Electrolyte abnormalities

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Author:
sgustafson
ID:
173410
Filename:
Electrolyte abnormalities
Updated:
2012-09-25 21:30:32
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electrolyte
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electrolytes
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  1. Hypernatremia (causes)
    6 D's: diuresis, dehydration, diabetes insipidus, docs (iatrogenic), diarrhea, disease (kidney/sickle)
  2. Hyperkalemia
    • K>5
    • Causes: renal insuff, spironolactone, triamterene, ACEi, trimethoprim, NSAIDs, hypoaldo, type IV RTA, tumor lysis, cell death
    • peaked T->wide QRS->PR prolongation->loss of P->sine wave->Vfib
  3. Duke criteria
    • Endocarditis = 5
    • major (2.5ea) - echo, new regurg murmur, 2 +culture endocarditis-causing organism
    • minor (1ea) - embolic phenom, fever, osler node(SC nodule -immuno), <full echo criteria, culture for other org, predisposition
  4. Hyperkalemia tx
    • calcium (stabilize membranes)
    • kayexelate (sodium polystyrene sulfonate - not w/sorbitol!)
    • bicarb/IVF
    • insulin/D5
    • B2 agonist (albuterol)
    • loop/thiazide diuretics
    • dialysis
  5. Effusion v. transduate (Light's criteria)
    • exudate
    • LDH eff/serum > 0.6
    • protein eff/serum > 0.5
    • serum-effusion alb gradient >1.2, chol eff>45, LDH eff >200
    • complicated: glucose < 60, +gm stain, pH<7.2 
  6. Wells
    • 3 - PE likelier than other dx or s/s DVT
    • 1.5 - tachy or prior PE/DVT
    • 1.5 - immob >3d or surgery 4wks
    • 1 - hemoptysis or malignancy
    • <2 low, 2-6 intermediate, >6 high probability
    • >4 "likely" -> justifies CTA
  7. transudate and exudate causes
    • transudate - low oncotic, incr hydrostatic
    • - CHF, constrictive pericarditis, cirrhosis, nephrotic, myxedema, PE
    • exudate - cap perm
    • - infection, malignancy, PE, collagen vascular dz, chylothorax, hemothorax,
  8. Charcot's triad
    ascending cholangitis: fever, jaundice, RUQ pain
  9. Reynolds pentad
    Charcot's (fever, RUQ pain, jaundice) + shock + AMS = obstructive ascending cholangitis
  10. conjugated/direct hyperbili
    >1 when tbili <5, if tbili above 5, >20%

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