Salty?
Hypomagnesemia is commonly associated with 2 things
Hypokalemia
Hypocalcemia
Electrolyte abnomality related to PPI. And the other 2 secondary to this.
Hypomagnesemia
Hypocalcemia and Hypokalemia
EKG findings of hypokalemia (4):
ST segment depression,
Inverted T waves
U waves
Prolonged PR interval
Assessing the percentage of body surface burned:
Adult and Peds
Adults:
Peds:
Pt with 2 weeks of vomiting was found to have gastric outlet obstruction. The main electrolyte of concern? Treatment?
Hypokalemia
Treat with IV K
Symptoms of hypermagnesemia (at least 3).
Flushing
Hypotension
Hyporeflexia
Respiratory depression
In the GI tract, the organ that secretes the most fluid is the ____ 1-2 L/day
stomach
EKG demonstrating peaked T-waves.
Which electrolyte abnormality is associated with this finding.
Name 2 rapidly acting therapies
Hyperkalemia
IV Calcium gluconate & IV Insulin + Glucose
What is Parkland formula?
When it is used?
How the calculated value is used?
Parkland formula: 4cc x %BSA x Weight
For burns > 20%BSA
[1st half first 8 hr; 2nd half the next 16hr]
[Target urine output Adults, children; <6 months; 0.5cc/kg/hr; 1cc/kg/hr, 2cc/kg/hr]
Pt s/p Total thyroidectomy complains of perioral numbness and tingling. What are the expected/possible physical exam findings for this patient?
Chvosek sign, Trousseau sign
3 signs of acute SEVERE hypocalcemia:
-Papilledema
-Tetany
-Seizures
___ leads to increased K, PO4 and Uric acid.
Which electrolyte is associated with this?
Treatment (Name 2):
Tumor Lysis syndrome
Hypocalcemia
Tx: Hydration, rasburicase, allopurinol, diuretics, alkalinizatino of urine
_____ can present with complete heart block with atrial asystole
Hyperkalemia
Equation for FENa
FENa (%):
(Urine Na/Cr)/(Plasma Na/Cr)×100
Pt s/p major hepatectomy now develops confusion and mental status changes. Which electrolyte abnormality is of concern? And why/how does it happen?
Hypophosphatemia
Utilization of phosphate in regenerating hepatocytes.
Despite multiple 10-mEq of K, K remains low. What would be the cause?
Hypomagnesemia
Insensible fluid losses accounts for 10cc/kg/day.
__% from ____
__% from ____
75% skin
25% respiration
Pt with stage 4 CKD has been taking laxatives for constipation and is found to have 1st-degree AV block.
Which electrolyte imbalance likely caused the 1st-degree AV block?
Treatment options for this condition?
Hypermagnesemia
Calcium gluconate IV, Hemodialysis, IV Lasix
FENa in prerenal, intrinsic, and postrenal.
Pt s/p nerosurgery with sodium 161 with very dilute urinary sodium. Other Lytes are normal.
Wat dis? The treatment? MOA?
Central diabetes insipidus
Vasopressin (form of 1-desamino-8d-arginine)
Primarily acts on V2 receptors in the renal collecting ducts to increase water reabsorption.
Rapid correction of hyponatremia leads to ____
Rapid correction of hypernatremia leads to ____
Central pontine myelinolysis
Cerebral edema
Pt with TBSA 60% being taken to the OR for burn wound excision under general anesthesia. Pt is found to have EKG shows an increase in T wave amplitude with narrow peaked symmetrical T waves and widening of the QRS complex.
Which agent was likely used for induction?
Succinylcholinecholine
Can cause a transient rise in plasma potassium because of muscular depolarization, which is usually seen >48 hours after severe burn injury patients.
Hypocalcemia may induce QT prolongation predisposing ____ which is treated with _____
Torsade de Pointes
Magnesium sulfate
Pt with Glucose 500 and Na 133. Calculate the actual sodium value.
141
Na + [2 every increment of 100 above 100] [500-100, 4 increments of 2]
133+ 2(4) = 141
Pt s/p MVA in the ICU after multiple injuries found to have PE started on Heparin drips. Pt becomes hypotensive and unresponsive to fluids and dopamine infusion. Labs reveal hyponatremia, hyperkalemia, Bicarb low, and normal BUN/Creatinine.
Likely diagnosis? Likely cause? and treatment (be specific)?
Addisonian crisis 2/2 heparin-induced adrenal hemorrhage
Tx: Hydrocortisone 100 mg IV
If IV not available then? IM