Electrolytes Paulson

Question 1

What diagnostics should be ordered for hypermagnesia?

Answer 1

• Mg level
• BMP
• EKG

Question 2

What EKG findings might you see with hypermagnesia?

Answer 2

• Diminished conduction
• Wide QRS
• Prolonged PQ interval

Question 3

What is the treatment for hypermagnesia when you want to stabilize the cardiac membrane?

Answer 3

Calcium gluconate given IV

Question 4

What med helps renal excretion of Mg?

Answer 4

Loop diuretics (cause ppl to pee out Mg)

Question 5

What are three things that can cause HYPOmagnesia?

Answer 5

• diuretics
• diarrhea
• chronic PPI usage

Question 6

Are Chvostek and Trousseaus sign for hyper or hypomagnesia?

Answer 6

hypomagnesia

Question 7

Patients with hypomagnesia often have concurrent _________ & _________

Question 8

For a patient with hypomagnesia with severe symptoms (tetany, arrythmias, seizures) what is the tx?

Answer 8

IV Mg sulfate

Severe = sulfate

*Need continuous cardiac monitoring

Question 9

For a patient with hypomagnesia with asymptomatic or minimal symptoms, what is the treatment? What is a major s/e

Answer 9

-Oral replacement

=MgCl or Mg oxide

**Diarrhea is a major s/e

Question 10

What major ddx should be on the top of your list of a patient with hypercalcemia?

Answer 10

• ***Malignancy
• Endocrine (***hyperparathyroidism)
• Granulomatous disease
• *Thiazide diuretics

Question 11

Stones, bones, groans, psychiatric overtones are symptoms of what?

Answer 11

Hypercalcemia

Question 12

ST elevation and short QT interval are classic findings of what?

Answer 12

Hypercalcemia

Question 13

What dx to order for hypercalcemia?

Answer 13

Serum total calcium in blood

Question 14

When checking for hypercalcemia, you need to correct for ______

Answer 14

albumin

Question 15

A patient comes in and has hypercalcemia, what do you do next?

Answer 15

1. Check Ca again
2. Check PTH
3. Still elevated –> check Vit D and PTHrP (if elevated could be a malignancy)

Question 16

What is the treatment for hypercalcemia?

Answer 16

-IV fluids and cardiac monitoring

Question 17

What tx should be AVOIDED in hypercalcemia?

Answer 17

Furosemide (Lasix)

Question 18

What are some osteoclast-inhibiting treatments for hypercalcemia?

Answer 18

• Bisphosphonates
• Calcitonin
• Glucocorticoids (pred)

Question 19

Pt has hypercalcemic crisis + hyperparathyroidism, what is the tx?

Answer 19

Parathyroidectomy

Question 20

An EKG finding in hypercalcemia is ______ QT whereas hypocalcemia is a ______ QT

Answer 20

short QT, prolonged QT

Question 21

What are the three most common pathophysiology reasons of hypocalcemia?

Answer 21

• Vit D deficiency
• PTH resistance
• Renal disease

Question 22

Two main clinical features of hypocalcemia?

Answer 22

Trosseau & Chvostek sign

Question 23

DIagnostics for hypocalcemia?

Answer 23

• Total serum calcium (corrected for albumin)
• Serum phosphate
• Vit D level
• Serum pth
• Mg level
• EKG
• BMP

Question 24

A patient comes in with acute and severely symptomatic hypocalcemia, what is the treatment??

Answer 24

IV calcium gluconate

Question 25

What is the treatment for mild hypocalcemia?

Answer 25

Oral calcium + vitamin D

Question 26

T/F: Treat any concurrent hypomagnesmia first to effectively treat the hypocalcemia

Answer 26

T

Question 27

Calcium does the _____ of phosphate, so when the calcium is high, the phosphate is ______. What regulates the two of these?

Answer 27

opposite, low, PTH

Question 28

What are three acute causes of hyperphosphatemia?

Answer 28

1. Acute renal Failure 2. Tumor lysis syndrome 3. Parathyroidectomy

Question 29

What are two main chronic causes of hyperparathyroidism?

Answer 29

1. CKD | 2. Hypoparathyroidism

Question 30

What labs to order for hyperphosphatemia?

Answer 30

- Serum phosphorous - PTH to see if this is the cause - serum calcium - Vit D

Question 31

Treatment for acute hyperphosphatemia and normal renal fxn?

Answer 31

Saline + diuresis

Question 32

Treatment for hypoparathyroidism causing hyperphosphatemia?

Answer 32

Calcium + Vit D

Question 33

Treatment for AKI caused by hyperphosphatemia?

Answer 33

phosphate binders

Question 34

Treatment for CKD and hyperphosphatemia?

Answer 34

Restrict dietary phosphate and need to take phosphate binders forever

Question 35

How to diagnose hypophosphatemia?

Answer 35

- Serum phosphorous | - Urinary phosphorous excretion

Question 36

Treatment of asymptomatic hypophosphatemia with serum phosphate <2.0?

Answer 36

oral phosphate

Question 37

Treatment of symptomatic hypophosphatemia 1.0-1.9

Answer 37

Oral but IV if rhabdo, CNS or hemolysis

Question 38

Treatment of symptomatic hypophosphatemia <1.0

Answer 38

IV phosphate but switch to PO once serum phosphate is >1.5

Question 39

Treatment of hypophosphatemia urinary phosphate wasting?

Answer 39

Dipyridamole QID -helps to increase phosphate levels