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Fluid_Lyte_LectureFinal_2012

Hypokalemia manifestations urine concentration

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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 medical problems, when he suffered a small MI. On that admission HTN and hypercholesterolemia were diagnosed & he was started on enalapril 20 mg BID, metoprolol 50 mg BID, pravastatin 20 mg QD, ASA 81 mg QD & clopidogrel 75 mg QD.
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Case 7 On arrival in the ED, the pt complained of severe, bilateral weakness in the lower extremities greater than upper, lower extremity numbness, tingling, & nausea. VS: 154/83-67-20 36.3 PE: unremarkable except mild abdominal tenerness Labs: 127 / 94 / 31 95 7.2 / 15 / 1.5 An EKG was ordered:
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Case EKG What is the problem?
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CALCIUM
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Overview of Calcium-Phosphate Regulation
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Hypoparathyroid Deficient PTH secretion Causes: neck surgery, thyroidectomy, bilateral neck surgery for cancer Results in hypocalcemia Manifestations: muscle cramps w/ tetany, paresthesias, anxiety, personality changes
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Hyperparathyroid Caused by hypersecretion of PTH Age > 50 yr; 3:1 women/men Results in hypercalcemia
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Causes of Hypocalcemia Impaired ability to mobilize Ca from bone Hypoparathyroidism Hypomagnesemia Decrease intake / absorption Malabsorption Vitamin D deficiency Failure to activate Liver, Renal dz Medications Abnormal renal loss Renal failure & hyperphosphatemia Increase binding Increase pH Tx citrated blood Increase sequestration Acute pancreatitis
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Hypocalcemia Manifestations < 8.5 mg/dl Neuromuscular Paresthesias Skeletal muscle cramps Abdominal spasms, cramps Hyperreactive reflexes Tetany Cardiovascular Hypotension Failure to respond to drugs Prolongation of QT interval Skeletal Osteomalacia Bone pain, fracture
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Am Fam Physician 03;67:1959- 66.
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