Acid Base and Electrolytes

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  1. What acid-base disturbance does ASA overdose cause?
    • High anion gap metabolic acidosis with respiratory alkalosis
    • Also see tinnitus, hypoglycemia, and vomiting
  2. 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
  3. Causes of euvolemic hyponatremia
    • SIADH
    • Psychogenic polydipsia
    • Oxytocin
  4. Hyponatremia in a laboring woman
  5. Signs and symptoms of hypokalemia
    • muscle weakness (paralysis, ventilatory failure)
    • ileus, hypotension
    • T wave flattening
    • PVC, tachyarrhythmias
  6. 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
  7. 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+
  8. Signs of hyperkalemia on ECG
    Peaked T waves and PR prolongation
  9. Etiologies of hyperkalemia
    • Renal failure
    • Tissue destruction
    • Hypoaldosteronism
    • Adrenal insufficiency
    • Meds (beta blockers, K+ sparing diuretics, ACE inhibitors, ARBs)
  10. 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
  11. Signs and symptoms of hypocalcemia
    • Tetany
    • Chvostek's and Trousseau's signs
    • Depression, dementia
    • Seizures
    • Prolonged QT
  12. 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
  13. Signs and symptoms of hypercalcemia
    • Osteopenia, fractures
    • Renal stones
    • GI discomfort, constipation, ileus
    • Psychiatric symptoms (depression, psychosis)

    Shortened QT on ECG
  14. Most common inpatient and outpatient causes of hypercalcemia
    • Inpatient: malignancy
    • Outpatient: hyperparathyroidism
  15. What diuretics are contraindicated in a hypercalcemia px?
  16. Management of a hypercalcemia px?
    • IV fluids
    • Lasix (to trigger Ca diuresis)
    • Bisphosphanates
    • Prednisone in malignancy-induced hypercalcemia
    • Surgery, for hyperparathyroidism
  17. In what clinical situation is hypomagnesemia commonly seen?
Card Set
Acid Base and Electrolytes
step II
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