Hypo and Hyper- Mg; HypoP and HypoCa
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Whats the normal serum [Mg] in mEq/L and mg/dL?
Mg: 1.4-1.8mEq/L or 1.7-2.3mg/dl
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
What are the 3 neuromuscular s/sx of hypoMg? Wut are the 3 CV s/sx?
- Sudden cardiac death
What is the tx for asymptomatic hypoMg?
PO MgOxide or Mg-containing antacids
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
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
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
Whats the normal [P] in mg/dL?
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)
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)
What 3 pt populations are at high risk of hypoP? What must be supplemented to these pts to prevent hypoP?
- At risk:
Supplement with IV P 10-30mmol/L in IV fluid
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)
HyperP typically occurs in what 2 diseases?
HyperCa typically occurs in what 2 diseases?
HyperP: CKD or hypoPTH
HyperCa: Malignancy or hyperPTH
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:
- Vit D
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)
Wut r the 8 s/sx of hypoCa?
- Muscle spasms
- Hypoactive reflexes
Wuts the asymptomatic tx for hypoCa?
PO Ca 2-4g/day (div doses) + Vitamin D
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
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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