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Boards and Beyond: Electrolytes (Potassium :banana: (HyperKalemia (Causes:…
Boards and Beyond: Electrolytes
Potassium :banana:
:pencil2:affects :<3:heart/sk muscle :muscle:
EKG changes
arrhythmias
weakness
HyperKalemia
s/s:
Arrhythmias
sinus arrest
AV block
Muscle weakness
ascending muscle weakness
EKG changes
peak T wave
wide QRS
Causes: Acute or CKD
can't excrete K
aldosterone failure
Secondary causes: K release from cells
acidosis
Insulin def
beta blockers
digoxin :musical_score:
tumor lysis
hyperosmolality (water w/ K leaves cells)
HypoKalemia
s/s:
arrhythmias
PAC/PVC
Bradycardia
ascending muscle weakness
EKG changes
U wave
flattened T waves
Causes: Renal and GI losses
Diuretics
Type 1/2 RTA
Vom/diarrhea
secondary causes:
increased K entry into cells
hyperinsulin
beta agonists :trumpet:
alkalosis
HypoMagnesemia
promotes urinary loss of K
need to correct Mg before K correction
Calcium :glass_of_milk:
Hypercalcemia
S/s: Asx often
recurrent kidney stones
polyuria in acute setting (nephrogenic DI)
AQ2 channel downreg, low GFR, acute kidney failure
Stones
Bones
groans (GI)
overtones
Causes:
Hyperparathyroidism
Malignancy
secondary causes:
Hypervitaminosis D (supplements or sarcoid)
Milk Alkali
hypercalcemia
metabolic alkalosis
renal failure
Hypocalcemia
S/s:
Tetany
small facial muscle twitch
Ca blocks Na channels
low Ca: easy to depolarize (twitch)
Trousseau: hand spasm
Chvostek: cheek tapping spasm
Seizures
Causes:
Low PTH (hypoparathyroid)
renal failure (low vitD)
pancreatitis (saponification of Mg/Ca in necrotic fat)
Rx Foscarnet :racing_car:
low or hi Magnesium (also affects K)
:pencil2:Low albumin: nephrotic syndrome shows low Ca, but total ionized Ca will be fine
:pencil2:(Uworld) Respiratory Alkalosis causes shift of ionized Ca onto albumin, lowering serum Ca. Can be symptomatic.
Phosphate
Hyperphosphatemia
Causes:
Acute and Chronic KD
low PTH (hypoparathyroid)
Hi phosphate load
tumor lysis
rhabdomyolysis :poultry_leg:
large amounts of phosphate laxatives (Fleets Phospho soda)
S/s:
Asx usually
other signs include same as hypocalcemia (renal failure)
Calciphylaxis
aka metastatic calcification
chronic hyper phosphate in CKD
calcifications in vascular walls
raises BP
small vessel thrombosis
painful skin nodules
Prophy: phosphate binders
Hypophosphatemia
Cause:
1º hyperparathyroidism
DKA
refeeding syndrome in alcoholics
Antacids (ammonium hydroxide)
Urinary wasting (Fanconi)
s/s:
ATP depletion: Respiratory weakness
(chronic) bone loss, osteomalacia
Magnesium :battery:
Hypermagnesemia
s/s: Mg blocks Ca and K
neuromuscular toxicity
paralysis
bad reflexes
bradycardia, hypotension, card arrest
hypoCalcemia (inhibits PTH) :glass_of_milk:
Cause: renal insufficiency
Hypomagnesemia
s/s:
HypoCalcemia
:glass_of_milk:
HypoKalemia
:banana:
Neuromuscular excitability
cardiac arrhythmias :heartpulse:
Considerations:
Low Mg causes PTH release
Super Low Mg inhibits PTH release
CaSr impairment
hypocalcemia
Mg inhibits K excretion
inhibits ROMK in tubules
low Mg causes ROMK to "go nuts" releasing K in your pee
Causes:
GI losses
Pancreatitis
Renal Losses (loops or etoh :beer_mugs::)
Drugs: omeprazole or foscarnet