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Intern survival guide Surviving Floor CallBuy MedCalc app ELECTROLYTE REPLACEMENT Potassium meq will raise K by Cannot absorb more than - meq orally at one time Max peripheral infusion is meq hr Max central line infusion is meq hr Oral replacement IV repl

Surviving Floor CallBuy MedCalc app ELECTROLYTE REPLACEMENT Potassium meq will raise K by Cannot absorb more than - meq orally at one time Max peripheral infusion is meq hr Max central line infusion is meq hr Oral replacement IV replacement Check and replace Mg Phosphorus Oral replacement IV replacement ?? Kphos mmol has meq K Hypophosphatemia Leads to weakness bone pain altered mental status Caused by chronic alcoholism refeeding syndrome TPN Sodium Hyponatremia Determine volume status Hypovolemic dehydration vomiting diarrhea ? NS Euvolemic ? water restriction Demeclocyline tolvaptan ADH antagonist Urine Na urine osmo serum osmo ? Hypervolemic ? Diuretics Correct serum Na by - in hours and in hours meq hr You generally only need to raise the serum sodium by about to see symptomatic improvement Use NS if symptomatic hyponatremia Must be in the ICU with central line to use this Check urine sodium urine osmolarity serum osmolarity x Na BUN blood sugar Corrected Na for glucose Na Glucose - FYI NS meq Na FYI saline meq Magnesium mg IV raises Mg by mg PO BID raises Mg by Calcium Calcium chloride is x as bioavailable as calcium gluconate for replacement in hypocalcemia Hypercalcemia Correct calcium for ? albumin Ca x -alb Due to increased resorption from bone increased GI uptake or decreased renal excretion HCTZ malignancy hyperparathyroidism serum Ca ? serum Phos Paget ? s milk-alkali sarcoidosis CStones bones groans and psychiatric overtones Treatment IVF Lasix bisphosphonates Calcitonin DIURETICS ??BUN Age lasix dose ? Creatinine x total daily lasix dose mg Bumex IV mg Lasix IV mg Lasix PO IV Lasix bolus IV lasix infusion e ?cacy Diuretics ? contraction alkalosis ? Na K Cl bicarb ANION GAP METABOLIC ACIDOSIS MUDPILES Methanol elevated osmol gap Can cause vision loss Treat with fomepizole or ethanol or hemodialysis Uremia DKA or alcoholic ketoacidosis which develops after the person stops drinking so serum alcohol will be negative Paraldehyde INH Lactic Acidosis Ethylene glycol isopropyl alcohol elevated osmol gap presence of calcium oxalate crystals in urine Treat with fomepizole or ethanol Salicylates NON-ANION GAP METABOLIC ACIDOSIS Hard-up May treat with bicarb Hyperalimentation TPN Acetazolamide Renal Tubular Acidosis RTA RTA type I distal tubule inability of distal tubule to secrete acid Urine pH ? serum K increased K excretion ? serum bicarb RTA Type II proximal inability of proximal tubule to reabsorb bicarb Urine pH ? ? serum bicarb Associated with Fanconi ? s syndrome RTA Type IV hypo-aldosterone decreased ammonia excretion serum K Diarrhea loss of bicarb Ureteroenteric ?stula Pancreatic ?stula Indications for emergent hemodialysis AEIOU Metabolic acidosis Electrolyte disturbance K Ingestion drug overdose Fluid overload CUremia SHOCK Type Causes Distributive Sepsis Anaphylaxis Neurogenic Cardiogenic ?CO MI arrhythmia Skin Cardiac output SVR CVP HR Treatment Warm Cool Pink Pale ? ? ? ? ? Antibiotics Fluids Pressors Steroids initially ? normal ? decreased NC or ? Oxygen Pressors IABP Adequate Urine Output ml kg hr BUN Cr ratio pre-renal Obstructive PE Tension pneumo Tamponade Cool Pale ? Treat cause Hypovolemic Hemorrhagic