ECG effects of electrolyte imbalances

A shift of potassium from intracellular to extracellular fluid with changes in cell membrane permeabUity or damage  

RED FLAG When cells can t repolarize or respond to elec-trical stimuli, the patient may develop cardiac standstill or asystole. 

RED FLAG When giving insulin for hyperkalemia, keep the patient from becoming hypoglycemic by gimng I. V. dextrose at the same time. 

RED FLAG Hypokalemia may result in digoxin toxicity. Monitor serum digoxin and potassium levels closely at the start of therapy and until maintenance doses are determined. 

RED FLAG Keep caldum. gluconate on hand for a patient with a positive Trousseau s or Chvostek s sign. Hypocalcemia may progress quickly to tetany, seizures, respiratory arrest, and death. 

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T Effects W/ antihypertensives, cliazoxicle, nitrates, EtOH T effects OF ACEIs, Li T risk of hypokalemia W/ amphotericin B, corticosteroids, mezlocillin, piperacillin, ticarcillin effects W/ cholestyramine, colestipol, NSAIDs EMS Monitor ECG for hypokalemia (flattened T waves) T risk of photosensitivity Rxns use caution w/ other diuretics, may T risk of electrolyte imbalances and dehydration may affect glucose (hyperglycemia) OD May cause dehydration, hypotension, drowsiness, headache, and fatigue symptomatic and supportive, do not do anything that would force greater fluid loss (ie, induce V)... 

Uses Edema, HTN, CHF, h atic cirrhosis Action Loop diuretic -1- reabsorption of Na Cr in ascending loop of Henle distal tubule Dose 5-20 mg/d PO or IV 200 mg/d max Caution [B, ] Contra Sulfonylurea sensitivity Disp Tabs, inj SE Orthostatic -1- BP, HA, dizziness, photosens, electrolyte imbalance, blurred vision, renal impair Notes 20 mg torsemide = 40 mg furosemide Interactions t Risk of ototox W/ aminoglycosides, cisplatin t effects W/ thiazides t effects OF anticoagulants, antih5rpCTtensives, Li, salicylates X effects IT/barbiturates, carbamaz ine, cholestyramine, NSAIDs, phenytoin, phenobarbital, probenecid, dandehon EMS t Effects of anticoagulants monitor for S/Sxs tinnitus, monitor ECG for hypokalemia (flattened T waves) OD May cause HA, hypotension, hypovolemia, and hypokalemia give IV fluids symptomatic and supportive... 

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