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Questions and Answers
What is the primary goal of administering 0.9% NS with KCL and Lasix in treating hypercalcemia?
Which of the following is NOT a treatment for hypercalcemia in patients with malignancy?
What is the recommended treatment for symptomatic and progressive hyperparathyroidism?
What is the purpose of administering 99m Tc Sestamibi in hyperparathyroidism?
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When referring a patient with hyperparathyroidism for surgery, what is an important consideration?
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What is the recommended daily dose of Prednisone for treating hypercalcemia?
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Which of the following is a treatment for mild hypercalcemia in postmenopausal women?
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What is the purpose of administering NS and Lasix in treating hypercalcemia?
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What is the primary goal of administering bisphosphonates in treating hypercalcemia?
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What is the recommended daily fluid output goal when treating hypercalcemia with NS and Lasix?
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Study Notes
Advanced Laboratory Evaluation
- Topic: Disorders of Sodium, Calcium, Phosphorus, Magnesium, and Proteins, and Uncommon Anemias
Disorders of Sodium
- Hypernatremia: plasma Na+ >145 mEq/L, caused by a deficit of H2O relative to solute
- Mortality rate: 40-60%
- Hypernatremia implies hyperosmolality of ECF, which results in H2O moving out of intracellular spaces until cellular tonicity equals that of ECF
Risk Factors for Hypernatremia
- Vomiting
- Diarrhea
- Renal losses
- Extrarenal losses (e.g., burns, excess sweating)
- Hypertonic IV fluids
- Inability to access H2O
- Primary hypodipsia
- Reset osmostat
Effects of Hypernatremia on CNS
- Brain cellular H2O increases in acute and chronic hyponatremia
- Symptoms of CNS dysfunction are more common and greater in acute hyponatremia
Hyponatremia
- Principle causes: hypovolemia, euvolemia, and hypervolemia
- Hyponatremia with hypovolemia: GI losses, vomiting, and diarrhea
- Hyponatremia with euvolemia: SIADH, primary hyperparathyroidism
- Hyponatremia with hypervolemia: congestive heart failure, nephrotic syndrome
Disorders of Calcium
- Hypercalcemia: can be caused by primary hyperparathyroidism, humoral hypercalcemia of malignancy, and vitamin D excess
- Diagnostic tests: parathyroid hormone assays (e.g., IRMA)
- Further evaluation: rule out malignancy and impaired renal status, check urinary excretion of calcium
Treatment of Hypercalcemia
- Mild hypercalcemia in postmenopausal women: estrogens
- Vitamin D excess: prednisone 20-40 mg/day PO
- With normal renal function: IV 0.9% NS with KCL and Lasix to increase renal excretion of Ca+
- In patients with malignancy: bisphosphonates plus NS and Lasix
- If hyperparathyroidism is symptomatic and progressive: surgery is the treatment of choice
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Description
This quiz covers various electrolyte disorders, including sodium, calcium, and phosphorus disorders. Evaluate your knowledge of these lab-related topics.