Path 232 W4

charged particles

What form is potassium in in the body?

muscle

When we think K+ imbalance, we think large impact on this type of tissue due to the electrical charge component it plays in movement of this type of cell

GI tract

Where is K+ absorbed from

cells, ECF

K+ tends to leak from ___ into ___ because cells have higher K+ concentration than the ECF

into

The sodium potassium pump pumps K+ ___ cells to maintain a concentration gradient

alkalosis, insulin, epinephrine

What 3 stimuli shift K+ into the cells?

acidosis

Some types of this shift K+ out of cells

metabolize

The body can not ____ K+. It is excreted in urine, feces, and sweat

K+, Na+, water

We are concerned about loss of these 2 ions and this 1 molecule when someone has acute diarrhea

flow-dependent

K+ excretion by kidneys is ____-___

greater

The ____ the volume of urine the more K+ is excreted

Aldosterone

_____ and glucocorticoid hormones such as cortisol increase excretion of K+ in urine

emesis

In terms of pathophysiology/abnormal K+ loss, it may be lost from the body through ____, drainage of GI tubes, or other loss of body fluids

serum K+

What test is run to determine potassium imbalance?

serum potassium

2.5-5.0 mEq/L is the reference range for what?

plasma, cells

Besides changes in Is and Os causing shifts in K+, shifts from ____ into ____ can also result in K+ imbalances

hyperkalemia

Plasma excess of K+

hypokalemia, diet

Decreases in K+ intake, while output remains the same can cause _____. These factors are primarily related to ____

excretion, hyperkalemia

An increase in aldosterone results in decreased ____ of K+ and can cause _____

hypokalemia, hyperkalemia

Because K+ is excreted in urine, an increase in urine output can lead to _____, while. a decrease in urine output can lead to _____

hyperkalemia, medical intervention

Factors that increase K+ intake while output remains the same can cause ____. Broadly speaking, factors that increase K+ intake result from ____ ____, such as excessive IV administration of KCl

hyperkalemia

Oliguria, hypovolemia, and decreased aldosterone are all factors that can decrease K+ output. When K+ output is decreased while input remains the same, there is a risk for ____

abnormal

_____ K+ loss can also result in hypokalemia. Examples of this is emesis, nasogastric suction, and intestinal decompression

Cells, plasma

DKA, crush injury, and acidosis are all factors that can shift K+ from ____ into ____, which is associated with hyperkalemia

Ca++, Mg++

In cases of chronic diarrhea, besides being worried about Na+, K+ and H2O loss, we are also concerned about the loss of these 2 other important electrolytes

floppy

Both hypokalemia and hyperkalemia are ____ processes, impacting muslces heavily

Hypokalemia

The following are sings and symptoms of _____;
- abdominal distention
-decreased bowel sounds
-constipation
-polyuria

-postural hypertension

-cardiac arrhythmias

hyperkalemia

The following are signs and symptoms of ____;

-transient intestinal cramping and diarrhea
-flaccid skeletal muscle weakness

-flaccid paralysis
-cardiac dysrhythmias
-cardiac arrest

K+

The following are all exampled of foods rich in which electrolyte?;

-bananas

-apricots

-dates

-figs

-grapefruit/grapefruit juice

-kiwi

-oranges

-peaches

-prunes

-raisins

-strasbs

k+

The following are all examples of foods rich in which electrolyte?

• asparagus

• beets

• bok choy

• broccoli

• carrots

• cauliflower

• celery

• potatoes

• pumpkin

• squash

  • tomatoe

K+

Which electrolyte are the following good sources of? almonds, brazil nuts, cashews, instant coffee

VitD

Ca++ is not directly absorbed from the GI tract. It is dependent on ____ dependent binding proteins

fat

Ca++ binds to ____ which can prevent its absorption. If intestinal contents are high in this, Ca++ absorption will be decreased

3

In plasma, how many forms of Ca++ are there?

ionized

The ____ form of Ca++ is the biologically active form

albumin

In the blood, Ca++ can bind to this protein, inactivating the Ca++

organic anions

Besides albumin, Ca++ in blood can bind to ___ ___ in a physiologically inactive form

alkalosis

This pH based pathology results in a decreased amount of physiologically available Ca++ by causing increased binding of Ca++ to albumin

urine, feces, sweat

What are the 3 normal mechanisms of Ca++ excretion?

parathyroid hormone

What hormone is responsible for decreasing urinary Ca++ excretion?

Ca++

the normal range of serum ___ is 9-11mg%, which reflects total, but not necessarily amount of active electrolyte

hypocalcemia

This is indicated a plasma deficit of Ca++. This condition purely reflects serum levels, not necessarily stored levels

physiologically unavailable

hypocalcemia occurs as a result of changes in Is and Os, but also when Ca++ shifts into a ____ ____ form in plasma or from plasma to bones

hypercalcemia

This is indicated by a serum Ca++ greater than 11mg%. Indicates excess plasma Ca++, does not account for stored Ca++

Ca++

This electrolyte is highly plasma protein bound

nutrition, vit D, chronic diarrhea

Factors that decrease Ca++ intake without effecting excretion can result in hypocalcemia. The general themes of factors that decrease Ca++ intake/absorption are ____, _____ (vitamin), and changes in GI tract, ___ ____.

fatty stool, pancreatitis

Factors that increase Ca++ output, putting patient at risk for hypocalcemia are ____ ____ and the abnormal pathology of acute ____

Ca++

Factors that can shift ___ into physiologically unavailable forms or from plasma into bones are medical interventions (massive transfusion, overuse of phosphate containing antacids), alkalosis, and decreased parathyroid hormone (removal, hypomagnesemia)

Mg++

This electrolyte stimulates PTH production

VitD

Hypercalcemia can be caused by excessive intake of what vitamin?

diuretic

Hypercalcemia from decreased output while input remains the same can result from thiazide ____ medications, since Ca++ is excreted in urine.

immobilization, cancer, PTH

Factors that can shift Ca++ from bones into plasma are prolonged ____, some types of ___ that secrete bone resorbing substances) and decreased ___

hyperkalemia, hypocalcemia

These 2 electrolyte imbalances can occur together

twitchy

Is hypocalcemia twitchy or floppy?

hypocalcemia

spasms, twitching, cramping, grimacing, tetany and cardiac dysrhythmias are associated with what Ca++ imbalance?

hypercalcemia

The following are symptoms of what kind of Ca++ imbalance?
Anorexia, constipation, nausea+emesis, muscle weakness/fatigue, confusion, lethargy, personality/mood changes, polyuria

floppy

Hypercalcemia is floppy or twitchy?

Na+

Low calcium stimulates opening of ___ channels, making muscle contraction more likely, while high calcium can block these channels

hypercalcemia

This type of Ca++ imbalance should require teaching to drink 3-4L of water per day to protect kidney function

Ca++

The following are rich in what electrolyte?

almonds, cream of wheat/farina, chocolate, canned fish w edible bones, oranges, oysters, tofu, corn tortillas, leafy dark green vegetables, nopales

ileum

Mg absorption in the GI tract occurs in the ____, while Ca++ absorption is in the duodenum.

fat

Similar to Ca++, Mg++ absorption in the GI tract is impaired by ___

bones, cells

Where in the body are the primary electrolyte pools of Mg?

cofactors

Mg++ intracellularly is so important because they act on enzymes as ____

3

How many forms of Mg++ are there in the blood?

ionized

What is the physiologically active form of Mg++

albumin

Mg++ in plasma binds to what protein?

feces, urine, sweat

How is Mg++ excreted from the body in normal physiology

fistulas, pancreatitis

Emesis, _____, prolonged NG suction, acute _____ are all abnormal routes of Mg++ loss.

fatty acids

acute pancreatitis is a concern for hypomagnesemia and hypocalcemia because Leaked pancreatic enzymes digest surrounding abdominal fat into free ____ ____, which bind and trap calcium and magnesium in the tissues

acute pancreatitis

When Mg++ levels are low, PTH secretion is decreased which can cause hypocalcemia. What condition is this a concern in?

GI tract

Factors that decrease Mg++ intake or absorption are risk factors for hypomagnesemia. The general theme of these factors is that they are all related to the _____ ____ and Is/Os.

diuretics

Because Mg++ is secreted in the urine, factors that increase Mg++ output include ____, DKA, and hyperaldosteronism

Massive transfusion, hypomagnesemia

____ ____ of citrated blood can shift Mg++ into physiologically unavailable forms because Mg binds anions like citrate. This puts the patient at risk of what Mg imbalance?

hypermagnesemia

______ due to increased Mg++ intake/absorption while output stays the same can be caused by excessive use of antacids and laxatives containing Mg++, and aspiration of sea water

decrease

Because Mg++ is excreted in urine, factors that ____ urine output, like oliguric kidney disease and adrenal insufficiency.

twtichy

Is hypomagnesemia a twitchy or floppy imbalance?

hypomagnesemia

hyperreflexia, insomnia, muscle twitching, cramping, tremors are all symptoms of what type of Mg++ imbalance?

Mg++

____ can be thought of as an opposing force to calcium or its offswitch

hypomagnesemia

This Mg++ imbalance results in a decreased ability to turn “off” calcium, resulting in neuromuscular excitabilityu

hypermagnesemia

This Mg++ imbalance results in an increased ability to turn “off” calcium, resulting in decreased neuromuscular response/tone

hypermagnesemia

The following are symptoms of what Mg++ imbalance?
hypotension, warmth, bradycardia, drowsiness, lethargy, weak/absent DTR, flaccid muscle paralysis

Mg++

The following are examples of foods rich in what electrolyte?
cocoa, coffee, egg yolk, dark leafy greens, legumes, milk, meat, nuts, whole grains

Trousseau sign

This sign of some electrolyte imbalances results in carpal spasms induced by inflating a blood pressure cuff

Chvostek sign

This sign of some electrolyte imbalances results in facial twitching when tapping on facial nerve

hypocalcemia, hypomagnesemia

Chvostek sign is associated with which two “twitchy” electrolyte imbalances

hypokalemia

Trousseau sign is associated with the same two “twitchy” electrolyte imbalances as Chvostek, but it can also be a sign of ____ and alkalosis.

hypomagnesemia

chronic high alcohol intake is a risk factor for ____