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Definition Mild: Serum Na 130-134mmol/L Moderate: Serum Na 120-129mmol/L Severe: Serum Na <120mmol/L Acute: <48hrs since development of hyponatremia Chronic: >48hrs since development of hyponatremia. (hyponatremia should be considered chronic whenever the...

Definition: Serum Na >135 mmol/L. Chronic means > 48 hours. Acute means < 48hrs. Etiology:  Renal water loss (U osm <700-800) loop diuretics Osmotic diuresis (hyperglycemia, mannitol, urea) Diabetes Insipidus: Central (trauma/post-surgical, pituitary le...

Definition: Serum <3.5mmol/L Etiology:  Intracellular shifts: Hypothermia, Exogenous insulin/refeeding, beta-agonists GI Potassium loss Metabolic acidosis: diarrhea, laxative abuse Metabolic alkalosis: Vomiting, NGT Renal Potassium Losses Hypotensive...

Definition Serum K+ >5.3-5.5 Etiology: Pseudohyperkalemia- K release from cells after blood draw, IVF with K Impaired excretion Low GFR (AKI or CKD) Drugs (spironolactone, ACEi, ARB, TMP-SMX, NSAIDs, digitalis overdose, heparin, chemo therapeutic agents)...

Definition Serum Mg++ <1.8 mg/dL Etiology: Malnutrition (assc. with heavy chronic alcohol use causing renal wasting) Malabsorption or diarrhea/GI loss PPI induced Renal losses (polyuria and high tubular flow, e.g., osmotic diuresis, post-ATN diuresis) H...

Definition Serum Mg++ >2.3 mg/dL Etiology: Insufficient excretion due to CKD Iatrogenic/excess intake due to overaggressive replacement, Magnesium-based laxatives/enemas use in CKD, Mg++ administration during preeclampsia/eclampsia treatment Clinical mani...

Evaluation:  verify with repeat measurement that there is a true decrease in the serum calcium concentration (total serum calcium corrected for albumin or ionized calcium)  Note alkalosis augments calcium binding to albumin and increases severity of symptoms...

Evaluation:  verify with repeat measurement that there is a true increase in the serum calcium concentration (total calcium corrected for albumin or ionized calcium)  Compare with previous values if available Clinical evaluation, including duration of hyper...

Evaluation:  Serum phosphorus levels should be interpreted with concomitant evaluations of PTH, serum total and ionized calcium, urine phosphate and calcium and Vitamin D Medical history, physical examination and lab tests to determine etiology of hypophosph...

Definition Serum Phosphate >4.5mg/dL. Etiology/Risk Factors Increased intake (external/internal): Excessive vitamin D (increases GI absorption of PO4) or vitamin A. Phosphate-containing enema, particularly in patients with kidney insufficiency. P...

Before You Begin: Gather Data What lab tests do you need? ABG vs. VBG VBG can provide reliable estimation for pH (0.02-0.04 lower than ABG) and HCO3 (1-2 mEq higher than ABG). pCO2 on VBG is higher than arterial PaO2 by 4-9mmHg. ABG is necessary to accura...

Definition Renal tubular acidosis refers to an impaired acid-base metabolism by the kidney in the setting of normal glomerular filtration. These conditions are characterized by a non-elevated anion gap (hyperchloremic) metabolic acidosis. Kidney disease must...

Admit to Telemetry Tele-nurse may reach out to you for > 6 PVCs/min, atrial fibrillation, ventricular fibrillation, > 3 beats of VT. Admit as “observation status” if the patient will likely be discharged within 24 hours. Activity Bed rest until rul...

Definition A condition in which the heart is not able to pump enough blood to meet the body’s metabolic needs or does so in the face of elevated filling pressure due to abnormalities of ejection or abnormalities of filling. Classification In patients presen...

  Overview Diagnosis requires 2 major, 1 major with 3 minor, or 5 minor criteria from the modified Duke Criteria listed below: MAJOR CLINICAL CRITERIA: Persistently positive blood cultures with typical IE organisms. Bacteremia is continuous and high grade....

Rates Normal: 60-100 bpm Tachycardia: > 100 bpm Bradycardia: < 60 bpm Readings Count the number of large squares present within one R-R interval. Divide 300 by this number to calculate heart rate. OR Count the number of complexes on the rhythm strip ...

Syncope Rapid onset of transient loss of consciousness Inability to maintain postural tone It may be associated with a fall Resolves spontaneously and quickly without intervention Presyncope (Near-Syncope) Weakness, Dizziness, lightheadedness, or "grayin...

  Diagnosis DKA vs HHS:  DKA sugar ranges from 250 to 500 mg/dL HHS typically has sugars > 600 mg/dL Serum osmolality > 320 in HHS Neurologic symptoms such as stupor and coma are primarily seen in HHS, but can sometimes be seen in severe DKA. Little to ...