| crystalloid taht provides 170 kcal/L; "free" water, use to replace conditions associated with water deficit (i.e. hypernatremia); moves from vascular into other spaces; may cause edema; monitor for hyperglycemia |
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|
Term
|
Definition
| isotonic; more stays intravascular than D5W; expands volume (used for hypotension or blood loss); replacement fluid for GI tract fluid losses |
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|
Term
|
Definition
| hypertonic fluid; decreases volume of ICF & increases volume of ECF; don't give 3% NaCl if patient is dehydrated |
|
|
Term
|
Definition
| hypotonic solution; adds volumne to ICF as well as ECF |
|
|
Term
|
Definition
| isotonic fluid; expands ECF; similar to NS; used to treat hypotension or blood loss; also has K, Ca, PO4, & lactate; replacement solution when used for fluid resuscitation (acidosis, fluid loss from pancrease, small bowel, saliva, or diarrhea); commonly used for pregnant women |
|
|
Term
| Daily Maintenance Fluid Volume Approximation |
|
Definition
| 0-10 kg: 100 mL/kg; >10-20 kg: add 50 mL/kg for each kg>10; >20 kg: add 20 mL/kg for each kg>20 |
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|
Term
|
Definition
| colloid that remains in IVF better than crystalloids; least likely colloid to distribute out of IVF |
|
|
Term
|
Definition
| colloid that increases risk of bleeding after cardiac & neurosurgery; increases risk of acute kidney injury in sepsis; contraindicated in kidney dysfunction |
|
|
Term
|
Definition
| colloid that can increase risk of bleeding |
|
|
Term
|
Definition
| when Na < 135 mEq/L; most common electrolyte abnormality; causes: 1) excess ECF water due to impaired excretion of water; 2) non-osmotic release of ADH (occurs in hypovolemia, HF, cirrhosis, nephrosis, & SIADH) |
|
|
Term
|
Definition
| causes ADH to be released by posterior pituitary allowing free water reabsorption; thirst is also stimulated: drinking water --> decreases it |
|
|
Term
| Hypovolemic Hypotonic Hyponatremia |
|
Definition
| pt exhibits both hypernatremia & hyperosmolarity; ADH released; kidney retains sodium; greater loss of Na compared to volume; commonly caused by thiazide diuretics within 2 wks of use |
|
|
Term
| Euvolemic Hypotonic Hyponatremia |
|
Definition
| ECF expansion may not be sufficient to cause this; caused by SIADH; also hypothyroidism & renal failure; also, low Na intake/polydipsia |
|
|
Term
| SIADH (Syndrome of Inappropriate ADH Hypersecretion) |
|
Definition
| inappropriately increased levels of ADH OR...exaggerated response to normal ADH levels; caused by: tumors, CNS disorders, pulmonary disease, & drugs (carbamazepine, SSRIs, many others) |
|
|
Term
| Hypervolemic Hypotonic Hyponatremia |
|
Definition
| condition caused by increased ECF but decreased effective circulating volume; kidneys reacting to perceived hypovolemia: retain more water than Na due to ADH |
|
|
Term
| Causes of Hypotonic Hypovolemic Hyponatremia |
|
Definition
| UNa<20 mEq/L; extrarenal losses: diarrhea, skin, lung; UNa>20 mEq/L: renal losses, diuretics |
|
|
Term
| Causes of euvolemic hypotonic hyponatremia |
|
Definition
| UNa>20 mEq/L caused by renal failure, SIADH |
|
|
Term
| Causes of Hypervolemic Hypotonic Hyponatremia |
|
Definition
| UNa<20 mEq/L: CHF, cirrhosis, neprhosis |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Clinical Presentration of Hyponatremia |
|
Definition
| Mental status: Mild = asymptomatic; Moderate/Severe = cerebral edema --> nausea, headache, lethargy, seizures, coma, permanent brain damage; Hypervolemia = dry mucous membranes, decreased skin turgor, orthostatic hypotension; if HYPERvolemic: edema, weight gain |
|
|
Term
| Osmotic Demyelination Syndrome |
|
Definition
| acute decrease in brain cell volume that results in para- or quadraparesis; caused by overly rapid correction of hyponatremia (>12 mEq/L increase of Na per day) |
|
|
Term
| Principles of Treatment for Hyponatremia |
|
Definition
| balance risk for neurologic sequelae with osmotic demyelination syndrome; 0.9% NaCl is fluid of choice; pts with severe symptoms, 3% of NaCl temporarily used +/- furosemide; for euvolemic or hypervolemic, use fluid restriction as first strategy |
|
|
Term
| Treatment of Acute/Severely symptomatic Hypovolemic Hypotonic Hyponatremia |
|
Definition
| use 0.9% NaCl; initial target of 5% increase or 120 mEq/L is advocated |
|
|
Term
| Treatment of Acute/Severely symptomatic SIADH hypotonic hyponatremia |
|
Definition
| use 3% NaCl; when UOsm > 300 mOsm/kg, administer furosemide to prevent volume overload |
|
|
Term
| Treatment of Acute/Severely Symptomatic Hypervolemic Hypotonic Hyponatremia |
|
Definition
| use 3% NaCl with fluid restriction and furosemide |
|
|
Term
| Nonemergent Treatment of Hypovolemic Hypotonic Hyponatremia |
|
Definition
| replace with 0.9% NaCl while addressing underlying disease states; with mildly asymptomatic patients, initial rates of fluid administration of 0.9% NaCl are often 200-400 mL/hr eventually reducing to 100-150 mL/hr |
|
|
Term
| Estimating ECF Volume Deficit |
|
Definition
| ECF desired = normal ECF - ECF current |
|
|
Term
| Nonemergent Treatment of Euvolemic Hypotonic Hyponatremia caused by SIADH |
|
Definition
| remove offending drug; treat underlying condition; restrict fluids to 1-1.2 L/day; target Na = 125 mEq/L; increase intake of Na and/or add loop diuretics; give demeclocycline (Declomycin), conivaptan (Vaprisol), or tolvaptan (Samsca) |
|
|
Term
| Demeclocycline (Declomycin) |
|
Definition
| used to treat SIADH euvolemic hypotonic hyponatremia; ADRs: nephrotoxicity; Efficacy: takes several days to increase Na, reserved for after trial of fluid restriction/NaCl administration |
|
|
Term
|
Definition
| used to treat SIADH euvolemic hypotonic hyponatremia; MoA: AVP V1A & V2 receptor antagonist which increases free water excretion (IV only!); ADRs: infusion site reactions, arrhythmias in HF pts; Efficacy: not for use in hypovolemic patients, COSTLY! |
|
|
Term
|
Definition
| used to treat SIADH euvolemic hypotonic hypernatremia; MoA: AVP V2 receptor antagonist increasing free water excretion; PO; ADRs: no increased arrhythmias in HF pts; Efficacy: not for use in hypovolemic patients; pts allowed to drink fluids |
|
|
Term
| Nonemergent treatment for hypervolemic hypotonic hyponatremia |
|
Definition
| fluid restriction (1-1.2 L/d); Na restriction (1-2 gm/d); ACEIs may play a role in hyponatremia related to HF & nephritic syndrome |
|
|
Term
| Monitoring Parameters for Acute/Severe Hyponatremia |
|
Definition
| monitor in ICU; mental status exams, cardiac & pulmonary status exams over first 12 hours; monitor serum Na every 2-4 hrs; UOsm, Na, & K every 4-6 hours first day |
|
|
Term
| Epidemiology of Hypernatremia |
|
Definition
| pts at highest risk = pts w/ altered mental status, intubated pts, elderly; more common in ICUs than general medicine; acute increase in Na to >160 mEq/L associated with 75% mortality |
|
|
Term
| Pathophysiology of Hypernatremia |
|
Definition
| causes: acute rise in Na can cause water movement from ICF to ECF which can rupture cerebral veins; diabetes insipidus: decreased ADH secretion, drugs like lithium, demeclocycline, and foscarnet, CNS disorders, electrolyte abnormalities |
|
|
Term
| Clinical Presentation of Hypernatremia |
|
Definition
| rapid elevation causes CNS symptoms; muscle weakness, lethargy, coma; "brain shrinkage" causing cerebral bleeding & permanent neurologic damage; if hypovolemic: postural hypotension, dry mucous membranes, reduced or diluted urine output, thirst |
|
|
Term
| Principles of Treatment for Hypernatremia |
|
Definition
| if it develops over a few hours, reduce Na by 1 mEq/L/hr; if more insidious, reduce Na at 0.5 mEq/L/hr with target of 10 mEq/L/day; cerebral edema is a concern with overly rapid administration of hypotonic fluids; preferred route for fluids is ORAL; if giving IV, ONLY hypOtonic fluids |
|
|
Term
| Treatment of Pure Water Loss/Hypotonic Sodium Loss Hypernatremia |
|
Definition
| give D5W, 1/2NS; calculate water deficit: 1/2 of water deficit is replaced in 12-24 hrs with remainder over the next 24-48 hrs |
|
|
Term
| Treatment of Diabetes Insipidus-inspired Hypernatremia |
|
Definition
| give desmopressin (ADH analog); can also use thiazide diuretics for nephrogenic DI |
|
|
Term
| Treatment for Hypertonic Sodium Gain Hypernatremia |
|
Definition
| treat with D5W and furosemide to reduce volume |
|
|
Term
| Monitoring Parameters for Hypernatremia |
|
Definition
| if symptomatic, serum Na every 2-3 hrs on 1st day, then every 6-12 hrs; check fluid status every 8 hrs initially, then every 24 hrs |
|
|
Term
| Epidemiology of Hypocalcemia |
|
Definition
| occurs when serum Ca < 8.5 mEq/L; not common for oupatients, common in ICUs |
|
|
Term
| Parathyroid Hormone Insufficiency in Hypocalcemia |
|
Definition
| causes hypocalcemia due to pancreatitis/GI surgery |
|
|
Term
| Vitamin D Insufficiency in Hypocalcemia |
|
Definition
| causes hypocalcemia due to malnutrition, malabsorption, chronic kidney disease/acute renal failure, nephrotic syndrome |
|
|
Term
| Calcium Chelation in Hypocalcemia |
|
Definition
| causes hypocalcemia by alkalosis |
|
|
Term
| Other-drug Induced cause for Hypocalcemia |
|
Definition
| causes hypocalcemia: furosemide, calcitonin, bisphosphonates, cincalcet |
|
|
Term
| Pathophysiology of Hypocalcemia |
|
Definition
| low serum Ca --> increases PTH --> increased Ca & PO4 from bone, intestinal absorption, and reabsorption of Ca and excretion of PO4 in kidney --> Increased serum Ca |
|
|
Term
| Albumin levels correspond with Ca levels |
|
Definition
| Corrected Ca = measured Ca + [0.8*(4 - albumin)] |
|
|
Term
| Clinical Presentation of Hypocalcemia |
|
Definition
| rapidity of Ca drop correlates with severity; Neuromuscular: cramps, paresthesia, TETANY; Cardiovascular: PROLONGED QT, decreased myocardial contraction; CNS (chronic): depression, anxiety, confusion |
|
|
Term
| Treatment of Acute Symptomatic Hypocalcemia |
|
Definition
| bolus: 100-300 mg elemental Ca over 5-10 min; Infusion: 0.5-2 mg/kg/hr elemental Ca; Maintenance Infusion: 0.3-0.5 mg/kg/hr elemental Ca; use CaCl or CaGluconate |
|
|
Term
|
Definition
| used to treat acute symptomatic hypocalcemia & hyperkalemia; given IV; MoA: replaces deficient Ca needed for neurotransmission & muscular contraction, stabilizes cardiac membrane; ADRs: severe cardiac dysfunction if infused too fast, precipitation if added with HCO3 or PO4; Effective in replacing Ca, reverses EKG in minutes in treatment of hyperkalemia; CaCl associated with more tissue necrosis |
|
|
Term
| Treatment of Chronic Asymptomatic Hypocalcemia |
|
Definition
| give 1-3 gm elemental Ca per day PO; MoA: replaces deficient Ca (CaCO3, CaCitrate [more effective in elderly with reduced acidity of stomach], CaLactate); also give Vitamin D (cholecalciferol, ergocalciferol, calcitriol) |
|
|
Term
| Monitoring for Hypocalcemia |
|
Definition
| serum Ca q4-6 hrs during IV infusions; serum Ca q1-2 days with initiation of oral therapy; improvements of signs/symptoms |
|
|
Term
| Epidemiology of Hypercalcemia |
|
Definition
| serum Ca > 10.5 mg/dL; very rare |
|
|
Term
|
Definition
| malignancy (cancers), medications (thiazides, lithium), granulomatous disorders, & miscellaneous endocrine disorders (i.e. hyperthyroidism) |
|
|
Term
| Pathophysiology of Hypercalcemia |
|
Definition
| many tumors release a protein similar to PTH which causes increased Ca resorption from bone & reabsorption from renal tubules |
|
|
Term
| Clinical Presentation of Hypercalcemia |
|
Definition
| due to malignancy: rapid onset of anorexia, nausea/vomiting, constipation; crisis: acute renal failure, obtundation (diminished level of consciousness), progress to ventricular arrhythmias; calcium or CaPhos deposits contribute to cardiac disease & heart failure |
|
|
Term
| Mild-moderate Hypercalcemia |
|
Definition
| total serum Ca > 13 mg/dL |
|
|
Term
| Hypercalcemic crisis of Hypercalcemia |
|
Definition
|
|
Term
| Treatment of Hypercalcemia with EKG Changes, Neurologic Manifestations, or Pancreatitis |
|
Definition
| treat by expanding fluid volume & increasing Ca excretion with a diuretic if fluid overload (bisphosphonates are first line); pt w/ stage 4-5 CKD or severe HF: hemodialysis, NS, furosemide (Lasix); If CKD or HF: calcitonin (Miacalcin), bisphosphonates, glucocorticoids |
|
|
Term
|
Definition
| used for treatment of hypercalcemia & hyperkalemia; MoA: inhibits Na/K/Ca channel in ascending loop of Henle, causing a reduction in serum Ca & K; ADRs: ototoxicity, hypokalemia; Efficacy: important to use AFTER hydration has been initiated otherwise it can increase Ca, onset K within minutes |
|
|
Term
|
Definition
| used to treat hypercalcemia; MoA: antagonizes effects of PTH - inhibits bone resorption & renal reabsorption causing more Ca to be excreted in urine; ADRs: allergic rxn; Efficacy: rapid onset bu unpredictable degree of Ca reduction |
|
|
Term
| bisphosphonates: pamidronate (Aredia), zoledronic acid (Zometa), ibandronate (Boniva) |
|
Definition
| used to treat hypercalcemia; MoA: osteonecrosis of jaw, acute renal failure; Efficacy: useful for reducing serum Ca in 48 hrs in combo with fluids & calcitonin, drug of choice for hypercalcemia of malignancy |
|
|
Term
| glucocorticoids: prednisone (Deltasone) |
|
Definition
| used to treat hypercalcemia; MoA: reduces calcitriol production by activated mononuclear cells, also decreases Ca absorption, increases Ca excretion, & increases bone resorption; ADRs: infection, osteoporosis, hyperglycemia; Efficacy: limited to patients with chronic granulomatous disease |
|
|
Term
| Treatment of Hypercalcemia in patients with less severe symptoms (muscle weakness, abdominal pain, cognitive deficits) |
|
Definition
| treat with volume expansion and diuresis |
|
|
Term
| Treatment of Hypercalcemia for patients that are asymptomatic |
|
Definition
| monitor and correct reversible causes |
|
|
Term
| Monitoring pts with Hypercalcemia |
|
Definition
| check serum Ca daily if hospitalized; signs & symptoms of hypercalcemia; fluid status/renal fcn if diuretics/fluids administered; cardiac rhythm if Ca is significantly elevated |
|
|
Term
| Epidemiology of Hypophosphatemia |
|
Definition
| Serum PO4 < 2.5 mg/dL; found in 1-3% of hospital admissions; severe form occurs in acute settings |
|
|
Term
| Etiology of Hypophosphatemia |
|
Definition
| caused by internal redistribution (refeeding syndrome/dextrose, insulin, respiratory alkalosis, alcoholism), decreased intestinal absorption (CaCO3, Sevelamer, Lanthanum, diarrhea), and increased urinary excretion |
|
|
Term
| Clinical Presentation of Hypophosphatemia |
|
Definition
| does not typically produce symptoms unless severe (<1 mg/dL); if severe: seizures, rhabdomyolysis, hemolysis |
|
|
Term
| Classification of Hypophosphatemia |
|
Definition
mild-moderate: 1-2.5 mg/dL;
severe: < 1 mg/dL |
|
|
Term
| Prevention of Hypophosphatemia |
|
Definition
| for patients receiving hyperalimentation, add 12-15 mmol/L phos to prevent |
|
|
Term
| Treatment of Severe Hypophosphatemia |
|
Definition
| treat with IV replacement (required); use IV phosphorous (NaPhos, KPhos) |
|
|
Term
|
Definition
| used to treat hypophosphatemia; MoA: replaces deficient phosphorous; ADRs: hyperphosphatemia, CaPhos precipitation; Efficacy: desired response typically seen in 24 hrs |
|
|
Term
|
Definition
| ORAL, used to treat hyperphosphatemia; Na (7 mEq), K (7 mEq), Phos (8 mmol) per packet; ADR: osmotic diarrhea |
|
|
Term
|
Definition
| ORAL, used to treat hypophosphatemia; K (14.25 mEq), Phos (Phos 8 mmol) per packet; ADR: osmotic diarrhea |
|
|
Term
|
Definition
| ORAL, used to treat hyperphosphatemia; Na (13 mEq), K (1.1 mEq), Phos (8 mmol) per packet; ADR: osmotic diarrhea |
|
|
Term
|
Definition
| ORAL,used to treat hyperphosphatemia; Phos (4 mmol) per mL; ADR: osmotic diarrhea |
|
|
Term
| Monitoring Parameters for Pts with Hypophosphatemia |
|
Definition
| severe: serum Phos q6 hrs with IV phos therapy for 48-72 hrs; mild-moderate: daily serum Phos, K, Mg, Ca |
|
|
Term
| Epidemiology of Hyperphosphatemia |
|
Definition
|
|
Term
| Etiology of Hyperphosphatemia |
|
Definition
| Phos intake: Phos containing laxatives/enemas; increased intestinal absorption; redistribution from ICF; decreased renal function: renal failure |
|
|
Term
| Clinical Presentation of Hyperphosphatemia |
|
Definition
| pt has obstructive uropathy, N/V/D, lethargy, seizures; for chronic: organ damage & osteodystrophy |
|
|
Term
| Classification of Hyperphosphatemia |
|
Definition
| Mild-moderate: Phos 4.6-7 mg/dL; Severe: Phos > 7 mg/dL |
|
|
Term
| Treatment of Severe Symptomatic Hyperphosphatemia |
|
Definition
| if hypocalcemic, IV Ca; if Ca is NOT severely low, restrict Phos intake, block additional Phos absorption: phosphate binders (CaAcetate [PhosLo], sevelamer [Renvela], lanthanum [Fosrenol], AlOH [Amphojel], MgOH [Milk of Magnesia]) |
|
|
Term
|
Definition
| phosphate binder used to treat hyperphosphatemia; MoA: binds to phos inhibiting intestinal absorption; ADR: hypercalcemia |
|
|
Term
|
Definition
| phosphate binder used to treat hyperphosphatemia; MoA: binds to phos inhibiting intestinal absorption; ADR: hypercalcemia |
|
|
Term
|
Definition
| phosphate binder used to treat hyperphosphatemia; MoA: non-absorbable hydrogel that binds Phos inhibiting intestinal absorption; ADR: N/V/D, arthralgia; Efficacy: costly, beneficial effects on HDL & LDL |
|
|
Term
|
Definition
| phosphate binder used to treat hyperphosphatemia; MoA: binds to phos inhibiting intestinal absorption; tablet should be CHEWED; ADR: N/V/D; Efficacy: cost limits utility |
|
|
Term
| aluminum hydroxide (Amphojel) |
|
Definition
| phosphate binder used to treat hyperphosphatemia; MoA: binds to Phos inhibiting intestinal absorption; ADRs: anemia, CNS disorders, bone disease; Efficacy: effective |
|
|
Term
| magnesium hydroxide (Milk of Magnesia) |
|
Definition
| phosphate binder used to treat hyperphosphatemia; MoA: binds to Phos inhibiting intestinal absorption; ADRs: hypermagnesemia; Efficacy: safety concerns limit utility |
|
|
Term
| Monitoring Parameters of Hyperphosphatemia |
|
Definition
| if severe, check serum Phos bid to qd; check Ca if severe hypocalcemia |
|
|
Term
| Epidemiology of Hypokalemia |
|
Definition
| one of most common electrolyte disturbances; K < 3.5 mEq/L |
|
|
Term
|
Definition
| caused by hyperaldosteronism (heart failure, cirrhosis, nephrotic syndrome, dehydration); renal tubular defects; drugs (insulin, beta-agonists, diuretics [loop & thiazide], bicarbonates; gastrointestinal (vomiting, diarrhea, malabsorption); increased losses from skin; alkalosis |
|
|
Term
| Clinical Presentation of Hypokalemia |
|
Definition
| Mild (K = 3-3.4 mEq/L): asymptomatic; Moderate (K = 2.5-3 mEq/L): cramping, weakening, myalgias; Severe (K = <2.5 mEq/L): ST segment & T-wave changes, many different arrhythmias |
|
|
Term
|
Definition
| if serum K = 3-3.5 mEq/L, administer oral therapy if cardiac conduction abnormalities (KCl, KPhos, KBicarb/KCitrate); if serum K <3 mEq/L, use oral products if asymptomatic OR if symptomatic, use: IV K |
|
|
Term
|
Definition
| used to treat symptomatic severe (K <3mEq/L) hypokalemia; MoA: replace depleted K; Dose notes: if rate of administration is >10 mEq/hr, monitor EKG...administer up to 40 mEq/hr IV in ICU...DO NOT administer IV PUSH...concentrations >40 mEq/L can cause irritation when administered peripherally; ADRs: pain & burning at injection site; Efficacy: prepare in NS or 1/2NS |
|
|
Term
| KCl (K-Dur, Klor-Con, MicroK), KPhos (Neutraphos, Neutraphos K), KBicarb/KCitrate (Effer-K, KlorCon/EF) |
|
Definition
| oral products used to treat moderate hypokalemia (serum K = 3-3.5 mEq/L); ADRs: GI irritation/ulceration; Efficacy: KPhos used when Phos deficiency too, KBicarb if there is metabolic acidosis, KCl most often used |
|
|
Term
| Monitoring Parameters for Hypokalemia |
|
Definition
| monitor serum K after each administration of 30-40 mEq of K; K measured 30 min after IV administration; monitor q2-3 days if oral products given to hospital patients; EKG monitoring |
|
|
Term
| Epidemiology of Hyperkalemia |
|
Definition
| largely occur because of overcorrection of hypokalemia and renal disease |
|
|
Term
|
Definition
| caused by psueodhyperkalemia (hemolysis of sample); increased K intake & absorption; impaired renal excretion (acute kidney injury, chronic kidney disease, NSAIDs); hypoaldosteronism (ACEIs, aldosterone receptor antagonists); transcellular shifts (acidosis, Beta-blockers, Digitalis toxicity); cellular injury |
|
|
Term
| Pathophysiology of Hyperkalemia |
|
Definition
| K elevation accompanied by low HCO3 (acidosis) & elevated BUN & SCr (AKI/CKD) |
|
|
Term
| Clinical Presentation of Hyperkalemia |
|
Definition
| Frequently asymptomatic, ventricular arrhythmias, neuromuscular symptoms; Mild: 5.1-6 mEq/L, Moderate: 6.1-6.9 mEq/L, Severe: >7 mEq/L |
|
|
Term
| Treatment of Asymptomatic Hyperkalemia |
|
Definition
| restrict dietary intake; no drugs needed if mild; loop diuretics (furosemide) or binding agents (sodium polystyrene sulfonate [SPS or Kayexalate]) |
|
|
Term
| sodium polystyrene sulfonate (SPS or Kayexalate) |
|
Definition
| binding agent used to treat asymptomatic & moderate-severe hyperkalemia; MoA: cation exchange resin (Na originally bound to resin & is substituted with K which passes through intestines); Efficacy: onset is within 1 hr, DON'T mix with OJ |
|
|
Term
| Treatment of Moderate Symptomatic or Severe Hyperkalemia |
|
Definition
| treat by antagonizing cardiac membrane with CaGluconate & CaCl; shift K intracellularly (dextrose/insulin therapy [Humulin R, Novolin R], NaBicarb, Albuterol); remove K from body (SPS, HD) |
|
|
Term
| Dextrose/Insulin Therapy (Humulin R, Novolin R) |
|
Definition
| used to treat moderate-severe hyperkalemia by shifting K intracellularly; MoA: insulin increases activity of Na/K/ATPase pump...dextrose prevents hypoglycemia; ADR: hypo/hyperglycemia; Efficacy: deemed effective by a Cochrane review |
|
|
Term
|
Definition
| used to treat moderate-severe hyperkalemia by shifting K intracellularly; MoA: increases serum pH causing K shift intracellularly; ADRs: tetany, hypernatremia, fluid overload; Efficacy: useful if underlying cause is metabolic acidosis, NOT useful if pts have CKD |
|
|
Term
|
Definition
| used to treat moderate-severe hyperkalemia by shifting K intracellularly; MoA: stimulates Na/K/ATPase pump; nebulizing solution; ADRs: tachycardia |
|
|
Term
| Monitoring Parameters for Hyperkalemia |
|
Definition
| in outpatients, monitor every 2-4 wks; if symptomatic, frequent EKG & K monitoring (continuous until K <5 mEq/L & EKG changes have resolved) |
|
|
Term
| Epidemiology of Hypomagnesemia |
|
Definition
| common electrolyte abnormality; seen in many alcoholics (30%) if hospitalized |
|
|
Term
| Etiology of Hypomagnesemia |
|
Definition
| caused by medications (alcohol abuse, diuretic use [TZD & loop]), renal losses, GI losses (chronic diarrhea, malnutrition), miscellaneous endocrine disorders |
|
|
Term
| Clinical Presentation of Hypomagnesemia |
|
Definition
| neuromuscular signs & symptoms: tetany, tremor, twitching, seizures; cardiac signs & symptoms: heart palpitations, other arrhythmias |
|
|
Term
| Treatment of Moderate & Severe Hypomagnesemia |
|
Definition
| treat with MgSO4 (magnesium sulfate); MoA: replenishes deficient Mg; ADRs: hypotension, vasodilation; Efficacy: works immediately as anticonvulsant, takes 3-5 days to replace deficient Mg |
|
|
Term
| Treatment of Mild Hypomagnesemia |
|
Definition
| manage with 4-6 grams IV per day for 5 days OR oral Mg preparations: MgOH (Milk of Magnesia) or magnesium oxide (Mag-Ox); ADRs: diarrhea; Efficacy: takes 3-5 days to replace Mg |
|
|
Term
| Monitoring Parameters for Hypomagnesemia |
|
Definition
| for severe: hourly Mg levels & continuous EKG until 1.8 mg/dL; mild/moderate: BID-daily Mg levels & assessment for diarrhea of oral Mg |
|
|
Term
| Epidemiology of Hypermagnesemia |
|
Definition
| rare electrolyte abnormality; more predisposed to critically ill pts |
|
|
Term
| Etiology of Hypermagnesemia |
|
Definition
| impaired renal excretion (ARF/CKD); exogenous Mg (antacids/laxatives); impaired Mg elimination; miscellaneous causes |
|
|
Term
| Pathophysiology of Hypermagnesemia |
|
Definition
| as ClCr descends below 30 mL/min, condition increases |
|
|
Term
| Clinical Presentation of Hypermagnesemia |
|
Definition
| early signs (3 mg/dL): N/V; as levels rise above 4 mg/dL: hyporeflexia, loss of deep tendon reflexes; levels of 5-6: hypotension & EKG changes; levels >9 mg/dL: respiratory depression, coma, complete heart block; levels of 10-15: asystole, cardiac arrest, death |
|
|
Term
| Treatment of Hypermagnesemia |
|
Definition
| treat with IV Ca products (antagonizes neuromuscular & cardiovascular effects of Mg), IV diuresis + fluids (furosemide); ESRD pts should receive emergent HD |
|
|
Term
| Monitoring of Hypermagnesemia |
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Definition
| severe: Mg & Ca levels hourly & continuous EKG until asymptomatic or Mg < 4 mg/dL; moderate w/ diuresis: Mg levels BID-QID |
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