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First Aid for the USMLE Step 1 2020 Medical (MD/DO) School Study Aid


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Normal Electrolyte Lab Values
Potassium (K+)
3.5 to 5.0 mEq/L
Calcium (Ca2+)
8.5 to 10.5 mg/dL
Phosphate (PO43–)
2.5 to 4.5 mg/dL
Magnesium (Mg2+)
1.5 to 2.5 mEq/L
Sodium (Na+)
135 to 145 mEq/L
Chloride (Cl)
95 to 105 mEq/L
1 min
Sodium (Na+) Lab Value
135-145 mEq/L
24 secs
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)
1 min
Hypernatremia
Assessment
> 145 mEq/L Na+
Change in LOC
Extreme Thirst
Orthostatic Hypotension
Dry Flushed Skin
Muscle Twitching
Seizures
Priority Interventions
Prevent Dehydration
Hypotonic Solutions (0.225% or 0.45% NaCl)
Sodium Restriction
Diuretics
1 min
Potassium (K+) Lab Value
3.5 to 5.0 mEq/L
20 secs
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
Infusion of Glucose and Insulin
Diuretics
Kayexalate
Prevention Education
1 min
Calcium (Ca2+) Lab Value
8.5 to 10.5 mg/dL
25 secs
Hypocalcemia
Assessment
< 8.5 mg/dL Ca2+
Decreased Bone Density
Muscle Spasms
Tetany
Chvostek's Sign
Trousseau's Sign
Increased DTR
ECG Changes
QT Prolongation
Considerations
Oral and IV Replacement of Ca2+
Seizure Precautions
2 mins
Hypocalcemia Causes
Hypoalbuminemia
Hypomagnesemia (Less Common Hypermagnesemia)
Hypovitaminosis D
Hypoparathyroidism
Medications
Hyperphosphatemia
Malnutrition
Acute Pancreatitis
Alkalosis
Sepsis
Chronic Kidney Disease
1 min
Hypocalcemia Treatments
Treat Underlying Disorder
Acute Treatments
IV Calcium Gluconate
Cardioprotective
Chronic Treatments
Calcium Carbonate
Calcium Citrate
Vitamin D Supplements
Considerations
Treat Hypomagnesemia
1 min
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
2 mins
Hypercalcemia Causes
Two CHIMPANZEES Acronym
Thyroid Disorders
Calcium Supplements
Hyperparathyroidism
Iatrogenic (Drugs, immobility)
Milk-Alkali Syndrome
Paget's Disease of Bone
Acromegaly or Addison's Disease
Neoplasms
Zollinger-Ellison Syndrome
Excessive Vitamin A
Excessive Vitamin D
Sarcoidosis
1 min
Hypercalcemia Treatments
Treat Underlying Disorder
Hydration
Dialysis
Calcium Restriction
Bisphosphonates
Calcitonin
Cinacalcet
Glucocorticosteroids
Denosumab
1 min
Magnesium (Mg2+) Lab Value
1.5 to 2.5 mEq/L
28 secs
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+
1 min
Magnesium Sulfate
Mechanism
Muscle Relaxant
Indications
Preterm Labor Contractions
Preeclampsia
Side Effects
Warm Feeling
Hypotension
Decreased Deep Tendon Reflexes (DTRS)
Decreased Respiratory Rate
Decreased Urine Output
Paralytic Ileus
Antidote
Calcium Gluconate
2 mins
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
1 min
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Nonpharmacologic Interventions
Monitor Serum and Urine Osmolality
IandOs with Daily Weights
Restrict Fluid Intake
Monitor Cardiovascular and Neurological Status
Seizure Precautions
1 min
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Pharmacologic Interventions
Diuretics
Hypertonic IV Fluids
Demeclocycline
Tolvaptan and Conivaptan
1 min

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