assorted electrolytes

Question 1

main intracellular ion

Answer 1

potassium

Question 2

main extracellular ion

Answer 2

sodium

Question 3

osmolarity

Answer 3

the concentration of a solution expressed as the total number of solute particles per litre

Question 4

isotonic

Answer 4

denoting or relating to a solution having the same osmotic pressure as some other solution, especially one in a cell or a body fluid.

Question 5

hypovolaemia

Answer 5

also known as volume depletion or volume contraction, is a state of abnormally low extracellular fluid in the body.

This may be due to either a loss of both salt and water or a decrease in blood volume. Hypovolemia refers to the loss of extracellular fluid and should not be confused with dehydration
corrected with hypertonic saline

Question 6

causes of hyponataemia

Answer 6

diuretics 
diarrhoea
heart failure 
liver or renal disease 
ADH secretion inappropriate

Question 7

symptoms of hyponataemia

Answer 7

headache
lethargy
dizziness
confusion

Question 8

hypernataemia is caused by dehydration from not drinking, diarrhoea, diuretics or kidney dyfcntion what are the symptoms - raised serum sodium

Answer 8

thirst
fever
dry mucous membranes restlessness

Question 9

hyperkalemia is caused by what and what are the symptoms

Answer 9

high serum potassium

Tissue damage, acidosis, aldosterone impairment

• Restlessness, intestinal cramping, loss of muscle tone, peaked T wave, Sine wave QRS

Question 10

how to treat hyperkalaemia especially if severe and shown on the ECG with a sine wave

Answer 10

insulin and glucose administration and maybe calcium if severe

Question 11

hypokalaemia is causes by what

Answer 11

alkalosis , primary aldosteronism

Question 12

symptoms fo hypokalaemia

Answer 12

Decreased muscle function, weakness, decreased smooth muscle tone, delayed ventricular repolarisation and bradycardia
causing membrane hyperpolarisation

Question 13

how to treat hypokalaemia

Answer 13

Oral or slow intravenous K+ administration is needed

Question 14

how does hypocalcaemia show on an ECG

Answer 14

prolonged QT interval as prolonged ventricular depolarisation

Question 15

how does hypercacaemia show on an ECG

Answer 15

shortened QT segment , depressed T waves , hypertension and kidney stones

Question 16

where is phophate mostly stored

Answer 16

bones

Question 17

hypophosphataemia causes

Answer 17

reduced intestinal absorption
primary hyperparathyroidism
alcohol abuse

Question 18

symptoms of low phosphate

Answer 18

reduced oxygen transport so left shift causing arrhymias and HF
muscle weakness , confusion and headaches

Question 19

how to treat low phosphate

Answer 19

O2 therapy or intravenous in severe cases

Question 20

hyperphosphataemia is only caused by one thing what is it and what are the symptoms

Answer 20

chronic kidney disease

Similar to hypocalaemia presentation

• Associated with hypocalcaemia due to calcium phosphate formation which precipitates in tissues such as the lungs, kidneys and joints

Question 21

hypomagnesaemia is caused by malnutrition or defective gut absorption, urinary loss, alcoholism and diuretics

what are the symptoms and what is seen on the ECG

Answer 21

Increased reflexes, confusion, irritability and tremor, carpopedal spasm and hallucinations

• Progressive QRS widening, PR interval prolongation and flattened T waves
• Oral/IV replacement and correct underlying cause

Question 22

Hypermagnesaemia Is caused by Kidney disease or magnesium containing laxatives or antacids- what are the symptoms

Answer 22

Depressed skeletal muscle contraction and nerve function, hyporeflexia proceding narcosis

Repiratory paralysis and cardiac function defects

Bradycardia, prolonged QT interval and heart blocks

Tx–> If renal function is normal, when magnesium therapy is stopped, levels return to normal

Question 23

chronic kidney disease can be associated with hypocalcaemia due to

Answer 23

increased serum phosphorus that will complex with serum calcium and deposit into bone and other tissues

decreased renal production of 1,25 (OH) 2 vitamin D that will reduce the absorption of calcium from GI track

Question 24

what are the consequences of prolonged elevation of plasma phosphorus ion

Answer 24

calcium phosphate formation and deposition

Question 25

John was admitted to hospital with altered ECG showing sine wave pattern. history of HF and is on mineralcorticodi blockers what is most likely happening

Answer 25

hyperkalaemia

short term stablaise myocardium with calcium and reduce circulating potassium by promoting cellular uptake (salbutamol and insulin dextrose)

long term solution Is to treat underlying cause and adjust spironolactone regimen

Question 26

if a patent has high sodium , high chloride , high blood urea , low urine sodium and concentrated urine that present as oliguria

what is this suggesting and what is the condition

Answer 26

low urien sodium volume depletion ( kidney is conserving salt)
increase urine osmolarity suggest ADH is conserving water so the patient is dehydrated

Hypovolaemic hyernatraemia

correction of hypovolaemic state is a priority and the patient should receive IV saline

Question 27

what is CKD

what is it caused by

Answer 27

Structural or functional anomalies of the kidney for greater than three months

diabetes, hypetension , glomerulonephrtis and polycytic kidneys

Question 28

what are the symptoms of CKD

Answer 28

Can be with or without decreased GFR

• GFR <60ml/min/1.73m2 for more than three months – CAGE – creatinine, age, gender, ethnicity
• Several stages, stage 5 and end stage are when transplants are needed

common to get anaemia

need renal replacement therapy

Question 29

Complications of CKD include

• Cardiovascular – IHD or heart failure
• MSK – CKD related metabolic bone disease
• Endocrine – secondary and tertiary hyperparathyroidism
• Haematological – normocytic anaemia
• metabolic acidosis , hyperkalaemia

what management strategies can be put in place

Answer 29

Lifestyle, exercise, weight loss, stop smoking

• Pharmacological – ACEi – stopping RAAS, relieving pressure so reducing protein being filtered ou

Question 30

Acute kidney injury is due to a decline of renal function with risk of significantly toxicity which is potentially reversible but couldn’t potentially require RRT
it presents as low urine output and what other major symptom

Answer 30

raised serum creatinine and urea

other symptoms
increased pulmonary vascular permeability - crackling in lung fields
increased Cardiac apoptosis - bidirectional cardio-renal syndrome