IM lytes a/b

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Author:
TerryZ
ID:
249612
Filename:
IM lytes a/b
Updated:
2013-11-29 11:47:20
Tags:
internal medicine IM electrolytes acid base lytes
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IM
Description:
Internal medicine - electrolytes/acid-base
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  1. HoK - causes
    • Shift: alkalosis, insulin admin
    • GI: …intest fistulae, K absorp
    • K: diur,tube/parenc dz,HAld,//glucocort,
    •     HoMg, Bartters syn (xNaCl reabsorp)
    • Oth: intake,Bactrim,amphoB,sweat,epi
  2. HoK - S/Sx
    • <3: arrhythm(->),flat T, U, /dig tox
    • Musc: weak/cramp, fatigue, paralysis
    • Neuro: DTRs
    • GI: Paralytic ileus
    • Const: N/V, polyuria/dipsia
  3. HoK - Tx
    • Underlying cause: ID & Tx
    • Meds: d/c aggrevators
    • PO: preferred(retest);10mEq->/.1mEq/L
    • IV: sev HoK or arrythm (slow/monitor)
    •   max periph 10mEq/hr; max centr 20
    •   + 1% lido to P
    • Mg: Correct first!
  4. HK - causes
    • Prim: acidosis, lysis (rhabdoHemoBurn)
    • /bodyK: RF, Addis, spiron, HoRen HoAld,
    •    ACEI/ARB, OD, transfusion
    • Redist: [Prim], GI bleed, ins, rapid BB
    • Pseudo: bef/aft venipunct;plasma nl;old
    • //intake: oral suppl, salt substitutes
    • Meds: NSAIDs,spiron,amiloride,triamt,
    •    ACEI,cyclo,tacro,hep,BB,succin,digox
  5. HK - S/Sx
    • Arryth: /T,wQRS,PR->,xP,sine
    • Musc: weakness, flaccid paralysis
    • Neur: DTRs
    • Resp: failure
    • Const: N/V, intest colic, D
  6. HK - Tx
    • Urgent: (K>6,abnl EKG) - IV Ca(Cl,glut)
    • ShiftK: Glu+Ins; bicarb(~acidotic ESRD) 
    • B2 agon: neb albuterol (Na-K-ATPase)
    • bodyK: furos, kayexalate, dialysis
  7. A/B - facts
    • pH: 7.35-7.45
    • pCO2: 40
    • HCO3: 25
  8. A/B - ABG interp
    • CO2:  /->resp acid OR comp metab alk
    •          \->resp alk OR comp metab acid
    • HCO3: /->metab alk OR comp resp acid
    •           \->metal acid OR comp resp alk
  9. Metabolic acidosis - /AG
    • Cause: \HCO3 w/o /Cl
    • M: methanol (intox)
    • U: uremia (RF-\NH4,excr,/SO4,PO4)
    • D: diabetic KA (DM,starv,/EtOH abuse)
    • P: propylene glycol
    • I: Isoniazid
    • L: lact acido (\perf,shock,//energ-seiz)
    • E: ethylene glycol (intox)
    • R: rhabdo
    • S: salycylates (ASA intox)
  10. Metabolic acidosis - nl AG
    • Etiol: /Cl + \HCO3
    • F: fistula (pancr, sm intest)
    • U: ureteroenterostomy
    • S: saline admin
    • E: endocrine
    • D: diarrhea (MC)
    • C: carb anhydr inhib (acetozolamide)
    • A: NH4Cl
    • R: renal tubular acidosis
    •    Prox:\HCO3,reabs,MM,cystinosis,Wilsn
    •    Dist:xHCO3,SLE<Sjogr,amphoB
    • S: spironolactone
  11. Metabolic alkalosis
    • Etiol: /blood pH, plasma CO2
    • Saline sens: Cl-responsive, U-Cl<10
    •   Char: \ECF, HoK
    •   V/NG: \HCl + gastr HCO3 gen
    •   Diur: \ECF; HCO3: -body, /plasm
    •   CA: colon vill aden, //Cl D (congen)
    •   CF: .
    • Saline resist: Cl-unresp, U-Cl>20
    •   Char: /ECF + HTN (<-/mineralocort)
    •   MC: 2/2 HAld->/reab Na,HCO3;\\U-Cl
    •   Oth: Cushing,sevHoK,Bartter,diurAbuse
  12. Respiratory acidosis
    • Etiol: \blood pH, PaCO2>40
    • Acute: comp /HCO3 1mmol <-10 PaCO2
    •   CNS: depr (meds/stroke)
    •   NeuroMusc: GBS, MG
    • Chron: adapt  /HCO3 3.5 <-10 PaCO2
    •   MC: underlying lung dz (COPD, NM,
    •         obesity-HoVent syndrome)  
    • Med: HoVent-morph,anesth,seds,\pupils
  13. Respiratory alkalosis
    • Etiol: /blood pH, \PaCO2
    • Acute: -10 PaCO2 -> HCO3\2,  pH/.08
    • Chron: -10 PaCO3 -> HCO3\4-5,pH\.02
    • Psych: anxiety, histeria, stress
    • Pulm: PE, PNA, asthma
    • Hypox: .
    • Sepsis: .
    • Vent: mechanical
    • Preg: /serum progest->HVent
    • Liver: cirrhosis (//NH4)
    • Meds: ASA, caffeine, coffee
    • CNS: stroke, subarach hemorrh, mening

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