Transcript T2 - 11-15

ELECTROLYTES TUTORING (PART 2):
CALCIUM, PHOSPHATE, POTASSIUM, AND MAGNESIUM
BY ALAINA DARBY
JR SHOWS UP TO THE ER WITH RENAL DYSFUNCTION AND A CALCIUM
CONCENTRATION OF 7 MG/DL. HIS ALBUMIN IS 1.5 G/DL. HOW WOULD
YOU EVALUATE HIS CALCIUM CONCENTRATION?
a. High
b. Normal
c. Low
FK SHOWS UP TO THE ER WITH RENAL DYSFUNCTION AND A CALCIUM
CONCENTRATION OF 6.5 MG/DL. HIS ALBUMIN IS 2 G/DL. HOW WOULD
YOU EVALUATE HIS CALCIUM CONCENTRATION?
a. High, corrected to 11
b. Normal, corrected to 9
c. Normal, corrected to 8
d. Low, corrected to 8
e. Low, it does not need to be corrected
FK SHOWS UP TO THE ER WITH RENAL DYSFUNCTION AND A CALCIUM
CONCENTRATION OF 6.5 MG/DL. HIS ALBUMIN IS 2 G/DL. WHAT IS THE
LIKELY CAUSE OF HIS LOW CALCIUM LEVEL?
a. Loss of conversion of 25-OH D to 1,25(OH)D
b. Decreased release of PTH from the parathyroid
c. Increased uptake of calcium by bone
d. Decreased hepatic production of 25-OH D
JR HAS LOW CALCIUM AND LOW MAGNESIUM. WHAT IS THE LIKELY
CAUSE OF HIS LOW CALCIUM LEVEL?
a. Loss of conversion of 25-OH D to 1,25(OH)D
b. Decreased release of PTH from the parathyroid
c. Increased uptake of calcium by bone
d. Decreased hepatic production of 25-OH D
WHICH OF THE FOLLOWING MEDICATIONS DOES NOT CAUSE
HYPOCALCEMIA THROUGH RENAL WASTING MECHANISMS?
a. Loop diuretic
b. Amphotericin B
c. Cisplatin
d. Bisphosphonates
WHICH OF THE FOLLOWING PATIENTS SHOULD BE TREATED FOR
HYPOCALCEMIA?
a. Patient with renal failure and iCa of 1.2
b. Patient who overdosed on diltiazem with unknown iCa or Ca
c. Patient who had a blood transfusion with Ca of 7
d. Patient undergoing hemodialysis with Ca of 6
FOR THE PATIENT WHO OVERDOSED ON DILTIAZEM… ICA CAME
BACK AS 0.8. HOW WOULD YOU TREAT HIM?
a. 2g IVPB over 2 hours
b. 4g IVPB over 2 hours
c. 2g IVPB over 4 hours
d. 4g IVPB over 4 hours
THE NURSE ADMINISTERED 4 G OVER 2 HOURS. WHICH OF THE
FOLLOWING MAY OCCUR?
a. Tachycardia
b. Hepatitis
c. Cerebral artery vasospasm
d. None of these will likely occur
AN ANOREXIC PATIENT COMES INTO THE ER IN A COMA. WHICH
OF THE FOLLOWING SHOULD BE STARTED WITH HER TPN?
a. Calcium
b. Phosphate
c. Magnesium
d. Potassium
A PATIENT WITH A TBI HAS A PHOS OF 1.8. HIS BODY WEIGHT IS 75
KG. WHICH OF THE FOLLOWING SHOULD YOU GIVE?
a. 48 mmol at 5 mmol/hr
b. 48 mmol at 7.5 mmol/hr
c. 25 mmol at 5 mmol/hr
d. 24 mmol at 7.5 mmol/hr
YOUR PATIENT HAS RENAL IMPAIRMENT WHICH HAS CAUSED
HYPERPHOSPHATEMIA. HIS LABS: CA 10.5, MAG 1.3, K 4.5. WHICH SHOULD
YOU GIVE HIM?
a. Selevamer
b. Calcium acetate
c. Aluminum hydroxide
d. No treatment should be given
WHICH OF THE FOLLOWING DOES NOT CAUSE HYPOKALEMIA?
a. HCTZ
b. Furosemide
c. Amoxcillin
d. Lisinopril
VD IS ANOREXIC AND HAS A POTASSIUM CONCENTRATION OF 2.7. WHAT
IS THE MOST LIKELY ESTIMATE OF HER CURRENT BODY STORES?
a. 10 mEq/kg
b. 15 mEq/kg
c. 20 mEq/kg
d. 25 mEq/kg
VD IS ANOREXIC AND HAS A POTASSIUM CONCENTRATION OF 2.7. HOW
SHOULD POTASSIUM BE ADMINISTERED IF SHE HAS A J TUBE AND NOT ON
AN ECG MONITOR?
a. KCl 40 mmol/L to enteral feeding
b. KCl 60 mEq/L at a rate of 10 mEq/L
c. KCl 40 mEq/L at a rate of 20 mEq/L
d. KCl 40 mEq bolus
VD IS ANOREXIC AND HAS A POTASSIUM CONCENTRATION OF 2.7. HER
CREATININE IS RISING. WHAT DOSE OF POTASSIUM SHOULD SHE GET?
a. 20 mEq x 2
b. 20 mEq x 3
c. 40 mEq x 2
d. 40 mEq x 3
WHICH OF THE FOLLOWING DRUGS ITSELF DOES NOT CAUSE
HYPERKALEMIA?
a. Heparin
b. Trimethoprim
c. Penicillin G
d. Octreotide
FK HAS WAS GIVEN A REGIMEN OF FUROSEMIDE, FOSCARNET, AMPHOTERICIN
B, AND CISPLATIN WHEN HE WAS HOSPITALIZED 6 MONTHS AGO. WHICH OF
THE FOLLOWING LIKELY HAS CAUSED HIS CURRENT HYPOMAGNESEMIA?
a. Furosemide
b. Foscarnet
c. Amphotericin B
d. Cisplatin
DG HAS A SERUM MAGNESIUM CONCENTRATION OF 1.3. HIS
WEIGHT IS 75 KG. WHAT IS LIKELY HIS DEFICIT?
a. 50 mEq
b. 100 mEq
c. 150 mEq
d. 200 mEq
DG HAS A SERUM MAGNESIUM CONCENTRATION OF 1.3. HIS
WEIGHT IS 75 KG. HOW SHOULD HE BE TREATED?
a. 40 g/hr IV
b. 80 g/hr IV
c. Mag oxide 1-2 tabs PO BID
d. Mag gluconate 1-2 tabs PO BID
DG HAS A SERUM MAGNESIUM CONCENTRATION OF 1.3. HIS WEIGHT IS 75
KG. YOU TREATED HIM WITH MAG OXIDE 1-2 TABS PO BID. WHEN SHOULD
YOU EXPECT TO SEE HIS MAGNESIUM NORMALIZE?
a. 24 hours
b. 48 hours
c. 5 days
d. 10 days
JD is a 54 y/o WM. His labs are the following:
 Na 130
 Ca 5.6, iCa 1.1
 Mg 1.5
 Phos 3.6
 K 3.0
JD IS A 54 Y/O WM. HIS LABS ARE THE FOLLOWING:
NA 130, CA 5.6, ICA 1.1, MAG 1.5, PHOS 3.6, K 3.0
HOW SHOULD YOU TREAT HIS HYPOCALCEMIA?
a. Magnesium and calcium
b. Calcium only
c. Magnesium only
d. Calcium and vitamin D
JD IS A 54 Y/O WM. HIS LABS ARE THE FOLLOWING:
NA 130, CA 5.6, ICA 1.1, MAG 1.5, PHOS 3.6, K 3.0
WHICH OF THE FOLLOWING MIGHT BE CAUSED BY HIS MAG LEVEL?
a. Hyponatremia
b. Hypokalemia
c. Hypophosphatemia
d. Hypomagnesemia
JD IS A 54 Y/O WM. HIS LABS ARE THE FOLLOWING:
NA 130, CA 5.6, ICA 1.1, MAG 1.5, PHOS 3.6, K 3.0
HE IS EXPERIENCING MUSCLE WEAKNESS, WHAT IS LIKELY TO HAVE CAUSED THIS?
a. Hyponatremia
b. Hypokalemia
c. Hypophosphatemia
d. Hypocalcemia
JD IS A 54 Y/O WM. HIS LABS ARE THE FOLLOWING:
NA 130, CA 5.6, ICA 1.1, MAG 1.5, PHOS 3.6, K 3.0
WHY SHOULDN’T HE BE GIVEN INSULIN EVEN IF HE HAS HYPERGLYCEMIA?
a. Hyponatremia
b. Hypokalemia
c. Hypophosphatemia
d. Hypocalcemia
JD IS A 54 Y/O WM. HIS LABS ARE THE FOLLOWING:
NA 130, CA 5.6, ICA 1.1, MAG 1.5, PHOS 3.6, K 3.0
WHICH CAN BE CAUSED BY HYPERPARATHYROIDISM?
a. Hyponatremia
b. Hypokalemia
c. Hypophosphatemia
d. Hypocalcemia