Acid Base and Electrolytes
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What acid-base disturbance does ASA overdose cause?
- High anion gap metabolic acidosis with respiratory alkalosis
- Also see tinnitus, hypoglycemia, and vomiting
What should you if your asthmatic patient's blood gas changes from alkalotic to normal?
- Prepare for elective intubation and continue aggressive med treatment (beta agonists, steroids, oxygen)
- Normal acid-base in an asthma exacerbation means the patient is getting too tired to breath--CRISIS
Causes of euvolemic hyponatremia
- Psychogenic polydipsia
Hyponatremia in a laboring woman
Signs and symptoms of hypokalemia
- muscle weakness (paralysis, ventilatory failure)
- ileus, hypotension
- T wave flattening
- PVC, tachyarrhythmias
What does pH do to serum potassium
- High pH causes low potassium (protons shift out of cells in exchange for potassium ions)
- Low pH causes high potassium
Administration of high dose potassium does not correct K+ levels in your hypokalemic px--what's the next step?
Check Mg--low Mg impairs the body's ability to retain K+
Signs of hyperkalemia on ECG
Peaked T waves and PR prolongation
Etiologies of hyperkalemia
- Renal failure
- Tissue destruction
- Adrenal insufficiency
- Meds (beta blockers, K+ sparing diuretics, ACE inhibitors, ARBs)
Your patient is hyperkalemic. What do you do?
- 1: Get ECG to monitor cardiac function
- 2: Give calcium gluconate
- 3: Give bicarb to raise pH and cause intracellular potassium shift
- 4: Give insulin (to trigger intracellular shift) and glucose (to prevent hypoglycemia)
- (can give beta agonists if n/t else works)
- Emergent dialysis is a last resort
Signs and symptoms of hypocalcemia
- Chvostek's and Trousseau's signs
- Depression, dementia
- Prolonged QT
What should you check in an asymptomatic hypocalcemic patient?
- Albumin--low albumin decreases total body calcium, but px will be asymptomatic because free calcium levels will be unchanged
- Ca falls 0.8 mg/dL for ever 1 mg/dL drop in albumin, once albumin is below 4
Signs and symptoms of hypercalcemia
- Osteopenia, fractures
- Renal stones
- GI discomfort, constipation, ileus
- Psychiatric symptoms (depression, psychosis)
Shortened QT on ECG
Most common inpatient and outpatient causes of hypercalcemia
- Inpatient: malignancy
- Outpatient: hyperparathyroidism
What diuretics are contraindicated in a hypercalcemia px?
Management of a hypercalcemia px?
- IV fluids
- Lasix (to trigger Ca diuresis)
- Prednisone in malignancy-induced hypercalcemia
- Surgery, for hyperparathyroidism
In what clinical situation is hypomagnesemia commonly seen?
What would you like to do?
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