Hypo and Hyper- Mg; HypoP and HypoCa

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Author:
Snooze
ID:
296247
Filename:
Hypo and Hyper- Mg; HypoP and HypoCa
Updated:
2015-02-19 19:22:10
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Mg Ca
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Description:
Disorders of Mg, P, and Ca
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  1. Whats the normal serum [Mg] in mEq/L and mg/dL?
    Mg: 1.4-1.8mEq/L or 1.7-2.3mg/dl
  2. HypoMg is common in hospitalized pts and is usually asso'd w/what 4 general causes?

    Occurs usually in what 2 specific conditions/disorders?
    1. Impaired intestinal absorption (UC, diarrhea, pancreatitis, chronic lax abuse)

    2. Inadequate intake

    3. HypoK (occurs concurrently with this or with HypoCa)

    4. Inc'd renal excretion (diuretic use)

    Usually asso'd w/alcoholism and delirium tremens
  3. What are the 3 neuromuscular s/sx of hypoMg? Wut are the 3 CV s/sx?
    • NM:
    • Tetany
    • Twitching
    • Seizures

    • CV:
    • Arrhythmias
    • HTN
    • Sudden cardiac death
  4. What is the tx for asymptomatic hypoMg?
    PO MgOxide or Mg-containing antacids
  5. What is the tx for symptomatic hypoMg? (drug n dose)

    Wuts the dose in kidney insufficiency?
    MgSO4 1-4g (8-32mEq) slow IV infusion over 1g/hour, then 0.5mEq/kg/d continuous infusion

    In kidney insufficiency, reduce by 1/2

    FYI replace over 3-5 days as 1/2 administered is excreted via urine
  6. HyperMg rarely occurs and is generally asso'd with what condition?

    S/sx (N/V, bradycardia, hypotension, heart block, resp failure) rarely occur unless [Mg] is greater than _______
    HyperMg asso'd w/CKD

    S/sx occur when Mg>4-5mg/dl
  7. What is treatment for both asymptomatic and symptomatic pt for hyperMg? Before tx, wut should be done 1st?
    1st d/c all Mg-containing meds

    Asxatic: w/normal kidney fx, treat w/ NS and loop diuretics

    Sxatic: 100-200mg of elemental Ca IV over 5-10mins

    FYI HD may be needed in CKD
  8. Whats the normal [P] in mg/dL?
    P: 2.5-4.5mg/dL
  9. What are the 4 general causes of hypoP?
    1. Inc'd renal elimination (diuretic, glucocorticoids, NaHCO3)

    2. Rapidly refeeding pt w/chronic malnutrition

    3. Resp alkalosis

    4. Tx of DKA (P shifts into IC as DKA is corrected)
  10. What are some of the organs and body systems affected by hypoP? (7)
    1. Neuro (confusion, delirium, seizures, coma)

    2. Pulmonary (tissue hypoxia to peripheri, resp failure, difficulty weaning frm mech vent)

    3. Cardiac (HF, arrhythmias)

    4. Muscle

    5. Hematological

    6. Bone

    7. Kidney
  11. What 3 pt populations are at high risk of hypoP? What must be supplemented to these pts to prevent hypoP?
    • At risk:
    • Malnourished
    • Alcoholism
    • DKA

    Supplement with IV P 10-30mmol/L in IV fluid
  12. What is tx for both asymptomatic and symptomatic hypoP (dose and rate)?
    Asxatic: Oral P (i.e. K-Phos Neutral) can be used but are poorly absorbed

    Sxatic: 15-30mmol Na3PO4 or K3PO4 IV over 3-6 hours (max 7.5mmol/hr)
  13. HyperP typically occurs in what 2 diseases?

    HyperCa typically occurs in what 2 diseases?
    HyperP: CKD or hypoPTH

    HyperCa: Malignancy or hyperPTH
  14. Although 99% of Ca is stored in skeletal bone, 1% is found in EC fluid, and abt 1/2 of that is bound to plasma proteins, like albumin.

    Active form, ionized Ca2+, is regulated by what 4 things?
    • Regulated by:
    • PTH
    • P
    • Vit D
    • Calcitonin
  15. HypoCa typically occurs in what 6 diseases/disorders?
    • 1. CKD
    • 2. HypoPTH
    • 3. Vitamin D deficiency
    • 4. Alcoholism
    • 5. HyperP
    • 6. Pt receiving large amt of blood products or CRRT (FYI Ca chelates w/citrate in blood products or CRRT)
  16. Wut r the 8 s/sx of hypoCa?
    • Tetany
    • Muscle spasms
    • Hypoactive reflexes
    • Anxiety
    • Hallucinations
    • Lethargy
    • Hypotension
    • Seizures
  17. Wuts the asymptomatic tx for hypoCa?
    PO Ca 2-4g/day (div doses) + Vitamin D
  18. Wut is the symptomatic tx for hypoCa (drug n dose)? (2)
    200-300mg elemental Ca IV over 5-10mins either:

    • 1. 1g CaCl2 (273mg elemental Ca) central IV only (FYI peripheral line can cause severe limb ischemia)
    • 2. 2-3g Ca Gluconate (180-270mg elemental Ca) peripheral IV
  19. What are 2 administration rules of IV calcium for hypoCa?
    1. Do not infuse at a faster rate than 60mg elemental Ca per min (NMT 60mg/min) (FYI b/c hypotension, bradycardia, asystole)

    2. Duration of bolus dose is 1-2hrs followed by CIV rate of 0.5-2mg/kg/hr elemental Ca

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