What are some causes of hypokalemia related to decreased intake?
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Drip arm effect and decreased dietary intake.
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What are some causes of hypokalemia related to decreased intake?
Drip arm effect and decreased dietary intake.
What types of drugs can lead to hyperkalemia?
Potassium-sparing diuretics and indomethacin.
How is the water deficit calculated?
Water deficit = 0.5 x BW x (plasma Na/140 – 1).
What are the plasma concentration ranges for hypermagnesaemia and their effects?
0.7-1.0 mmol/L (normal), 2.0-3.0 mmol/L (therapeutic), 3.0-3.5 mmol/L (ECG changes), 4.0-6.0 mmol/L (areflexia), 6.0-7.0 mmol/L (respiratory arrest), 10.0-12.5 mmol/L (cardiac arrest).
What is the recommended dose for calcium acetate tablets?
2 tablets three times a day (tid).
What gastrointestinal losses can lead to hypokalemia?
Vomiting, huge gastric aspirate, diarrhea, and fistula.
Which renal conditions can cause hypokalemia?
Primary and secondary hyperaldosteronism, excess mineralocorticoids, chronic pyelonephritis, and renal tubular acidosis.
What are some causes of hypomagnesaemia?
GI loss, reduced intake, reduced absorption, renal loss, drug-induced loss, burns, sepsis, cardiopulmonary bypass, Mg-free dialysate.
What are some clinical features of hypokalemia related to the cardiovascular system?
ECG changes (flattening of T waves, ST depression, U waves, prolonged QT) and arrhythmias (SVT, VT, torsades).
What is a potential complication of hyperphosphatemia?
Nephrocalcinosis, nephrolithiasis, and band keratopathy.
What is a common clinical feature of hyperkalemia related to the cardiovascular system?
ECG changes such as tall T waves and prolonged QRS.
What is a common symptom associated with hyperphosphatemia?
Symptoms are usually caused by accompanying hypocalcemia.
What are some endogenous causes of hyperkalemia?
Burns, trauma, rhabdomyolysis, and tumor lysis.
Which condition is associated with decreased renal excretion of potassium?
Addison’s disease and hypoaldosteronism.
What clinical features are associated with hypomagnesaemia?
Arrhythmia, coronary artery spasm, congestive heart failure, anorexia, dysphagia, muscle weakness, lethargy, seizures, confusion, irritability.
What is the first step in treating hyperkalemia?
Treat the underlying cause.
When is rapid correction of hyponatremia indicated?
In symptomatic patients, such as those experiencing convulsions.
What is the maximum rate for correcting sodium levels?
0.5 mmol/l/hour.
What is vitamin D toxicity associated with in terms of phosphate balance?
It can lead to a positive phosphate balance due to increased phosphate absorption.
What is the primary aim of treatment for hyperphosphatemia?
To correct the underlying hypocalcemia.
What solutions can be used to replace water deficit?
Water orally, ½ saline, D5 solution.
What is the first step in treating hypermagnesaemia?
Stop magnesium supplementation.
What can be used to antagonize neuromuscular effects of hypermagnesaemia?
10 ml of 10% calcium gluconate.
What muscular symptoms can be seen in hypercalcaemia?
Weakness, areflexia, atrophy.
What gastrointestinal symptoms are associated with hypokalemia?
Ileus and constipation.
What serious arrhythmia can occur due to hyperkalemia?
Ventricular fibrillation (VF).
What is a method to enhance potassium excretion?
Using resonium A (sodium polystyrene sulphonate) or resonium C (calcium polystyrene sulphonate).
What is the formula to estimate sodium deficit?
0.6 x BW x (desired – current Na).
What is a critical illness that can cause hypocalcaemia?
Sepsis or burns.
What medication can be used to decrease bone resorption in hypercalcaemia?
Calcitonin, glucocorticoids, bisphosphonates, mithramycin (after specialist advice).
What is a skeletal clinical feature of hypophosphataemia?
Muscle weakness and rhabdomyolysis.
What are two approaches to correct hyperphosphatemia?
What is the primary effect of pure water depletion?
Large increase in sodium and osmolarity.
What condition can lead to renal retention of phosphate?
Renal failure.
What is the treatment for asymptomatic hypomagnesaemia?
10 mmol MgSO4 over 2 hours.
What is the oral potassium supplement dosage for hypokalemia?
Syrup KCL: 1G = 13.4mmol; slow K: 600mg = 8mmol.
How can potassium shift to cells be enhanced in hyperkalemia treatment?
By administering 10 units of actrapid with 50 ml of 50% D50 over 20 minutes.
What is the maximum rate of sodium correction for acute hyponatremia?
No greater than 2 mmol/l/hr.
Which disease is associated with hypercalcaemia and involves abnormal tissue growth?
Malignancy.
What is the sodium content in NaCl 0.9%?
0.15 mmol/ml.
Which form of calcium is more physiologically important?
Ionized calcium is more important than total calcium.
Name a cause of hypocalcaemia related to respiratory conditions.
Respiratory alkalosis.
What are some clinical features of hypocalcaemia related to the cardiovascular system?
Hypotension, bradycardia, insensitivity to catecholamines and digoxin, ECG changes (QT/ST prolongation).
What is the usual daily requirement of calcium?
1000 mg/day.
What is a treatment approach for hyponatremia in SIADH?
Fluid restriction.
What medications can promote phosphate binding in the upper GI tract?
Sucralfate, aluminium-containing antacids, and calcium acetate tablets.
What medications can contribute to hypokalemia?
Diuretics, amphotericin, and gentamicin.
What is the treatment for pure water depletion?
Depends on the underlying cause; correct systemic hemodynamics and water deficit.
What central nervous system symptoms can occur due to hypokalemia?
Cramps, paresthesia, weakness, tetany, and rhabdomyolysis.
What is the recommended sodium correction rate for symptomatic hyponatremia?
100 mmol – 250 mmol Na over 10 minutes, followed by a slow correction.
What is a potential treatment for hypermagnesaemia in patients with renal failure?
Dialysis may be necessary.
What should be assumed if the duration of hyponatremia is uncertain?
Assume it has developed chronically.
What thyroid condition can lead to hypercalcaemia?
Thyrotoxicosis.
What is the formula for adjusted calcium?
Adjusted Ca = (40 – albumin)/40 + measured Ca.
What is the first step in the treatment of hypercalcaemia?
Remove the offending cause and treat the underlying condition.
What renal factors can lead to hypophosphataemia?
Increased loss due to diuretics, steroids, and haemodialysis.
What should be monitored after treating hypophosphataemia?
Check potassium (K), phosphate (PO4), and calcium (Ca) levels.
What is the treatment for severe symptomatic hypomagnesaemia?
10 mmol MgSO4 over 5 minutes.
What is a common cause of hypercalcaemia related to hormone imbalance?
Hyperparathyroidism.
What gastrointestinal symptoms can occur due to hypercalcaemia?
Anorexia, constipation, peptic ulcer, pancreatitis.
What neuromuscular symptoms can occur due to hypocalcaemia?
Anxiety, psychosis, confusion, seizures, tetany, cramps, paresthesia, laryngospasm, bronchospasm.
What are some clinical features of pure water depletion?
Thirst, lethargy, seizures, and coma.
What is a key treatment approach for hypokalemia?
Treat the underlying cause, such as replacing magnesium or correcting alkalosis.
What is the role of hemodialysis in treating hyperphosphatemia?
It enhances phosphate clearance, especially in patients with renal failure.
What urgent treatment can be administered for hyperkalemia?
50-100 ml of 8.4% NaHCO3 IV.
What is the maximum sodium increase allowed in 24 hours for chronic hyponatremia?
Do not raise Na >12 mmol/24 hours.
What must be monitored closely during sodium correction?
Plasma sodium levels.
What cardiovascular symptoms are associated with hypercalcaemia?
Hypertension, arrhythmia, ECG changes (QT shortening).
Name some other causes of hypophosphataemia.
Hyperparathyroidism, vitamin D deficiency, alcoholism, treatment of DKA, refeeding syndrome, burns, and alkalosis.
What urine sodium level suggests renal loss in hyponatremia?
Urine Na > 20 mmol/l.
What is a specific treatment for diabetes insipidus (DI)?
Treat with ddAVP.
Why should sodium be corrected slowly?
To reduce the risk of central pontine myelinolysis.
What dietary factor can contribute to hypercalcaemia?
Excess vitamin D intake.
What central nervous system symptoms are associated with hypercalcaemia?
Depression, retardation, coma, seizure.
What renal problems can arise from hypercalcaemia?
Nephrocalcinosis, tubular dysfunction, diabetes insipidus.
What are some gastrointestinal causes of hypophosphataemia?
Decreased oral intake, malabsorption, fistula, and diarrhoea.
What cardiovascular clinical features are associated with hypophosphataemia?
Myocardial depression, hypotension, and heart failure.
Why must plasma sodium be monitored closely?
To prevent possible cerebral edema.
What granulomatous disease can lead to hypercalcaemia?
Granulomatous disease.
What are the causes of hypernatremia?
Iatrogenic, hypovolemia, euvolemia, hypervolemia, hypotonic fluid depletion, pure water depletion, salt gain.
When do most experts recommend treating ionized calcium levels?
When levels are <0.8 mmol/L or if symptoms develop.
What are some causes of hyperphosphataemia?
Factitious causes like haemolysis and sample separation delay, and redistribution due to trauma, rhabdomyolysis, and acidosis.
What is the intravenous potassium supplementation dosage for hypokalemia?
10-20 mmol in 100 ml NS/D5 over 1 hour.
What should be discussed with the ICU senior if hypertonic saline is to be used?
The use of hypertonic saline.
What happens during isotonic fluid loss from the extracellular component?
Minimal fluid shift and a small increase in sodium and osmolarity.
What is the recommended saline infusion for increasing calcium excretion?
2-3L over 3-6 hours, maintaining urine output of 200ml/hour.
What central nervous system symptoms can occur due to hypophosphataemia?
Confusion, delirium, and seizures.
What condition related to inactivity can cause hypercalcaemia?
Immobilization.
What does hypotonic fluid depletion include?
Isotonic fluid loss and pure fluid loss.
What hydration strategy is recommended in treating hypercalcaemia?
Hydration to achieve a dilution effect.
What is the treatment for severe or symptomatic hypophosphataemia?
KH2PO4/K2HPO4 10ml = 14.5mmol PO4, replace 5-10ml in maintenance fluid over 6 hours.
What is the emergency treatment for hypocalcaemia?
Bolus 2.5-5 mmol over 10 minutes intravenously.
What is a common cause of hyponatremia related to plasma osmolarity?
Hypotonic, hypertonic, and isotonic conditions.
What urine sodium level is indicative of extrarenal loss in hyponatremia?
Urine Na < 20 mmol/l.
What are some clinical features of hyponatremia?
Nausea, vomiting, headache, confusion, seizures, and coma.
