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First Aid for the USMLE Step 1 (2023) | Medicine (MD/DO) School Study Aid
Hyponatremia
- Assessment
- < 135 mEq Na+
- Nausea and Vomiting
- Decreased LOC
- Confusion / Lethargy
- Seizures
- Priority Interventions
- Assess Airway
- Reduce Diuretic Dosage
- Fluid Excess Hyponatremia
- Mannitol (Osmitrol)
- Fluid Restriction
- Fluid Deficit Hyponatremia
- Hypertonic Solution (3% or 5% NaCl)
2 mins
Hypernatremia
- Assessment
- > 145 mEq/L Na+
- Change in LOC
- Extreme Thirst
- Orthostatic Hypotension
- Dry Flushed Skin
- Muscle Twitching
- Seizures
- Priority Interventions
- Treat and Prevent Dehydration
- Hypotonic Solutions (0.225% or 0.45% NaCl)
- Sodium Restriction
- Diuretics
2 mins
Hypokalemia
- Assessment
- < 3.5 mEq/L
- Muscle Weakness
- Arrhythmia
- U Wave
- Ileus
- Hyporeflexia
- Interventions
- IV K+ Infusion at 5-10 mEq/hr
- Give Orally with Food
- Nursing Considerations
- Monitor Respiratory Status
3 mins
Hyperkalemia
- Assessment
- > 5.0 mEq/L K+
- Abdominal Cramps
- Muscle Weakness
- Diarrhea
- Arrhythmia
- Tall, Peaked T Waves
- Interventions
- IV Calcium
- Infusion of Glucose and Insulin
- Loop or Thiazide Diuretics
- Kayexalate
- Dialysis
- Prevention Education
2 mins
Hypocalcemia
- Muscle Spasms
- Assessment
- < 8.5 mg/dL Ca2+
- Decreased Bone Density
- Tetany
- Chvostek's Sign
- Trousseau's Sign
- Increased DTR
- ECG Changes
- QT Prolongation
- Considerations
- Oral and IV Replacement of Ca2+
- Seizure Precautions
2 mins
Hypercalcemia
- Assessment
- > 10.5 mg/dL Ca2+
- Pathologic Fractures
- Lethargy
- Hypercoagulation
- Constipation
- ECG Changes
- QT Shortening
- Interventions
- No Calcium Intake
- Chelating Drugs
- Calcitonin
- Bisphosphonates
- Loop Diuretics instead of Thiazide Diuretics
- Considerations
- Increased Risk for Renal Calculi
- Increase Fluids
3 mins
Hypomagnesemia
- Assessment
- Confusion
- Increased Deep Tendon Reflexes (DTRs)
- Neuromuscular Irritability
- Seizures
- Muscle Cramps
- Tremors
- Insomnia
- Tachycardia
- Interventions
- Magnesium Sulfate
- Foods High in Magnesium
1 min
Hypermagnesemia
- Assessment
- Flushing
- Lethargy
- Muscle Weakness
- Decreased Deep Tendon Reflexes (DTRs)
- Decreased Respirations
- Bradycardia
- Hypotension
- Interventions
- Dialysis
- IV Calcium Gluconate
- Diuretics
- Avoid Antacids and Laxatives containing Mg2+
2 mins
Phosphate (PO43-) Lab Value
- 2.5 to 4.5 mg/dL
29 secs
Syndrome Of Inappropriate Antidiuretic Hormone (SIADH)
- Pathophysiology
- Hypersecretion of ADH
- Increased Sensitivity to ADH
- Signs & Symptoms
- Serum Hypoosmolality
- Coma and Seizure
- Dilutional Hyponatremia
- Cramps and Tremors
- Euvolemia
- Change in LOC
2 mins
Primary Hyperaldosteronism
- Etiology
- Increased Aldosterone Secretion
- Adrenal Adenoma
- Bilateral Adrenal Hyperplasia
- Clinical Features
- Hypertension
- Hypokalemic Metabolic Alkalosis
- No Significant Edema
- Diagnosis
- Increased Aldosterone
- Decreased Renin
- Abdominal CT Scan
- Management
- Aldosterone Antagonists
- Surgery
3 mins
Bartter Syndrome
- Pathophysiology
- Autosomal Recessive
- Thick Ascending Limb of Loop of Henle
- Defective NKCC Cotransporter
- Decreased Na+ Reabsorption
- Decreased Ca2+ Reabsorption
- Increased Aldosterone
- Clinical Features
- Hypovolemia
- Polyuria and Polydipsia
- Metabolic Alkalosis
- Mimics Loop Diuretics
- Nephrolithiasis
- Treatment
- Spironolactone (Aldactone)
4 mins
Gitelman Syndrome
- Pathophysiology
- Autosomal Recessive
- Defective Sodium-Chloride Cotransporter in Distal Tubule
- Mechanism Mimics Thiazide Diuretics
- Clinical Presentation
- Cramping and Tetany
- Severe Fatigue
- Polyuria
- Diagnosis
- Hypokalemia
- Metabolic Alkalosis
- High Urine Chloride
- Treatment
- Electrolyte Supplements
- Spironolactone
4 mins
Liddle Syndrome
- Pathophysiology
- Autosomal Dominant
- Collecting Duct
- Gain of Function Mutation in Epithelial Sodium Channel (ENaC)
- Excess Na+ and H2O Reabsorption
- Clinical Features
- Decreased Renin
- Decreased Aldosterone
- Hypertension with Hypokalemia
- Metabolic Alkalosis
- Pseudohyperaldosteronism
- Treatment
- Amiloride and Triamterene
3 mins
Syndrome Of Apparent Mineralocorticoid Excess (SAME)
- Pathophysiology
- 11 Beta-Hydroxysteroid Dehydrogenase Deficiency
- Elevated Cortisol
- Low Renin
- Low Aldosterone
- Causes
- Autosomal-Recessive
- Licorice (glycyrrhetinic acid) Ingestion
- Signs & Symptoms
- Hypertension
- Hypokalemia
- Metabolic Alkalosis
- Treatment
- Potassium-Sparing Diuretics
4 mins
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