Fluid_Lyte_LectureFinal_2012

87 ca 2 87 mg 15 po 4 29 31 22 16 case 6 a 67 yo

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154 / 98 / 15 87 Ca +2 8.7 Mg + 1.5 PO 4 2.9 3.1 / 22 / 1.6
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Case # 6 A 67 y/o volunteer gardener arrives to her routine physician visit tired and weak. When asked she indicates that the weeds are out of control & she is just tired from to much work. Her PMH includes glaucoma . She takes furosemide 20 mg QD, diltiazem 90 mg QID, and metformin 500 mg BID . Her physical exam is unremarkable with the exception that her extremeties & mucous membranes are dry . 154 / 98 / 15 87 Ca +2 8.7 Mg + 1.5 PO 4 2.9 3.1 / 22 / 1.6
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Causes of Hypokalemia <3.5 mEq/L Intake Diet Inability to eat K free PN Excess renal loss Diuretic therapy Phase of renal failure Primary hyperaldosteronism Corticosteroid tx Excess GI loss Vomiting Diarrhea GI suction Gi fistula drains Shifts β-adrenergic agent Insulin administration Alkalosis
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EmergMedClinNAm5;23:723 Etiologies of Hypokalemia
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Drug-Induced Hypokalemia MOA: Transcellular Shifts Β 2 -Receptor Agonists Epinephrine Albuterol Terbutaline Salmeterol Ephedrine Pseudoephedrine Tocolytic agents Ritrodrine Theophylline Caffeine Insulin overdose
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Drug-Induced Hypokalemia MOA: Enhanced Renal Excretion Diuretics Acetazolamide Thiazides Metolazone Furosemide Torsemide Bumetanide Ethacrynic acid High-dose PCN Nafcillin Ampicillin Penicillin Mineralocorticoids Aminoglycosides Amphotericin Cisplatin
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Drug-Induced Hypokalemia MOA: Enhanced Fecal Excretion Sorbitol Sodium polystyrene
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Hypokalemia Manifestations ↓ urine concentration Polyuria, polydipsia Low urine Osm GI Anorexia, N/V Abdominal distension Paralytic ileus Neuromuscular cramps, tenderness Paresthesias, paralysis CV EKG changes Wide QT Dysrhythmias hypotension CNS Confusion, depression Acid/base Metabolic alkalosis
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www.wtz-zone.com 9/09 EKG Overview
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www.merck.com 9/09 Potassium Related EKG Changes
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EKG What problem(s) exist?
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Causes of Hyperkalemia > 5 mEq/L Excessive intake Diet, oral supplements PN Release from Intracellular compartment Tissue trauma burns Crush injuries Extreme exercise, seizures No response to aldosterone Inadequate renal elimination Renal failure Adrenal insufficiency Tx w/ K sparing diuretics Tx w/ ACEI
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Hyperkalemia Manifestations GI N/V Intestinal cramps diarrhea Neuromuscular Parestesias Weakness, dizzyness Muscle cramps CV Change in EKG Peaked T waves Risk of cardiac arrest
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Case #7 A 40 y/o male presented to the ED with a chief complaint of profound weakness. He had noticed some mild weakness, generalized malaise, & mild nausea for 2 days but this marked weakness developed suddenly on the morning of admission. He was unable to weight bear & had to slide himself along the floor to call a neighbor. He was brought in by ambulance. Until 3 weeks ago, the pt had been healthy w/ no known
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87 Ca 2 87 Mg 15 PO 4 29 31 22 16 Case 6 A 67 yo volunteer...

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