FUNDS EXAM 4 - ELECTROLYTES

when dissolved in water, these substances conduct electricity

electrolytes

Which of these is NOT true about electrolytes?

A) They allow an electric current to be propagated through them.

B) They conduct in solid form.

C) They are also known as ionic solutes.

D) When dissolved in water, the molecules separate into ions.

B) They conduct in solid form.

Electrolytes DO NOT conduct in solid form.

Normal levels for Na

135-145 mEq/L

Normal levels for K+

3.5-5.0

Normal levels for Ca

8.2-10.2

Normal levels for Mag

1.5-2.5

Normal levels for Phos

2.5-4.5

Normal levels for Chl

96-106

Functions of __________ include transmission of nerve impulses, maintaining fluid balance, electrochemical state for nerve balance, brain's ability to be sensitive to changes.

sodium

__________ helps with muscle contraction and neuromuscular function.

SODIUM

____________ is the main cation in the extracellular fluid.

Sodium

A patient who has been vomiting for the past few days is at risk of ...

A) hypernatremia

B) hyponatremia

C) hyperkalemia

D) hypocalcemia

B) hyponatremia

Causes of ____________ include vomiting, diarrhea, hemodilution, diuretics, adrenal insufficiency, and SIADH.

A) hypernatremia

B) hyponatremia

C) hyperkalemia

D) hypocalcemia

B) hyponatremia

too much fluid in the blood

hemodilution

Side effects of hyponatremia:

- nausea and vomiting

- abdominal cramps

- muscle cramps

- lethargy, confusion, headaches, seizures

- decreased saliva, muscle twitch, exhaustion

The main determinant of osmolality in the extracellular fluid that keeps the fluids where they are supposed to be so that swelling is not occurring.

sodium

Which electrolyte imbalance would you need to fluid RESTRICT?

hyponatremia

You can either replace the Na+ or restrict fluid intake to get everything back to normal.

For hypernatremia, give ______tonic fluid.

hypotonic

fluid loss

dehydration

Heat stroke can cause...

A) hyponatremia

B) hypernatremia

B) hypernatremia

Fluid loss can lead to an overabundance of sodium solutes in the body.

sodium level less than 135

hyponatremia

sodium level greater than 145

hypernatremia

The brain is especially sensitive to ____________ changes.

sodium

So, if there is an imbalance of sodium, monitor the patient's neuro.

For ______________, infuse hypotonic solution such as 0.3% NS or give fluids.

hypernatremia management

True or false: Diabetes insipidus has nothing to do with glucose or diabetes mellitus.

TRUE

___________________ literally means passing lots of insipid or "tasteless" urine

Diabetes insipidus

Diabetes insipidus is characterized by _____ antidiuretic hormone.

LOW

Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is characterized by ___________ antidiuretic hormone.

HIGH

With DI, there is (high/low) urinary output, and with SIADH, there is (high/low) urinary output.

With DI, there is HIGH urinary output, and with SIADH, there is LOW urinary output.

With DI, the biggest risk is ______________.

hypovolemic shock

With SIADH, the biggest risk is ______________.

seizures

_________ is associated with high hemogloblin, hematocrit, and serum osmolality from dehydration.

A) SIADH

B) DI

B) DI

__________ is associated with low serum osmolality.

A) SIADH

B) DI

A) SIADH

Most common intracellular cation:

Potassium

___________ helps us with neuromuscular function but especially with cardiac function. _____________ levels really affect the heart rhythm. A lot of the electrolytes affect the heart rhythm, but ____________ especially.

potassium

Causes of hypokalemia:

- nausea

- vomiting

- diarhhea

- GI suctioning

- diuretics

- decreased intake

- IV insulin

- alkalosis

Signs and symptoms of hypokalemia:

- fatigue

- muscle weakness

- leg cramps

- decrease bowel activity

- cardiac arrhythmias

- EKG changes

- decreased strength

- decreased deep tendon reflex

If somebody is on a thiazide or a loop diuretic like Lasix, then they can become ______________.

hypokalemic because the reabsorption of potassium from the filtrate is blocked

Replace K+ in which of the following ways? Select all that apply.

A) IV push

B) IM injection

C) PO

D) IV piggy back

C) PO

D) IV piggy back

Never give potassium in an IV push or IM!!!!!

Causes of hyperkalemia:

- renal failure

- acidosis

- crushing injury

- malignant cell lysis

- certain medications

Signs and symptoms of hyperkalemia:

- GI hyperactivity

- muscle weakness

- flaccid muscles

- paresthesias

- cardiac arrhythmias

Drugs that cause hyperkalemia (hint: THANKS cycle)

T - Trimethoprim

H - Heparin

A - ACEs/ARBs

N - NSAIDs

K - K+ sparing diuretics

S - Succinyl Choline

Cycle - Cyclosporin

How is hyperkalemia managed?

It depends on the cause but...

- Kayexalate

- Diuretics

- IV sodium bicarb

- IV insulin and glucose

- IV Ca Gluconate

- Hemodialysis

- Monitor cardiac rhythm

Hypokalemia causes a ________ T wave.

shallow/depressed

Hyperkalemia causes a _________ T wave.

elevated/tall

Calcium and phosphorus are (directly/inversely) related.

Calcium and phosphorus are INVERSELY related.

"If the blood is toned, it can send calcium to the bones." What does this mean?

The parathyroid releases a hormone to raise the level of calcium in the blood and the thyroid produces calcitonin which sends the calcium in the blood into the bones.

The body needs vitamin ___________ to be able to absorb calcium so the GI system needs to be functioning.

vitamin D

"A glass of milk is 8-10 oz." This can help you remember that ...

calcium's normal levels are 8.2-10.2 mg/dl

Functions of calcium:

-> cardiac muscle function

-> blood coagulation

-> muscle relaxation and contraction

-> nerve impulses

-> bone and teeth

Causes of hypocalemia:

-> poor intake

-> aluminum containing antacids

-> hypoparathyroidism

-> pancreatic disease

Signs and symptoms of hypocalcemia:

-> mental changes

-> EKG changes

-> numbness and tingling fingers and toes

-> increased never excitability

-> increased deep tendon reflex

-> tetany

-> positive Trousseau's sign

-> positive Chvostek's sign

how to treat hypocalcemia:

-> replace orally

-> replace with IV calcium gluconate

Hypocalcemia is calcium that is less than ________

8.2

Why does IV calcium gluconate have to be administered slowly?

to avoid cardiac arrhythmias

Causes of Hypercalcemia:

-> hyperparathyroidism

-> malignancy

-> excess vitamin D

-> calcium supplements

Signs and symptoms of hypercalcemia:

-> nausea and vomiting

-> constipation

-> anorexia

-> muscle weakness

-> decreased tone

-> fatigue

-> lethargy

-> confusion

-> decreased deep tendon reflex

-> EKG changes

How to manage hypercalcemia:

-> IVF for dilution and excretion

-> oral phosphates

-> diuretic

-> calcitonin

-> bisphosphonates

Causes of HYPOmagnesemia:

Malnutrition

Alcoholism

GI suction

Diarrhea

Diuretics

Signs and symptoms of hypomagnesemia:

Weakness

Confusion

Positive Trousseau's sign

Positive Chvostek’s sign

Increased deep tendon reflexes

EKG changes

Twitching

Seizures

hypomagnesemia treatment:

PO or IV replacement of magnesium

Torsades de pointes is a specific type of abnormal heart rhythm that can lead to sudden cardiac death. It can be treated by giving the patient ___________.

magnesium

Which patients would receive magnesium?

-> torsades de pointes

-> preeclampsia patients

Causes of HYPERmagnesemia:

Renal disease

Addison’s disease

IV magnesium

Use of too many antacids

Signs/Symptoms of HYPERmagnesemia:

Flushing

Sweating

Warmth

Drowsiness

Muscle weakness

Decreased blood pressure

Decreased deep tendon reflex

Decreased respiratory rate

EKG changes

HYPERmagnesemia treatment:

Hemodialysis

Diuretics

In emergency: calcium gluconate

Causes of HYPOphosphatemia:

Malnutrition

Decreased absorption

Alcoholism

Hyperparathyroidism

Respiratory alkalosis

Signs/Symptoms of HYPOphosphatemia:

Fatigue

Irritability

Numbness

Bleeding

Bruising

Muscle weakness

Seizures

HYPOphosphatemia treatment:

PO or IV replacement / supplementation

Causes of HYPERphosphatemia:

Renal disease

Hypoparathyroidism

Cell lysis

Acidosis

Signs/Symptoms of HYPERphosphatemia:

EKG changes

Nausea

Vomiting

Tetany

Increased deep tendon reflexes

Muscle spasms

HYPERphosphatemia treatment:

Dialysis or other medications (calcitriol, phosphate binders)