Biochemistry Flashcards
Hypernatraemia
Diabetes insipidus
Poor water intake
Excess Na in IV fluids
Drugs with high Na concentration
Hyponaturaemia
Hypovolaemic: extrarenal- GI (vomiting, diarrhoea), fluid shifts; renal- diuretics, salt-wasting renal disease, nephropathy, adrenal insufficiency; cutaneous losses
Isovolaemic: water intoxication, SIADH, drugs, renal failure hyperthyroidism
Hypervolaemic: liver failure, CCF, hypoproteinaemia, iatrogenic (excess fluids)
Hypokalaemia
HAIRDRIER
Hyperaldosteronism Alkalosis Insulin Renal tubular acidosis Drugs (diuretics, steroids, ß agonists) Refeeding syndrome Iatrogenic Extra renal losses (intestinal, excess vomit/diarrhoea, stoma output) Rapid cellular proliferation
Hyperkalaemia
MACHINES
Medications Acidosis, e.g. DKA Cell damage Haemolysis of blood sample Iatrogenic Nephrogenic renal damage Endocrine, e.g.hypoaldosterone Spurious, wrong tube EDTA
Hypoglycaemia
PAINTED
Post-prandial Alcohol Insulin Neonatal and hereditary disorders, e.g. Glycogen storage Tumours Endocrine, e.g. Addison's, GH deficiency Drugs (sulphonureas)
Increased plasma urea:creatinine ratio
High protein intake GI bleeding Hypercatabolic state Dehydration Urinary stais Muscle wasting Amputation
Decreased plasma urea:creatinine ratio
Low protein intake
Dialysis
Severe liver disease
Hypercalcaemia
CHIEFS
Cancer, malignancy and PTHrP, multiple myeloma
Hyperparathyroid, adenoma
Iatrogenic, e.g. Thiazide diuretics
Endocrine, e.g. Thyrotoxicosis, vit D deficiency
Familial hypocaliuric hypercalcaemia
Sarcoidosis/TB
Hypocalcaemia
HARD
Hypoparathyroid
Artifact, from EDTA tube
Renal failure
vit D deficiency
Hyperphosphataemia
Renal impairment Hypoparathyroidism Acromegaly Excessive phosphate intake Vit D intoxication Catabolic states
Hypophosphataemia
Redistribution: DKA, enteral/parentral nutrition, IV glucose therapy, respiratory alkalosis
Renal loss: hyperparathyroidism, renal tubular disease, diuretics, rickets
Decreased intake: dietary, malabsorption, vomiting, alcohol withdrawal
Raised ALP
POPPYCOCK
Pregnancy Osteomalacia/rickets - vit D deficicency Paget's disease of bone Primary hyperparathyroidism Young age Cholestasis Osteomyelitis and bone inflammation Cirrhosis Kidney failure, causing renal osteodystrophy
Raised AST/ALT
Hepatocellular damage:
Viral hepatitis Autoimmune hepatitis Drugs, toxins, alcohol Fatty liver Malignancy Metabolic disease, e.g. Wilson's
Raised ALP and gammaGT
Bile outflow obstruction:
Obstruction in bile duct lumen
Abnormal bile duct wall (stricture, cholangiocarcinoma)
Compression of bile duct, by extrinsic lesion
