Diagnostics: First Aid for the Emergency Medicine Clerkship

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1.

Acidosis causes potassium to

shift into _______

Serum

2.

Administration of insulin and

glucose causes a _______ shift
of potassium

Intracellular

3.

Alkalosis causes potassium

shift into ________

Cells

4.

At what level of Potassium are

high risk patients treated?

3 - 3.5 mEq/L; patients with

CHF, on digitalis, history of
MI

5.

At what level of Potassium is

definitive therapy indicated?

Less than 3 mEq/L

6.

How do you calculate the anion

gap?

Sodium minus .. chloride

plus bicarb...

7.

How do you tell if an acid base

disorder is metabolic?

pH and PCO2 more in same

direction

8.

How do you tell if an acid base

disorder is respiratory?

pH and PCO2 move in

opposite direction

9.

In what waves are Q's not

pathologic?

aVR, lead III, lead VI

10.

Name three causes of

psuedohyponatremia

Hyperglycemia
Hyperlipidemia
Hyperproteinemia

11.

True or false: correct

hypocalcemia before
correction of acidosis in
metabolic acidosis

True

12.

True or false: New LBBB is

always considered myocardial
ischemia

True

13.

True or false: parathyroid

hormone increases serum
calcium

True

14.

True or false: T waves should

generally have the same
deflection as the QRS

True

15.

What are EKG abnormalities in

hypokalemia?

Inverted T waves; U waves;

ST segment depression;
PVCs, ventricular arrhythmia

16.

What are increased release

reasons for hyperkalemia?

Metabolic acidosis; trauma;

burns; rhabdomyolysis;
tumor lysis; succinylcholine

17.

What are signs

and symptoms
of
hyperkalemia?

GI: NVD; neuro: muscle cramps,

weakness, paralysis, areflexia, tetany,
confusion; respiratory insufficiency;
cardiac arrest

18.

What are signs

and symptoms
of hypokalemia?

Muscle weakness; hyporeflexia; intestinal

ileus; respiratory paralysis; nephrogenic
diabetes insipidus; dehydration; potentiates
digitalis, increased likelihood of dig toxicity

19.

What are some

causes of
hypernatremia?

GI losses, think vomiting, diarrhea,

decreased thirst. Renal losses, think
diabetes insipidus, osmotic diuretics,
adrenal/renal disease. Insensible losses
like repspiratory, skin

20.

What are some

causes of
hypocalcemia?

Hypoalbuminemia; hypoparathyroidism; real

failure; pancreatitis; medications like SSRIs
and PPIs

21.

What are some

causes of
hyponatremia in
a euvolemic
patient?

Hypotonic fluid infusions

Psychogenic polydipsia
SIADH

22.

What are some

causes of
hyponatremia in
a hypervolemic
patient?

Increase total body free water, think CHF<

nephrotic syndrome, cirrhosis
OR Decreased excretion of sodium, think
renal failure

23.

What are some

causes of
hyponatremia in
a hypovolemic
patient?

Renal failure with decreased excretion of

free water
Diuretics
Salt wasting nephropathies
Extrarenal losses, like vomiting; diarrhea;
extensive burns

24.

What are some

possible
"erroneous"
reasons for high
potassium?

Hemolysis; thrombocytosis; leukocytosis;

polycythemia

25.

What are the

causes of
metabolic
acidosis?

Loss of H+, think renal, like diuretics/GI,

vomiting
Gain of bicarbonate, milk-alkali syndrome,
exogenous NaHCO3

26.

What are the

causes of
respiratory
acidosis?

Hypercapnia secondary to hypoventilation

like brain stem injury or ventilation
perfusion mismatch, think COPD,
pneumona, PE, pulmonary edema

27.

What are the

causes of
respiratory
acidosis?
Pneumonic is
Mishaps

Mechanical overventilation; Increased ICP;

Sepsis; Hypoxemia, Hyperpyrexia, Heart
failure; Anxiety, asthma, ascites;
Prengnancy, pain, pneumonia; Salicylates

28.

What are the

causes of
respiratory
alkalosis?

Hyperventilation secondary to anxiety,

increased ICP, salicylates, fever,
hypoxemia, systemic disease, pregnancy;
Alkalosis causes decrease in serium K and
ionied Calcium, leading to paresthesia,
carpopedal spasm, and tetany

29.

What are the

early and late
signs of
hyponatremia?

Early: Nonspecific headache, vomiting

Late: confusion, seizures, coma,
bradycardia, respiratory arrest

30.

What are the

EKG findings
for
hypocalcemia?

Prolonged QT intervals?

What are the

most common
causes of
hypercalcemia?

Malignancy and hyperparathyroidism

What are the

signs of
hypercalcemia?

Stones; Bones; Abdominal groans; Psychic

moans; Fatigue overtones

What are the

signs of
hypocalcemia?

Perioral/digital parethesia, think Chvostek &

Trousseau's sign; also decreased
myocardial contractility can predispose to
CHF

31.

32.

33.

What are the

two varities of
metabolic
acidosis?

Anion gap and non anion gap

What are three

decreased
excretion
reasons for
high
potassium?

Renal failure; ACEI; potassium sparing

diuretics; rental tubular acidosis

What are three

general
reasons for
increased
potassium?

Decreased excretion; increased released;

increased intake

37.

What are three

increased
intake reasons
for
hyperkalemia?

Iatrogenic, dietary, salt substitutes

38.

What diagnosis
is no
association
between P
wave and QRS?

Third degree AV block

What diagnosis
is PR interval
consistently
longer than 200
ms

First degree AV block

34.

35.

36.

39.

40.

What diagnosis is
the PR interval
consistent with
dropped beats in a
repeated pattern

Second degree Mobitz Type II AV block

41.

What diagnosis is
the PR interval
progressively
longer and
eventually
dropping a beat?

Second degree Mobitz Type I AV block,

Wenckebach

42.

What EKG
Changes will you
see for potassium
level of 8.0 - 10.0
?

Classic sine wave

43.

What EKG
changes will you
see for potassium
levels of 5.0 - 6.0

Peaked T waves, most prominent in

precordial leads

44.

What EKG findings

are associated
with
hypercalcemia?

Shortened QT interval; Bradycardia;

Heart blocks

45.

What is one large

box on the ekg?

0.2 s

46.

What is one small

box on the ekg?

0.04 s

47.

What is the
appropriate
treatment for
potassium level of
3.5 - 4.5 ?

Oral supplementation, change to

potassium sparing diuretic if on diuretic
therapy

48.

What is the
calculation for
serum
osmolarity?

2(Na) + (glucose/18) + (BUN/2)

49.

What is the cat

mudpiles
pneumonic for
causes of elevated
anion gap
metabolic
acidosis?

Cyanide, carbon monoxide; Alcoholic

ketoacidosis; Toluene; Methanol,
metabolism; Uremia; Diabetic
ketoacidosis; Paraldehyde; Iron,
isoniazid; Lactic acidosis; Ethylene
glycol; Salicylates, strychnine

50.

What is the
characteristic of
an atrial
fibrillation EKG?

No P waves, irregularly irregular rhythm

51.

What is the
characteristic of
atrial flutter EKG?

No P waves, sawtooth shaped waves

52.

What is the
consequence of
correcting sodium
too quickly?

Central pontine myelinosis

53.

What is the critical

value of calcium?

Life threatening if values ar eless than

2 mg/dL or 0.5 mmol/L

69.

Where is potassium primarily

excreted?

Urine

54.

What is the early

signs of
hypernatremia?

Irritability, lethargy, anorexia, vomiting;

Ataxia, tremulousness, hypertonicity,
spasms. Death >430 mOsm/L

70.

Where is sodium mostly found?

Extracellular fluid,
98%

55.

What is the first

line of treatment for
sodium correction?

Normal Saline

56.

What is the hardup

pneumonic for
causes of normal
anion gap metabolic
acidosis?

Hyperparathyroidism; Adrenal
insufficiency, anhydrase inhibitors;
Renal tubular acidosis; Diarrhea;
Ureteroenteric fistula; Pancreatic
fistulas

57.

What is the most

common cause of
hypernatremia?

Decreased total body water, think

dehydration

58.

What is the normal

anion gap?

Normal anion gap is greater than or

equal to 12-14

59.

What is the
pathognomonic
finding for PE on
EKG?

S in I, Q in III, inverted T in III

60.

What is the
pathophysiology of
hypocalcemia?

Neuronal membranes become more

excitable secondary to increased
sodium permeability

61.

What is the
presentation of
central pontine
myelinolysis

bulbar dysfunction, quadriparesis,

delirium, death

62.

What is the risk of

calcium in the
setting of digitalis
toxicity?

May induce tetany, "stone heart"

63.

What is the rough

correction for total
body clacium in
hypoalbuminemia/

Add 1 mg/dL to serum calcium for every

1 mg/dL reduction in albumin below 4
mg/dL

64.

What is the
treatment for
hypercalcemia?

Rehydrate with NS; Furosemide; Monitor

for hypokalemia and hypomagnesemia

65.

What is the
treatment for
hyperkalemia?

Calcium gluconate; sodium bicarbonate;

insulin/glucose; nebulized albuterol;
lasix; kayexalate; dialysis

66.

What is the
treatment for
hypernatremia?

Address fluid status, hydrate with NS

until volume is restored. Hypotonic
solution once perfusion is established.
Monitor urine output. Correct sodium
over 48-72 hours

67.

What is the
treatment for
hypocalcemia?

Oral calcium if asymptomatic; IV

calcium if symptomatic; 5% dextrose
can be used as carrier fluid for the
infusion

68.

When is rightward
axis on EKG
frequently seen?

Asthma and COPD patients