1. Electrolytes Tutoring (Part 2): calcium, Phosphate, Potassium, and Magnesium
By Alaina darby

2. JR shows up to the ER with renal dysfunction and a calcium concentration of 7 mg/dl. His albumin is 1.5 g/dl. How would you evaluate his calcium concentration?
High
Normal
Low

3. FK shows up to the ER with renal dysfunction and a calcium concentration of 6.5 mg/dl. His albumin is 2 g/dl. How would you evaluate his calcium concentration?
High, corrected to 11
Normal, corrected to 9
Normal, corrected to 8
Low, corrected to 8
Low, it does not need to be corrected

4. FK shows up to the ER with renal dysfunction and a calcium concentration of 6.5 mg/dl. His albumin is 2 g/dl. What is the likely cause of his low calcium level?
Loss of conversion of 25-OH D to 1,25(OH)D
Decreased release of PTH from the parathyroid
Increased uptake of calcium by bone
Decreased hepatic production of 25-OH D

5. JR has low calcium and low magnesium
JR has low calcium and low magnesium. What is the likely cause of his low calcium level?
Loss of conversion of 25-OH D to 1,25(OH)D
Decreased release of PTH from the parathyroid
Increased uptake of calcium by bone
Decreased hepatic production of 25-OH D

6. Which of the following medications does not cause hypocalcemia through renal wasting mechanisms?
Loop diuretic
Amphotericin B
Cisplatin
Bisphosphonates

7. Which of the following patients should be treated for hypocalcemia?
Patient with renal failure and iCa of 1.2
Patient who overdosed on diltiazem with unknown iCa or Ca
Patient who had a blood transfusion with Ca of 7
Patient undergoing hemodialysis with Ca of 6

8. For the Patient who overdosed on diltiazem… iCa came back as 0. 8
For the Patient who overdosed on diltiazem… iCa came back as 0.8. How would you treat him?
2g IVPB over 2 hours
4g IVPB over 2 hours
2g IVPB over 4 hours
4g IVPB over 4 hours

9. The nurse administered 4 g over 2 hours
The nurse administered 4 g over 2 hours. Which of the following may occur?
Tachycardia
Hepatitis
Cerebral artery vasospasm
None of these will likely occur

10. An anorexic patient comes into the ER in a coma
An anorexic patient comes into the ER in a coma. Which of the following should be started with her TPN?
Calcium
Phosphate
Magnesium
Potassium

11. A patient with a TBI has a phos of 1. 8. His body weight is 75 kg
A patient with a TBI has a phos of 1.8. His body weight is 75 kg. Which of the following should you give?
48 mmol at 5 mmol/hr
48 mmol at 7.5 mmol/hr
25 mmol at 5 mmol/hr
24 mmol at 7.5 mmol/hr

12. Your patient has renal impairment which has caused hyperphosphatemia
Your patient has renal impairment which has caused hyperphosphatemia. His labs: ca 10.5, mag 1.3, K 4.5. Which should you give him?
Selevamer
Calcium acetate
Aluminum hydroxide
No treatment should be given

13. Which of the following does not cause hypokalemia?
HCTZ
Furosemide
Amoxcillin
Lisinopril

14. VD is anorexic and has a potassium concentration of 2. 7
VD is anorexic and has a potassium concentration of 2.7. What is the most likely estimate of her current body stores?
10 mEq/kg
15 mEq/kg
20 mEq/kg
25 mEq/kg

15. VD is anorexic and has a potassium concentration of 2. 7
VD is anorexic and has a potassium concentration of 2.7. How should potassium be administered if she has a J tube and not on an ECG monitor?
KCl 40 mmol/L to enteral feeding
KCl 60 mEq/L at a rate of 10 mEq/hr
KCl 40 mEq/L at a rate of 20 mEq/hr
KCl 40 mEq bolus

16. VD is anorexic and has a potassium concentration of 2. 7
VD is anorexic and has a potassium concentration of 2.7. Her creatinine is rising. What dose of potassium should she get?
20 mEq x 2
20 mEq x 3
40 mEq x 2
40 mEq x 3

17. Which of the following drugs itself does not cause hyperkalemia?
Heparin
Trimethoprim
Penicillin G
Octreotide

18. Furosemide Foscarnet Amphotericin B Cisplatin
FK has was given a regimen of furosemide, foscarnet, amphotericin B, and cisplatin when he was hospitalized 6 months ago. Which of the following likely has caused his current hypomagnesemia?
Furosemide
Foscarnet
Amphotericin B
Cisplatin

19. DG has a serum magnesium concentration of 1. 3. his weight is 75 kg
DG has a serum magnesium concentration of his weight is 75 kg. What is likely his deficit?
50 mEq
100 mEq
150 mEq
200 mEq

20. DG has a serum magnesium concentration of 1. 3. his weight is 75 kg
DG has a serum magnesium concentration of his weight is 75 kg. How should he be treated?
40 g/hr IV
80 g/hr IV
Mag oxide 1-2 tabs PO BID
Mag gluconate 1-2 tabs PO BID

21. DG has a serum magnesium concentration of 1. 3. his weight is 75 kg
DG has a serum magnesium concentration of his weight is 75 kg. You treated him with Mag oxide 1-2 tabs PO BID. When should you expect to see his magnesium normalize?
24 hours
48 hours
5 days
10 days

22. JD is a 54 y/o WM. His labs are the following:
Na 130
Ca 5.6, iCa 1.1
Mg 1.5
Phos 3.6
K 3.0

23. JD is a 54 y/o WM. His labs are the following: Na 130, Ca 5. 6, iCa 1
JD is a 54 y/o WM. His labs are the following: Na 130, Ca 5.6, iCa 1.1, Mag 1.5, Phos 3.6, K 3.0 How should you treat his hypocalcemia?
Magnesium and calcium
Calcium only
Magnesium only
Calcium and vitamin D

24. JD is a 54 y/o WM. His labs are the following: Na 130, Ca 5. 6, iCa 1
JD is a 54 y/o WM. His labs are the following: Na 130, Ca 5.6, iCa 1.1, Mag 1.5, Phos 3.6, K 3.0 Which of the following might be caused by his Mag level?
Hyponatremia
Hypokalemia
Hypophosphatemia
Hypomagnesemia

25. JD is a 54 y/o WM. His labs are the following: Na 130, Ca 5. 6, iCa 1
JD is a 54 y/o WM. His labs are the following: Na 130, Ca 5.6, iCa 1.1, Mag 1.5, Phos 3.6, K 3.0 He is experiencing muscle weakness, what is likely to have caused this?
Hyponatremia
Hypokalemia
Hypophosphatemia
Hypocalcemia

26. JD is a 54 y/o WM. His labs are the following: Na 130, Ca 5. 6, iCa 1
JD is a 54 y/o WM. His labs are the following: Na 130, Ca 5.6, iCa 1.1, Mag 1.5, Phos 3.6, K 3.0 Why shouldn’t he be given insulin even if he has hyperglycemia?
Hyponatremia
Hypokalemia
Hypophosphatemia
Hypocalcemia

27. JD is a 54 y/o WM. His labs are the following: Na 130, Ca 5. 6, iCa 1
JD is a 54 y/o WM. His labs are the following: Na 130, Ca 5.6, iCa 1.1, Mag 1.5, Phos 3.6, K 3.0 Which can be caused by hyperparathyroidism?
Hyponatremia
Hypokalemia
Hypophosphatemia
Hypocalcemia