L3 - Objectives

Obj 11: What are some causes of hypokalemia?

Inadequate intake, GI loss, hypomagnesemia, and medication-induced

Obj 11: What medications can induce a transcellular shift in potassium, leading to hypokalemia?

B2 agonists can bind to Na+/K+ ATPase and cause potassium to move inside the cell

Albuterol and Terbuataline

Obj 11: What medications can induce an increased renal elimination of potassium, leading to hypokalemia?

Amphotericin B

Loop diuretics: furosemide, torsemide, and bumetanide

Thiazide diuretics: HCTZ and chlorothiazide

Obj 11: Name three hypomagnesemia etiologies

GI loss, renal loss, and medication-induced loss

Obj 11: Name a drug that induces GI loss of magnesium

Laxatives such as magnesium citrate

(Theoretically, someone could get hypermagnesemia if they take too much, but it acts more as a laxative)

Obj 11: Name diuretics that induce loss of magnesium

Loop: Furosemide, torsemide, and bumetanide

Thiazide: HCTZ and chlorothiazide

Obj 11: Name an antifungal drug that induces loss of magnesium

Amphotericin B

(also causes DI and hypokalemia)

Obj 11: Name two anti-rejection drugs that induce loss of magnesium

Tacrolimus and cyclosporine

Obj 11: Name some hypocalcemia etiologies

Hypoparathyroidism (less PTH, less calcium conc), vitamin D deficiency, severe hypomagnesemia, and medication-induced

Obj 11: What are some medications that induce hypocalcemia?

- Loop diuretics such as furosemide, bumetanide, and torsemide

- Calcitonin

Obj 11: What drugs decrease GI absorption, leading to hypophosphatemia?

Phosphate binders such as sucralfate, sevelamer, and calcium carbonate.

Obj 11: What drugs increase urinary excretion, leading to hypophosphatemia?

Acetazolamide

Obj 11: What drugs cause intracellular or intestinal redistribution, leading to hypophosphatemia?

Insulin therapy: shifts phosphorus into cells

Diabetic ketoacidosis: insulin for treatment shifts phosphorus into cells

Alcoholism

Obj 11: What are common causes of hyperphosphatemia due to decreased GFR?

Chronic kidney disease or acute kidney injury means phosphate is not excreted effectively by the kidneys.

Obj 11: What iatrogenic causes can lead to hyperphosphatemia?

Sodium phosphate-containing enemas (e.g., Fleet's enema)

Bisphosphonates: etidronate, pamidronate, zoledronate

Obj 11: What other conditions can cause hyperphosphatemia?

Rhabdomyolysis (rapid breakdown of muscle releases phosphate into the blood).

Obj 12: 1. What is the first step in treating someone with hyperkalemia?

Determine if they have an abnormal ECG

Obj 12: 1. Describe the treatment recommended if a hyperkalemic patient has an abnormal ECG

Administer calcium gluconate (peripherally IV) or calcium chloride (central IV)

Obj 12: 2. Describe the treatment recommended if a hyperkalemic patient has a normal ECG

AND

Describe the treatment recommendation for a hyperkalemic patient with abnormal ECGs after calcium administration

Determine if the patient is hyperglycemic (>250 mg/dL)

Obj 12: 2. Describe the treatment recommended if a hyperkalemic patient is hyperglycemic (> 250mg/dL)

Give insulin without dextrose and follow blood sugar

Obj 12: 2. Describe the treatment recommended if a hyperkalemic patient is not hyperglycemic (< 250mg/dL)

Give insulin with dextrose

Obj 12: 3. Describe the treatment recommendation for a hyperkalemic patient after insulin administration

Consider albuterol

Obj 12: 4. Describe the treatment recommendation for a hyperkalemic patient after albuterol administration

Consider sodium bicarbonate if acidic (pH < 7.2)

Obj 12: 5. Describe the treatment recommendation for a hyperkalemic patient after sodium bicarbonate administration

Consider dialysis or exchange resin

Obj 12: What are alternative therapies for hyperkalemia?

Kayexalate (for chronic management only).

Loop diuretics (if normal renal function).

Hemodialysis (if renal failure).

Obj 12: Describe the first-line treatment recommended for a hypermagnesemia patient who has an abnormal ECG

Administer calcium gluconate (peripherally IV) or calcium chloride (central IV)

Obj 12: Describe the second-line treatment recommended for a hypermagnesemia patient

Increase renal elimination of magnesium

Normal kidney: isotonic fluid bolus or loop diuretics

Kidney failure: dialysis

Obj 12: Describe the third-line treatment recommended for a hypermagnesemia patient

Decrease magnesium intake

Obj 12: What are the treatments recommended for a patient with symptomatic hypercalcemia with normal kidney function?

1. Isotonic fluid bolus (aids in volume depletion and excreting calcium)

2. Loop diuretic

3. Calcitonin

4. Glucocorticoid (reduces intestinal calcium absorption and decreases bone resorption)

Obj 12: What are the treatments recommended for a patient with symptomatic hypercalcemia with kidney failure?

1. Hemodialysis

2. Calcitonin

3. Glucocorticoid

Obj 12: What are the treatments recommended for a patient with asymptomatic hypercalcemia < 12 mg/dL?

Monitor, eliminate, and treat the underlying cause

Obj 12: What are the treatments recommended for a patient with asymptomatic hypercalcemia > 12 mg/dL?

1. Isotonic fluid bolus

2. Loop diuretic

3. Caclitonin

4. Glucocorticoid

5. IV bisphosphonate (works slowly, more chronic treatment, such as cancer. Phosphate and calcium are inversely related!)

Objective 13 practice is in notes!

OK