Na-lied It!
K-razy
Electrolyte Chaos
The case files
Name that electrolyte
100
Elevated blood levels of this substance may lead to falsely low lab values of sodium.
What is glucose?
THe lab value is falsely low and does not measure true sodium concentration due to additional osmotic pull from the glucose. However tonicity and osmolality of serum is normal and thus there is no intracellular shift of wafter. Serum sodium is actually the same.
100
Treatment for hyperkalemia reserved for patients with acidosis and dose
What is Sodium Bicarbonate 8.4% 50-100 ml?
100
This syndrome occurs when nutrition is restarted after prolonged starvation (anorexia, etohism) and causes phosphate, potassium, and magnesium shifts placing patients at risk of arrhythmias.
What is re-feeding syndrome?
100
Patient is brought in from home. They look unwell and and they are put in resus bed. You are told they have missed their dialysis for the last week. You are handed this EKG and it is new from prior. This is the first medication you order and the dose.
What is Calcium gluconate 10 ml (2.2 mml) IV
100
Electrolyte often seen critically elevated in crush injuries, trauma, or after prolonged down time.
What is potassium.
200
Patient has CHF and anasarca. Na is 115. What is the name to classify this condition and what is the primary treatment.
What is Hypervolemic hyponatremia and fluid restriction?
200
Thsee are the 3 treatments to assist the body to excrete extra potassium from the body.
What is calcium resonium (exchange resin/bowel), Furosemide, dialysis.
200
Cut off lab value at which point local protocols define severe hypokalemia and recommend cardiac monitoring and considering IV replacement?
What is < 2.6 mmol/L?
200
Elderly women brought in for weakness and falls. She has a history of poor nutrition and has been ill lately with vomiting and diarrhea. She appears dehydration. You are given this EKG to help diagnosis her condition.
What is hypokalemia?
200
A patient with weakness and cramps has K⁺ 2.7 mmol/L. This electrolyte should always also be checked and supplemented as needed.
What is magnesium?
300
Recommended rise per 24 hours for symptomatic hyponatremia in an elderly patient presenting with weakness with no recent labs in the last 3 years.
What is 4-6 mmol/24 hours, Max < 8 mmol/24 hours.
300
Medication that at toxic levels can lead to hyperkalemia. This specific medication has an antidote as first line treatment that is different than standard hyperkalemia treatment.
What is digoxin?
Bonus 100 points
Can you name the medication we traditionally use in acute hyperkalemia that should not be given (or with exteme caution) and why.
300
Daily Double!!
2 side effects of rapid Magnesium supplementation and reasons that it is given slowly if not emergent.
What is facial flushing, hypotension, weakness?
At VERY high or rapid levels may cause bradycardia.
300
30 yof is there for fever and cough. A VBG shows K⁺ 7.8 mmol/L, but the patient looks well. Her EKG is below. This should be your FIRST step before treatment.
What is await lab chemistry and do nothing :)
300
The electrolyte that can result in loss of reflexes at toxic or elevated levels.
What is magneium?
400
First line IVF for elderly dehydrated hypotensive patient brought in for confusion, agitation and found to have Na 162
What is 0.9% NS?
Restore perfusion first, then convert to hypotonic solution. 0.45% NS
400
Mechanism by which salbutemol, bicarb, insulin/glucose work to lower labs potassium levels.
What is intra-cellular shift?
+100 if you can name how long albuterol works for
400
Risk of rapid correction in hypernatremia patient.
What is cerebral edema?
400
Patient is brought in by ambulance for syncope. He is elderly and was seen yesterday for dehydration, fatigue, anorexia with the flu. No labs were done but the patient was treated with azithromycin, ondansetron. Shortly after arrival the patient becomes unresponsive and you see this strip on monitoring. In addition to standard resuscitative medications (adreneline/amio) what other medication are you giving?
What is IV magnesium?
2.5 g is 10 mmol
5 g is 20 mmol
400
A patient with pancreatitis develops perioral tingling and QT prolongation. The likely electrolyte abnormality is this and what is the treatment?
What is hypocalcemia? What is Calcium gluconate?
500
The condition caused by rapid correction of hyponatremia in patients that have chronic hyponatremia.
What is Osmotic Demyelination Syndrome or Central Pontine Myelinolosis?
500
Hyperkalemia patients in the first few hours need to be monitored closely. Name one life threatening complication we monitor closely for of hyperkalemia itself and another of the treatment for hyperkalemia.
What are arrhythmia and hypoglycemia?
500
A patient has lactate 7.8 mmol/L but is hemodynamically stable with no infection. They have recently started metformin for diabetes and were sent in after routine labs showed the elevated lactate. Other labs are normal This elevation of lactate is called.
What is Type B lactic acidosis?
500
25 yof presents from marathon. At mile 20 he collapsed. This was followed by 5 minutes of tonic clonic activity. She is confused and agitated. She has already been given 2 L of 0.9% NS by paramedics at the scene. Her lab sodium level is 112. This is the first line treatment to prevent further seizures and dose.
What is 100 ml 3% hypertonic NCl?
3-5 ml/kg@ 50 ml per hour in non critical patient.
500
A 55-year-old male presented to the emergency department with a 3-week history of progressive lethargy, confusion, severe constipation, and diffuse bone pain. x-ray of L spine reviews lytic lesions. What electrolyte abnormality is likely contributing to the patients symptoms.
What is hypercalcemia?