Blood and Nutrition Flashcards
Sickle cell anaemia description
Deformed, less flexible red blood cells
Acute complications of sickle cell anaemia
- sickle cell crisis - restricted blood supply to organs
- hospitalisation - fluid replacement, analgesia, tx infections
- complications: anaemia, leg ulcers, renal failure, susceptibility to infections
Haemolytic anaemia treatment
increase folate - give folic acid supplementation
Treatment of sickle cell anaemia complications
hydroxycarbamide - reduces frequency of painful crises and reduces transfusion requirements
G6PR (glucose-6-phosphate dehydrogenase) deficiency anaemia
- common in Africa and Asia, more common in males
- susceptible to developing acute haemolytic anaemia (haemolysis = RBC destruction)
Drugs with definite risk of haemolysis in G6PR deficient people
- dapsone and other sulfones
- fluoroquinolone/quinolones
- nitrofurantoin
Drugs with possible risk of haemolysis in G6PD deficient people
- aspirin
- chloroquine
- menadione
- quinine
- sulfonylureas
What is megaloblastic anemia
Either a B12 or folate deficiency - 1st step = establish cause
Vit B12 deficiency treatment
Hydroxycobalamin initiated with frequent IM injections to replenish stores then
hydroxycobalamin 3 monthly
Folate deficiency treatment
- due to poor nutrition, pregnancy, or antiepileptics (phenytoin, carbamazepine, phenobarbital)
- folic acid daily for 4 months
Megaloblastic anaemia deficiency emergency
- give hydroxycobalamin and folic acid together while plasma assay results are waiting
- don’t give folic acid alone if undiagnosed - may cause neuropathy
Folic acid doses
- regular pregnancy: 400mcg OD from before conception to week 12
- risk of NTD: 5mg OD from before conception to week 12
Risk factors for neural tubular defects
- smoking
- sickle cell anaemia
- diabetes
- obesity
- anti-epileptics
- anti-malarials
Iron deficiency anaemia symptoms
tiredness, SOB, palpitations, pale skin
When is prophylaxis with iron appropriate in IDA
malabsorption, menorrhagia, pregnancy, after total/subtotal gastrectomy, in haemodialysis patient, in management of low birth-weight infants e.g. preterm neonates
Precautions before treating IDA with iron
- must show iron deficiency to treat with iron
- exclude underlying cause e.g. gastric erosion, GI cancer
Oral iron types and dose
- fumarate, gluconate, sulfate, sulfate (dried)
- daily elemental iron dose = 100 to 200mg per day
- usually sulfate (dried)
- sulfate (dried) can be MR too (reduced absorption)
- when Hb in range - continued for 3 months
Oral iron side effects
- constipation/diarrhoea, black tarry stools
- stop in C. diff due to diarrhoea
Oral iron absorption
- with vitamin C (orange juice) to aid absorption
- before food to aid absorption
- after food to reduce side effects
Iron toxicity treatment
desferrioxamine
Parenteral iron types
dextran, sucrose, carboxymaltose, densomaltose
When should parenteral iron be used
- oral not tolerated/doesn’t work
- chemo-induced anaemia
- chronic renal failure who are receiving haemodialysis
Parenteral iron MHRA warning
- serious hypersensitivity reactions
- appropriately trained staff and resuscitation must be available
- monitor for reaction for at least 30 minutes after every administration
What is neutropenia
- low neutrophil count (<1.5 x 10^9/L)
- increased risk of infection and sepsis, especially in chemotherapy
Treatment for neutropenia
- recombinant human granulocyte-colony stimulating factor (rhG-CSF)
- e.g. filgrastim, lenograstim, pegfilgrastim, lipefilgrastim
- stimulates neutrophil production do decreased duration of chemo-induced neutropenia so reduces incidence of febrile neutropenia
Normal ranges for electrolytes in mmol/L
- Calcium: 2.2 - 2.6
- Magnesium: 0.6 - 1
- Phosphate: 0.87-1.45
- Potassium: 3.5 - 5.3
- Sodium: 133 - 146
Hypokalaemia side effects
muscle cramps, rhabdomyolysis, fatigue, palpitations, arrhythmias
Hyperkalaemia side effects
fatigue, numbness, nausea, SOB, chest pain, palpitations
Hyponatraemia side effects
nausea, headache, confusion, fatigue, irritability, seizures
Hypernatraemia side effects
thirst, fatigue, confusion
Hypocalcaemia side effects
muscle cramps, confusion, depressed, forgetful
Hypercalcaemia side effects
nausea, lethargy, muscle cramps, confusion, arrhythmias
Hyponatraemia and Lithium interaction
Hyponatraemia predisposes patient to lithium toxicity
Drugs that cause Hyponatraemia
Carbamazapine
Diuretics
Desmopressin/vasopressin
SSRIs
Certain Drugs Ditch Salt
Drugs that cause Hypernatraemia
Sodium bicarbonate/chloride
Corticosteroids
Effervescent formulations
Oestrogens/androgens
Salty CEO
Hyponatraemia treatment
mild - mod = oral supplements (sodium chloride/bicarbonate)
severe = IV NaCl
Hypernatraemia treatment
dietary: reduce salt intake
Drugs that cause hypokalaemia
Aminophylline/theophylline
Beta agonists
Corticosteroids
Diuretics (loop/thiazide)
Erythro/clarithromycin
Insulin
ABCDEI
Drugs that cause hyperkalaemia
Trimethoprim
Heparin
ACEi/ARBs
NSAIDs
K-Sparing diuretics
Beta - blockers
THANKS B
Potassium imbalance causes:
cardiac side effects e.g. arrhythmias
Hypokalaemia and digoxin interaction
Hypokalaemia predisposes patients to digoxin toxicity
Hypokalaemia treatment
mild - mod = oral replacement (sando K)
severe = IV KCl in NaCl
K replaced cautiously in renal impairment - risk of hyperkalaemia secondary to renal impairment
Hyperkalaemia treatment
mild - mod = ion exchange resins to remove excess K (calcium resonium)
acute sever (>6.5) = urgent tx:
- IV calcium chloride 10%/ calcium glauconate 10%
- IV soluble insulin (5-10 units) with 50mL glucose - 50% given over 5-15 minutes
- salbutamol nebulisation or slow IV injection
- drugs exacerbating hyperkalaemia reviewed/stopped
Use of magnesium
- essential in enzyme systems, energy generation - stored in skeleton
- excreted by kidney so retained in renal failure = hypermagnesaemia
Drugs causing hypomagnesaemia
PPIs, diuretics
hypomagnesaemia treatment
mild = oral magnesium
symptomatic = IV/IM magnesium sulfate (IM=painful)
hypermagnesaemia treatment
muscle weakness and arrhythmias
calcium glutinate injection used for management of magnesium toxicity
hypocalcaemia cause and treatment
- from reduced dietary calcium
- tx with calcium supplements and vitamin D
- in osteoporosis - double the recommended amount of calcium to reduce rate of bone loss
- severe = initial slow IV calcium glauconite with plasma calcium and ECG monitoring - repeat if needed or follow with continuous IV infusion to prevent recurrence
Drugs causing hypocalcaemia
rifampicin, phenytoin, phenobarbital, bisphosphonates
Drugs causing hypercalcaemia
thiazide diuretics, lithium, vit D
hypercalcaemia treatment
severe:
- correct dehydration with IV NaCl 0.9%
- stop drugs causing hyper, restrict dietary
- bisphosphinates and pamidronate disodium used
- corticosteroids if due to sarcoidosis or with vit D toxicity
- calcitonin in hyper associated with malignancy
Hypercalciurea treatment
- increase fluid intake and give bendroflumethiazide
- decrease dietary calcium but not severe restriction (harmful)
What is hyperparathyroidism
increase in parathyroid hormone= hypercalcaemia, hypercalciurea and hypophosphataemia
hyperparathyroidism symptoms
thirst, polyurea, constipation, fatigue, memory impaired, CVD, kidney stones, osteoporosis
- affects 2x women than men, common in women 50 - 60 yrs
1st line treatment of primary hyperparathyroidism
parathyroidectomy surgery
assess CVD risk and fracture risk
hyperparathyroidism drug treatment
- cincalcet if surgery unsuccessful/declined
- in 2ndory care - measure vit D - supplement if needed
- bisphosphonates to reduce fracture risk
Hypophosphataemia cause and treatment
- alcohol dependence or severe DKA
- oral supplements
Hyperphosphataemia treatment
- phosphate binders (calcium or non-calcium based)
- stage 4/5 CKD = manage diet and dialysis before starting tx
1. calcium acetate
2. sevelamer
3. CaCO3 (calcium based) or sucroferric oxyhydroxide (non-calcium based)
What is acute porphyrias
a metabolic, hereditary disorder of haem biosynthesis.
Causes severe pain in belly, chest, legs or back, digestive problems, confusion, red/brown urine.
Drugs that can induce acute porphyria crises
amiodarone, carbamazepine, chloramphenicol, clindamycin, diltiazem, erythromycin, indapamide, isoniazid, mefenamic acid, methyldopa, nitrofurantoin, phenytoin, rifampicin, risperidone, spironolactone, tamoxifen, topiramate, trimethoprim, valproate, verapamil
acute porphyria treatment
mod - severe = IV haem arginate
Name the fat soluble vitamins
DEAK
Vitamin A
- is retinol
- deficiency = ocular defects and increase risk of infections
- avoid in pregnancy (teratogenic)
- is in cheese, eggs, oily fish, milk, yogurt, liver products e.g. paté
Vitamin D
- is ergocalciferol (D2), cholecalciferol (D3), alfacalcidol, calcitriol
- deficiency = rickets, from reduced sun and diet intake
- vit D dose = 10mcg (400 units)
- is in oily fish, red meat, liver, egg yolk, fortified foods e.g. cereal
Vitamin E
- is tocopherol
- deficiency = neuromuscular abnormalities
- is in plant oils, nuts, seeds, wheatgerm
Vitamin K
- is phytomenadione
- blood clotting factors - reversal agent for warfarin
- menadiol (water-soluble derivative) given orally in malabsorption syndromes
- is in green leafy veg, veg oils, cereal grains
Name the water soluble vitamins
BC
Vitamin B
- B1 (thiamine) = deficiency = wernickes encephalopathy
- B2 (riboflavin) = keeps skin, eyes and nervous system healthy
- B6 (pyridoxine) = to treat isoniazid associated peripheral neuropathy
- B12 (hydroxocobalamin) = treatment of megaloblastic anaemia
- is in meats, cereals and vegetables
Vitamin C
- is ascorbic acid
- deficiency = scurvy
- helps with wound healing and maintains healthy skin, blood vessels, bone and cartilage
- is in oranges, peppers, strawberries, blackcurrants, broccoli, sprouts, potatoes
IV nutrition 2 methods
- supplemental parenteral nutrition - addition to ordinary feeding
- TPN - sole source of nutrition
How is IV nutrition given
via central venous catheter (central line) or a peripheral vein
What does IV nutrition contain
amino acids, glucose, fat, electrolytes, trace elements, vitamins
- proteins as synthetic L-amino acids - source of energy
- preferred card: glucose (infused through central venous catheter to avoid thrombosis)
- phosphate - for phosphorylation of glucose and preventing hypophosphataemia
- fructose and sorbitol - prevents hyperosmolar hyperglycaemic non-ketotic acidosis
- fat emulsions - high energy to fluid volume ratio (not to mix in additives)
