Biochemistry

Question 1

Hyponatremia causes

Answer 1

Hypovolamic
- fluid loss, addisons, diuretics

Euvolamic
-siADH——- small cell lung tumours, infection abscess, drugs (carbamazepine and APs) and head injury
Polydipsia
Hypothyroidism

Hypovolaemic
Heart failure
Renal failure
Hypoalbunimia (liver or nutrition)
Hypothyroidism

Question 2

Hypernatremia

Answer 2

Drips
Dehydration
Drugs

Question 3

Hypokalaemia

the consequences are DIRE

Answer 3

Diuretics: loop and thiazide
Inadequate intake or intestinal loss
RTA
Endocrine (cushings and conn’s)

Question 4

Hyperkalaemia

You’d DREAD to think what happens

Answer 4

Drugs: K sparing diuretics, ACE-i
Renal failure
Endocrine (addisons)
Artefact
DKA

Question 5

AKI: how would you spot pre-renal? Caused by?

Answer 5

Urea>Creatinine rise

Caused by dehydration or RAS

Question 6

AKI: how would you spot renal? Caused by?

Answer 6

Creatinine rise>Urea  rise
INTRINSIC
Ischaemic due to pre-renal, causing ATN
Nephrotoxic Tablets: ABX, NSAIDs, ACE
Radiological
Injury (rhabdo)
Neg birefringent  crystals
Syndromes
Inflammation (vasculitides)
Choleserol emboli

Question 7

AKI: how would you spot post-renal? Caused by?

Answer 7

Creatninine > Urea rise
Palpable bladder?

Obstruction etc

Question 8

Break down the LFTs into what they indicate

Answer 8

ALT
Bilirubin
AST

These are markers of hepatocyte injury

Albumin 
Clotting factors (II, VII, IX, X) are vit K dependant and measured by PT/INR

These measure the liver’s ability to make proteins

Question 9

Pattern of LFT derangement for pre-hepatic issues, and cause

Answer 9

Bilirubin raised

haemolysis, CN syndrome or Gilberts

Question 10

Pattern of LFT derangement for hepatic issues, and cause

Answer 10

Bili raised, AST/ALT raised
fatty liver 
hepatitis : drugs (paracetomol, statins,rifampicin), hep/CMV/EBV, alchohol, AI (PBcirrhosis, PScholangitis,AI hep)
cirrhosis
malignancy
metabolic (wilson's/haemochromatosis)
heart failure

Question 11

Pattern of LFT derangement for post-hepatic issues, and cause

Answer 11

Bili and ALP up
In lumen: stone (gallstone), drugs causing cholestasis**
In wall: tumour (cholangiocarcinoma), primary biliary cirrhosis, sclerosing cholangitis
Extrinsic pressure: pancreatic or gastric cancer, lymph node

**Flucloxacillin, coamoxiclav, nitrofurantoin, steroids and sulphonylureas.

Question 12

Causes of raised ALP?

ALKPHOS

Answer 12

Any fracture
Liver damage (post-hepatic)
Kancer
Pagets
hyperparathyroidism
Osteomalacia
Surgery

Question 13

Drugs that require monitoring

Answer 13

The most common of these are digoxin, theophylline, lithium, phenytoin and certain antibiotics (gentamicin (see later in chapter) and vancomycin).

Question 14

Signs of gentamycin or vancomycin toxicity

Answer 14

ototoxicity and nephrotoxicity

Question 15

Signs of phenytoin toxicity

Answer 15

gum hypertrophy, nystagmus, ataxia, peripheral neuropathy, teratogenicity

Question 16

Lithium toxciity

Answer 16

Early: tremor
Intermediate: tiredness
Late: arrhythmias, seizures, coma, renal failure and diabetes insipidus

Question 17

Digoxin toxicity

Answer 17

Confusion, nausea, visual halos and arrhythmias

Question 18

INR >8 no bleeding?

Answer 18

Omit warfarin and give Vit K PO

Question 19

INR > 3 minor bleeding?

Answer 19

IV vit K

Question 20

INR>3 major bleeding

Answer 20

Prothrombin complex

Question 21

INR<8 no bleeding

Answer 21

Omit warfarin for 2 doses, recheck INR. Review medications (inhibitors- AODEVICES)