L16-L17- Potassium/Magnesium Disorders

K is the abundant cation ________ the cell —> _____cellular

inside, intra (since it does not freely cross the membrane)

______ is the abundant cation inside the cell —> intracellularq

K (since it does not freely cross the membrane)

_____ disorders manifest as cardiac, skeletal, and nervous symptoms

K (since K does not cross the blood brain barrier like Na)

K disorders manifest as _______, ___________, and _________ symptoms

cardiac, skeletal, nervous (since K does not cross the blood brain barrier like Na does)

90-92% of K+ absorption takes place in the _____ _______

GI tract (much better PO absorption than Mg or Phos)

when there is a __________ plasma K+, the Na+/K+/ATPase pump is stimulated d/t ________ insulin, B-2 adrenergic agonist, a-1 antagonist, aldosterone

decreased, excess (all those things are pushing K into the cell)

when there is a decreased plasma K+, the Na+/K+/ATPase pump is _____________ d/t metabolic _________

stimulated, alkalosis

when there is a __________ plasma K+, the Na+/K+/ATPase pump is inhibited d/t __________ insulin, B-2 adrenergic agonist, a-1 antagonist, or digoxin toxicity

increased, deficient (K+ being pulled out of the cell)

when there is a increased plasma K+, the Na+/K+/ATPase pump is _________ d/t metabolic _________

inhibited, acidosis

metabolic acidosis causes an intracellular shift of _____ (pushes it into the cell) and in order to maintain neutrality a shift of ______ extracellularly

H+, K+ (less K+ in cell =more K+ extracellular =increased plasma K+)

metabolic alkalosis causes an intracellular shift of _____ (pushes it into the cell) and in order to maintain neutrality a shift of ______ extracellularly

K+, H+ (more K+ in cell =less K+ extracellular =decreased plasma K+)

hypokalemia is a K+ <____mEq/L

3.5

_______ ___________ agonists can cause an intracellular shift of K+ —> which leads to hypokalemia

beta-2 adrenergic

a excessive K+ _______ is more often the cause for hypokalemia

loss (diarrhea, sweat, renal)

the number one drug class that can cause of hypokalemia are ________

diuretics (d/t increased renal elimination of K+)

hypo__________ can lead to hypokalemia (if there’s not enough of it, any amount of K+ you give will not help)

magensemia

are seizures associated with hypokalemia

NO! (this is a brain problem d/t Na disorder)

is ascending paralysis associated with hypokalemia

YES! (muscle problem)

is constipation associated with hypokalemia

YES! (GI muscle weakness)

if a pt with hypokalemia is mildly asymptomatic and their plasma K+ is 3.1-3.4 mEq/L —> they should be treated with _______, ________, or _____________ potassium

dietary, PO, IV

if a pt with hypokalemia is moderately asymptomatic and their plasma K+ is 2.5-3.0mEq/L —> they should be treated with ________ or _____________ potassium

PO or IV

if a pt with hypokalemia is severe of symptomatic and their plasma K+ is <2.5 mEq/L —> they should be treated with _____________ potassium

IV (± PO supplement)

PO potassium supplement should be given in divided doses or no more than ____mEq /dose

40 (q3-4hrs)

can potassium be given IM or IV Push

NO! (only IVPB or continuous infusion)

can potassium be given IVPB

YES! (not IM, IV Push, or subQ)

when giving potassium via central access the max administration rate is _______ mEq/hr

20 (larger vein) (peripheral access is half of that)

when giving potassium via peripheral access the max administration rate is _______ mEq/hr

10 (smaller vein) (central access is double that)

when giving potassium via ____________ IV access the max administration rate is 20 mEq/hr

central (larger vein)

when giving potassium via ____________ IV access the max administration rate is 10 mEq/hr

peripheral (smaller vein)

hyperkalemia is a K+ >___ mEq/L

5

medications such as spironolactone, eplerenone, triamterene, and amiloride can all cause _______kalemia

hyper (K-sparing diuretics)

Cyclosporine and Tacrolimus can cause ______kalemia

hyper

are arrhythmias associated with hyperkalemia

YES! (cardiac muscle problem)

are muscle twitching or muscle weakness associated with hyperkalemia

YES! (muscle problems, not brain problems)

an inverted T wave on an EKG is indicative of _____kalemia

hypo (low K =low wave)

a peak T wave on an EKG is indicative of _____kalemia

hyper (high K =high wave)

an __________ T wave on an EKG is indicative of hypokalemia

inverted (low K =low wave)

a __________ T wave on an EKG is indicative of hyperkalemia

peak (high K =high wave)

mild hyperkalemia with a K+ 5.1-5.9 mEq/L should be treated with ___________ (± __________ drugs)

Kayexalate (± redistribution drugs)

moderate hyperkalemia with a K+ 6.0-7.0  mEq/L should be treated with ___________, __________ drugs, and/or __________

Kayexalate, redistribution drugs, furosemide

severe hyperkalemia with a K+ >7.0 mEq/L should be treated with ___________, _____________, and/or __________ drugs

IV Calcium, Kayexalate, redistribution drugs

the indication for Calcium in the treatment of hyperkalemia is to restore the __________ __________ _________

resting membrane potential (membrane stabilizer)

the indication for ___________ in the treatment of hyperkalemia is to restore the resting membrane potential

calcium (membrane stabilizer)

insulin is used in the treatment of hyperkalemia via a __________ ________ of potassium

intracellular shift

albuterol is used in the treatment of hyperkalemia via a __________ ________ of potassium

intracellular shift

sodium bicarbonate is used in the treatment of hyperkalemia via a __________ ________ of potassium

intracellular shift

furosemide is used in the treatment of hyperkalemia through __________ of potassium via the _________

elimination, kidneys

Kayexalate is used in the treatment of hyperkalemia through ________ of potassium via the ________

elimination, GI tract

Lokelma is used in the treatment of hyperkalemia through ________ of potassium via the ________

elimination, GI tract

in the treatment fo hyperkalemia, __________ and __________ eliminate K through the GI tract, while ________ eliminates K through the kidneys

Lokelma and Kayexalate, Furosemide

insulin in the treatment of hyperkalemia is given _______

IV

____________ is a cofactor for many enzymatic reactions like glycolysis, protein biosynthesis, nucleotide metabolism, etc.

magnesium

hypomagnesemia is when Mg is <___ mg/dL

1.7

the most common cause of hypomagnesemia is ______ losses

renal

_______ diuretics can cause renal losses which lead to hypomegnesemia

osmotic

_________ __ _______ (ventricular tachycardia) is a common cardiac symptoms of hypomegnesemia

torsade de pointes

torsade de pointes (ventricular tachycardia) is a common cardiac symptoms of _______magnesemia

hypo

torsade de pointes is ventricular _____cardia and is a common cardiac symptom of hypomagnesemia

tachy

is hypomagnesemia is mildly asymptomatic and Mg is 1.5-1.6 mg/dL, pt should be treated with _______, ________, or __________ supplemental magnesium

dietary, PO supplement, IV

if hypomagnesemia is moderately asymptomatic and Mg is 1.2-1.4 mg/dL, pt should be treated with _______, ________, or __________ supplemental magnesium

dietary, PO supplement, IV

is hypomagnesemia is sever or symptomatic and Mg is <1.2 mg/dL, pt should be treated with _______ supplemental magnesium

IV

which salt form(s) of PO magnesium supplementation has the highest total elemental Mg

Hydroxide (Milk of Magnesia) =480-640

Oxide (Mag-Ox, MagGel, Uro-MAg) =338-676

is PO magnesium supplementation dosed once daily

NO! (either BID, TID, or QID) —> compliance issues :(

can supplemental magnesium be given via IV Push

NO! (only slow IV infusion)

can supplemental magnesium be given via IV infusion

YES! (not IV Push)

magnesium ________ is used for parenteral supplementation

sulfate

IV supplemental magnesium for mild hypomagnesemia is dosed as __-__g/100mL D5W or 0.9NS

1-2

IV supplemental magnesium for moderate hypomagnesemia is dosed as __-__g/100mL D5W or 0.9NS

2-4

IV supplemental magnesium for severe hypomagnesemia is dosed as __-__g/100mL D5W or 0.9NS

4-8

IV supplemental magnesium for mild hypomagnesemia is dosed as 1-2 g/100mL D5W or 0.9NS at an infusion rate of ___ grams per ______

1 g/hour

IV supplemental magnesium for moderate hypomagnesemia is dosed as 2-4 g/100mL D5W or 0.9NS at an infusion rate of ___ grams per ______

1 g/hour

IV supplemental magnesium for severe hypomagnesemia is dosed as 4-8 g/100mL D5W or 0.9NS at an infusion rate of ___ grams every _________

2 grams every 15 mins (—> then at 1 g/hour)

in the treatment of hypomagnesemia parenteral dose is ____% of the PO dose

~50%

hypermagnesemia is a Mg >___ mg/dL

2.4

a GFR <___ mL/min/1.73m² is indicative of hypermagnesemia d/t kidney disease

30

hyporeflexia, muscle paralysis, and cutaneous vasodilation are all symptoms of hypermagnesemia that are caused by _____________

flushing SE from giving hypokalemia treatment too fast!!

flushing SEs from giving hypokalemia treatment too fast, like hyporeflexia, muscle paralysis, and cutaneous vasodilation are all symptoms of ______________

hypermagnesemia

if hypermagnesemia is mildly asymptomatic and Mg is 2.5-4 mg/dL, pt should be treated with _______ infusion, _________ or _________

saline infusion, furosemide or hemodialysis

if hypermagnesemia is moderately asymptomatic and Mg is 4.1-12.5 mg/dL, pt should be treated with _______ infusion, _________ or _________

saline infusion, furosemide or hemodialysis

if hypermagnesemia is severe or symptomatic and Mg is >12.5 mg/dL, pt should be treated with __________, _______ infusion, or _________

Calcium, saline infusion, or hemodialysis

calcium is given in the treatment of hypermagnesemia to treat ________ side effects

cardiovascular

______ is given in the treatment of hypermagnesemia to treat cardiovascular side effects

calcium (CaCl₂ or CaGluconate)