9. Blood Flashcards
What are the normal ranges for potassium and sodium?
Potassium 3.5-5.0 mmol/L
Sodium 135-145 mmol/L
What are the normal ranges for calcium and magnesium?
Calcium (total) 2.2 - 2.6 mmol/L
Calcium (ionised) 1.19 - 1.37 mmol/L
Magnesium 0.7 - 1.00 mmol/L
What is used for acute severe hyperkalaemia?
(3)
more than 6.5mmol/L or presence of ECG changes
Calcium gluconate 10% by slow intravenous injection to protect against myocardial excitability
5-10 units of soluble insulin with 50ml glucose 50% given over 5 to 15mins
Unlicensed use - salbutamol
Sodium bicarbonate can be used to correct acidosis in hyperkalaemia. Why should it not be administered in the same line as calcium?
risk of precipitation
What can be used in mild or moderate hyperkalaemia without ECG changes?
Ion -exchange resins
What is used for hyponatraemia?
sodium chloride usually given intravenously
in mild or chronic - oral supplements of sodium chloride or sodium bicarbonate
Treatment for hypokalaemia if pt cant get enough potassium orally?
Potassium chloride with sodium chloride infusion
Why shouldn’t glucose be given with potassium replacement therapy?
glucose can further decrease plasma potassium concentration
What is used for severe metabolic acidosis (pH <7.1)?
Sodium bicarbonate
ORT - once reconstituted how long after can u use any unused solution?
Should be discarded no later than 1 hour after prep unless store in fridge - can for up to 24 hours
Name some drugs that can cause hypERnatramia? (9)
- Lithium
- Phenytoin
- Lactulose
- Corticosteroids
- Anabolic steroids
- Androgens
- Oestrogens
- Oral contraceptives
- Sodium bicarbonate
Lithium can cause diabetes insipidus-like syndrome within 2 weeks of starting therapy and causes hypernatraemia. Is this reversible?
Yes upon stopping
Name some drugs that can cause hypOnatramia? (14)
- Desmopressin
- Oxytocin
- Carbamazepine
- Chlorpropamide (sulfonylurea)
- Amitriptyline & other tricyclic antidepressants
- ACE inhibitors
- Diuretics
- Heparin
- Lithium - by damaging renal
- NSAIDs
- Miconazole
- Vasopressin
- Opiates
- Amphotericin (antifungal)
Name some drugs that can cause hypERkalaemia? (12)
- Separate and COMBINED USE OF Potassium sparing diuretics - spironolactone, amiloride, triamterene & ACE inhibitors
- NSAIDs
- Digoxin (in acute overdose)
- Heparin
- Isoniazid
- Lithium
- Penicillin’s (potassium salt)
- Potassium supplements
- Tetracycline
- Beta blockers
- Tacrolimus
- Trimethoprim & co-trimoxazole
Name some drugs that can cause hypOkalaemia? (14)
- Gentamicin
- Thiazides
- Loop diuretics
- Glucose
- Insulin
- Corticosteroids
- Aspirin
- Laxatives
- Penicillin G (sodium salt)
- Salicylates
- PipTaz
- Terbutaline
- Sodium chloride/ sodium bicarbonate
- Amphotericin (antifungal)
How to manage hypERcalcaemia?
Correction of dehydration with normal saline
Frusemide - inhibits tubular reabsorption of calcium
Name some drugs that can cause hypOcalcaemia? (7)
- Bisphosphonates
- Phenytoin
- Frusemide
- Calcitonin
- Phenobarbital
- Aminoglycoside
- Cisplatin
Name some drugs that can cause hypERcalaemia? (4)
- Thiazide diuretics
- Lithium
- Tamoxifen
- Calcium supplements used in management of osteoporosis
What are the 3 mechanisms that can lead to hypokalaemia? examples of what can cause them
- Transcellular movement into cells - reported with intravenous B adrenoreceptor agonists such as salbutamol. Parenteral insulin. Adrenaline/epinephrine and theophylline
- Loss from GI tract - chronic diarrhoea, laxative abuse
- Loss from kidney - primary/secondary hyperaldosteronism e.g. Cushing’s syndrome or gentamicin (nephrotoxic)
Glucose 6 phosphate dehydrogenase deficiency is highly prevalent in individuals originating from…
- Africa
- Asia
- Oceania
- South Europe
More common in males than female
Those with G6PD deficiency are more susceptible to developing which type anaemia
also when they eat..
acute haemolytic anaemia (red blood cells are destroyed faster than they can be made)
Fava beans
What are the treatment options for iron deficieny anaemia
Oral iron salts
100mg to 200mg daily
Ferrous sulphate
Ferrous fumarate
Ferrous gluconate
Not much difference between the salts in terms of speed of work. So side effects and costs determine choice
Some iron preparations contain ascorbic acid…why ?
aid the absorption of iron - but advantage is minimal
Why should modified release of iron not be advised?
No therapeutic advantage
release iron gradually but the iron is carried past the first part of duodenum where absorption may be poor
What is the MHRA warning on intravenous iron?
Anaphylactic/serious hypersensitive reactions - even if they been given previous dose
caution is needed. trained staff and resuscitation facilities available.
Pts closely monitored during and 30mins after administration
Higher risk in those with known allergies, asthma, eczema etc
Can IV iron be used in pregnancy?
AVOID in 1st trimester
caution if benefits outweigh risks in 2nd and 3rd trimester
When can patients take oral iron after IV dose?
5 days after
Side effects of IV iron?
Dizzines, headache, flushing Hypo or hyper tension Hypophosphataemia Skin reactions Taste altered
Kounis syndrome - symptoms such as chest pain relating to reduced blood flow to the heart) caused by an allergic reaction
