Feelin' Kinda Depressed
Symptoms: nausea, vomiting, abdominal pain, lethargy
Causes include diuretics, dehydration, or adrenal insufficiency
Low Sodium
-- Seizures/coma <120
-- Euvolemic hypoNa= vague complaints, consider in improper mixing of formula and SIADH
Improper mixing of formula can lead to seizures from which abnormality?
This antiHTN medication can convert to cyanide leading to cyanide poisoning
Sodium nitroprusside
Correction of hyponatremia including dosing and complications
Na < 120, 3% 3-5 ml/kg over 20 minutes; too rapid -> edema, locked-in syndrome
Correct 0.5 meq/L/hr
Check this to ensure hypocalcemia is not a false measurement
Albumin -- Ca decreases 0.8 for every 1 reduction in albumin
Please explain the Chvostek sign and Trousseu signs, including why they happen
Chvostek: tapping on cheek 2cm anterior to tragus to stimulate facial nerve
Trousseu: inflation of BP cuff to 20mmHg for several minutes to induce carpopedal spasm
Both signs of low Calcium
List 3 reasons for hyperkalemia
AKI, diuretics, metabolic acidosis, muscle necrosis, NSAIDS, hemolysis, burn, trauma
What timeframe should you reduce blood pressure by?
25% in the first 6-8 hours
List 3 medication options for hyperkalemia
IV Ca Gluc 50-100mg/kg/dose (max 2000)
IV insulin 0.1 u/kg + IV dextrose 0.5-1 g/kg/dose
Albuterol 2.5-5mg
IV Na Bicab 1-2 meq/kg/dose (max 50)
IV furosemide 0.5-2 mg/kg/dose (max 40)
Name 2 neonatal reasons for free water loss
Dehydration, tachypnea, phototherapy, skin defects
With this electrolyte being extremely low, you could expect delayed gastric emptying, lower extremity weakness, and eventually respiratory paralysis
Potassium
Most commonly diarrhea; also from RTA, hypoMg, alkalosis, tachycardia from beta agonists
Which electrolytes are high in rhabdomyolysis?
Hyperphosphatemia, hyperkalemia, hyperuricemia
ED Work-up for concerning hypertension in children
UA, serum electrolytes, CBC for anemia, possibly EKG, renal U/S
Name 3 possible anti-HTN medications the article suggested using in pediatrics
Labetalol: can be used for <2 years at lower dosing
Esmolol: first-line at many institutitions; 3 dosing levels (125 mcg/kg, 250, 500) - safe for kidney/renal disease
Na Nitroprusside: could consider due to short onset and half-life
Nicardipine: rapid, avoids hypotension, nausea and headaches can happen
Name 3 EKG findings of hyperkalemia
T wave progression, decreased R wave, widened QRS, prolonged PR, S wave (happen >8, Vfib > 10)
Name 3 reasons for low phosphorus
Refeeding syndrome, burns, severe malnutrition, DKA, sepsis
Adrenal insufficiency can cause these 3 electrolytes to be high
Calcium, magnesium, potassium
Please provide new definitions for HTN including classifications.
Elevated: 90-95th percentile, 129-80 > 13 years, 95+ patient age x2 (repeat, follow-up)
Stage 1: 95-99th + 12mm Hg, 130-139 (repeat, education, follow-up)
Stage 2: >99th, >140; 115 + 2x age (repeat, consider drugs)
Electrolyte abnormalities in refeeding syndrome and how to correct
Phos: 0.5-2 mmol/kg/day
Mg: 25-50 mg/kg/dose
K: 1-2 meq/kg/day of KCl
PhosNaK, Thiamin
Most common neonatal reason for hypertension
Umbilical artery catherization
A 16-year-old with POTS, chronic fatigue, and PPI therapy for non-specific belly pain presents with convulsions, intermittent nystagmus, and vague muscle weakness. Your attending thinks it's PNES, but you're way smarter. You know it's due to this electrolyte deficiency.
Magnesium: chronic diarrhea or malabsorption; neurological symptoms, seizures, cardiac
A family in Texas is treating their unvaccinated child for measles with homeopathic medication. The child, already sick with rash and fever, develops fatigue and weakness. You watch Tik Tok so you know this is related to an electrolyte issue.
Excess Vitamin A --> hypercalcemia (stones, bones, groans, moans, psychiatric overtones)
Define PRES including name, presentation, and treatment
Posterior Reversible Encephalopathy Syndrome: AMS, seizures, visual disturbances, headaches; typically secondary to hypertension ; imaging shows vasogenic edema in posterior circulation/spinal cord; supportive care with steroids, antiHTN, anti-seizure meds
Medication (and dosing...) for severe hypercalcemia
IV pamidronate 0.5-1 mg/kg (max 90)
Explain the difference between DI and SIADH including presentation, electrolytes, and treatments
SIADH: high ADH, water retention, low urine output, low sodium--> fluid restriction
DI: low ADH, high urine output, high sodium --> water intake management, desmopressin