Fluid_Lyte_LectureFinal_2012

Until 3 weeks ago the pt had been healthy w no known

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Until 3 weeks ago, the pt had been healthy w/ no known medical problems, when he suffered a small MI. On that 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. Hypercalcemia
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Causes of Hypercalcemia Increased intestinal absorption Excessive vitamin D Excessive calcium Milk-alkali syndrome Decreased elimination Thiazide diuretics Lithium therapy Increased bone resorption Increased PTH level Malignant neoplasm Prolonged immobilization
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Hypercalcemia Manifestations > 10.5 mg/dl Renal Polyuria, polydipsia Signs of kidney stones GI Anorexia, N/V constipation Neuromuscular Muscle weakness Ataxia, loss of muscle tone Skeletal Osteopenia Osteoporosis CNS Lethary, stupor, coma Personality changes CV Hypertension Shortening QT interval AV block on EKG
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PHOSPHATE
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Causes of Hypophosphatemia Decreased intestinal absorption Antacids Severe diarrhea Lack of vitamin D Increased renal elimination Alkalosis Hyperparathyroidism DKA Renal tubular absorption defects Malnutrition & intracellular shifts Alcoholism PN Recovery from malnutrition Administration of insulin in DKA treatment
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Hypophosphatemia Manifestations < 2.5 mg/dl Neural Intention tremor Ataxia Paresthesias Confusion, stupor, coma seizures Musculoskeletal Muscle weakness Joint stiffness Osteomalacia Bone pain Blood Hemolytic anemia Platelet dysfunction w/ bleeding disorders
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Causes of Hyperphosphatemia Acute phosphate overload Laxatives, enemas IV phosphate supplementation
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