BLOOD & NUTRITION (key aspects) Flashcards
FLUID AND ELECTROLYTE IMBALANCE RANGES
Ca2+? Mg2+? Po4-? K+? Na+?
Ca2+? 2.2-2.6 mmol/L Mg2+? 0.6-1 mmol/L Po4-? 0.87-1.45 mmol/L K+? 3.5-5.3 mmol/L Na+? 133-146 mmol/L
HYPOKALAEMIA vs HYPERKALAEMIA?
HYPOKALAEMIA- muscle cramps, arrhythmias
HYPERKALAEMIA- numbness, nausea, SOB, chest pain
both palpitations- heart rate
HYPONATRAEMIA vs HYPERNATRAEMIA?
HYPONATRAEMIA- nausea, headache, irritability, seizures
HYPERNATRAEMIA- thirst, fatigue, confusion
HYPOCALCAEMIA vs HYPERCALCAEMIA?
HYPOCALCAEMIA- depressed, forgetful
HYPERCALCAEMIA- nausea, lethargy, arrhythmias
both muscle cramp/confusion
DRUGS THAT CAUSE HYPOKALAEMIA?
ABCDE I Aminophylline/Theophylline Beta-agonists Corticosteroids Diuretics (Loop/Thiazides) Erythromycin/Clarithromycin Insulin
DRUGS THAT CAUSE HYPERKALAEMIA?
THANKS, B Trimethoprim Heparins ACE-inhibitors/ARBs NSAIDs K-sparing Diuretics Beta-blockers
POTASSIUM IMBALANCE RISK?
HYPOKALAEMIA AND DIGOXIN?
POTASSIUM IMBALANCE RISK? Cardiac side-effects- arrhythmias
HYPOKALAEMIA AND DIGOXIN? Toxicity risk
HYPOKALAEMIA TREATMENT
MILD-MODERATE?
SEVERE?
K+ replaced cautiously in patients w/ renal impairment?
MILD-MODERATE? Oral replacement (Sando-K)
SEVERE? IV KCL in NaCl
K+ replaced cautiously in patients w/ renal impairment? Risk of hyperkalaemia secondary to impaired K+ excretion
HYPERKALAEMIA TREATMENT
ACUTE SEVERE HYPERKALAEMIA? >/= 6.5mmol/L, URGENT
ACUTE SEVERE HYPERKALAEMIA? IV CaCl 10% OR IV CaGlu 10% IV soluble insulin (5-10units) w/ 50mL glucose 50% over 5-15 mins Salbutamol (nebs/slow IV) caution in CVD \+ review drugs worsening the hyper
HYPERKALAEMIA IMPORTANT NOTE- SODIUM BICARBONATE AND CALCIUM SALTS?
DO NOT ADMINISTER IN SAME LINE- RISK OF PRECIPITATION
HYPERKALAEMIA TREATMENT
MILD-MODERATE HYPERKALAEMIA?
Ion-exchange resins- (Calcium Resonium)
DRUGS THAT CAUSE HYPONATRAEMIA?
CERTAIN DRUGS DITCH SALT Carbamazepine Diuretics Desmopressin/Vasporessin SSRIs
DRUGS THAT CAUSE HYPERNATRAEMIA?
SALTY CEO Sodium Bicarbonate/Chloride Corticosteroids Phenytoin Lithium side-effect, hypernatraemia in OD Effervescent Formulations Oestrogens/Androgens
HYPONATRAEMIA TREATMENT
Mild-moderate?
Severe?
FLUID RESTRICTION IDEAL THOUGH
Mild-moderate? Oral supplements (NaCl Na2CO3)
Severe? IV NaCl
HYPOCALCAEMIA NOTES
Poor diet?
Osteoporosis?
Oral supplements given w/?
Poor diet? Calcium supplements
Osteoporosis? Double recommended amount reduces rate of bone loss
Oral supplements given w/? Vitamin D
HYPOCALCAEMIA TREATMENT
SEVERE ACUTE HYPOCALCAEMIA/HYPOCALCAEMIC TETANY?
SEVERE ACUTE HYPOCALCAEMIA/HYPOCALCAEMIC TETANY?
SLOW IV Calcium Gluconate 10% w/ plasma-calcium & ECG monitoring (arrhythmias L if rapid
Repeat if need be/continuous IV to prevent recurrence
HYPERCALCAEMIA TREATMENT
SEVERE HYPERCALCAEMIA?
Hypercalcaemia due to sarcoidosis/vitamin D deficiency?
Hypercalcaemia w/ malignancy?
SEVERE HYPERCALCAEMIA?
Correct dehydration first w/ IV NaCl 0.9%+discontinue the bad drugs
Use BISPHOSPHONATES+PAMIDRONATE SODIUM
Hypercalcaemia due to sarcoidosis/vitamin D deficiency? Corticosteroids
Hypercalcaemia w/ malignancy? Calcitonin
HYPERCALCIURIA TREATMENT?
INCREASE FLUID INTAKE
GIVE BENDROFLUMETHIAZIDE
REDUCE DIETARY CALCIUM INTAKE BUT NOT SEVERE RESTRICTION (harmful)
HYPERPARATHYROIDISM
EXCESS parathyroid hormone leads to?
Hypercalcaemia
Hypercalciuria
Hypophosphataemia
SIDE-EFFECTS OF HYPERPARATHYROIDISM?
THIRST POLYUREA CONSTIPATION FATIGUE MEMORY IMPAIRMENT CVD KIDNEY STONES OSTEOPOROSIS
HYPERPARATHYROIDISM FACTS
Leading cause of hypercalciuria
Affects twice as many women than men women 50-60 most common
PRIMARY HYPERPARATHYROIDISM TREATMENT
1st line?
SURGERY
HYPERPARATHYROIDISM
DRUG TREATMENT? (Surgery unsuccessful/declined)
SECONDARY CARE?
REDUCING FRACTURE RISK?
DRUG TREATMENT? (Surgery unsuccessful/declined) CINACALCET
SECONDARY CARE? MEASURE VITAMIN D LEVELS
REDUCING FRACTURE RISK? BISPHOSPHONATE
MAGNESIUM NOTES- essential in enzyme systems, generation- stored in skeleton
Excreted by kidneys, so retained in renal failure, thus-> hypermagnesamia
HYPERMAGNESAEMIA TREATMENT? (Causes muscle weakness & arrhythmias)
Calcium gluconate injection- magnesium toxicity
HYPOMAGNESAEMIA TREATMENT
SYMPTOMATIC?
MILD?
SYMPTOMATIC? IV/IM magnesium sulfate (IM= painful)
MILD? Oral magnesium
HYPOHPOSPHATAEMIA TREATMENT? (Common in alcohol dependence/severe DKA)
Oral phosphate supplements
HYPERPHOSPHATAEMIA- patients w/ stake 4/5 CKD prerequisite?
MANAGE DIET
+
DIALYSIS BEFORE STARTING AGENTS
HYPERPHOSPHATAEMIA TREATMENT
1st LINE?
2nd LINE?
3rd LINE?
1st LINE? Calcium acetate
2nd LINE? Sevelamer
3rd LINE? CaCO3 (calcium-based) OR Sucroferric Oxyhydroxide (non-calcium based)
UREA CYCLE DISORDERS TREATMENT?
SODIUM BENZOATE (unlicensed) SODIUM PHENYLBUTYRATE
What is ACUTE PORPHYRIAS?
Hereditary disorder of haem biosynthesis (1 in 75000)
MODERATE-SEVERE-ACUTE PORPHYRIA CRISES TREATMENT?
IV Haem Arginate
DRUGS UNSAFE IN ACUTE PORPHYRIAS?
ANTIDEPRESSANTS HORMONAL CONTRACEPTIVES, HRT BARBITUATES PROGESTOGEN SULFONYLUREAS TAXANES
Orlistat impairs absorption of fat-solube vitamins so…?
GIVE VITMAIN D SUPPLEMENTS
VITAMINS (FAT-SOLUBLE)
VITAMINA A (retinol) deficiency? avoid in? found in?
VITAMINA A (retinol) deficiency? ocular defects+infections avoid in? pregnancy, teratogenicity found in? cod liver/cheese/eggs/oily fish/milk/yoghurt/ DO NOT TAKE COD LIVER PREGNANT
VITAMINS (FAT-SOLUBLE)
VITAMIN D (ergocalciferol [D2], colecalcifero l[D3], alfacalcidol, calcitriol) deficiency leads to? deficiency occurs in? normal dose? found in?
VITAMIN D (ergocalciferol [D2], colecalcifero l[D3], alfacalcidol, calcitriol) deficiency leads to? rickets, children, soft and deformed bones deficiency occurs in? reduced sunlight+diet intake normal dose? 10mcg (400UI) found in? oily fish, red meat, liver, egg yolk, cereal So vegans are deficient in vitamin D b12 i guess?
VITAMINS (FAT SOLUBLE)
VITAMIN E (tocopherol) deficiency leads to? found in?
VITAMIN E (tocopherol) deficiency leads to? neuromuscular abnormalities found in? plant oils/nuts/seeds/wheatgerm
VITAMINS (FAT SOLUBLE)
VITAMIN K (phytomenadione)
blood clotting factor?
menadiol (water-souble derivate) given orally in?
found in?
MENADIOL BONUS?
VITAMIN K (phytomenadione)
blood clotting factor? warfarin reversal agent
menadiol (water-souble derivate) given orally in? malabsorption syndromes
found in? green leafy vegetables/vegetable oils/cereal grains
For menadiol sodium phosphate G6PD deficiency (risk of haemolysis); vitamin E deficiency (risk of haemolysis)
VITAMINS (WATER-SOLUBLE)
VITAMIN C (ascorbic acid)
deficiency leads to?
helps w/?
found in?
VITAMIN C (ascorbic acid) deficiency leads to? scurvy- bleeding gums helps w/? wound healing+maintains healthy skin/blood vessels/bone & cartilage found in? oranges/peppers/strawberries/blackcurrants/broccoli/sprouts/potatoes
VITAMINS (WATER-SOLUBLE)
VITAMIN B- TREATMENTS B1 (thiamine)? B2 (riboflavin)? B6 (pyridoxine)? B12 (hydroxocobalamin)? found in?
VITAMIN B- TREATMENTS
B1 (thiamine)? Wernicke’s encephalopathy
B2 (riboflavin)? keeps skin/eyes/nervous system healthy
B6 (pyridoxine)? peripheral neuropathy caused by isoniazid (TB)
B9 (folic acid)? +with methotrexate separate day, 5mg weekly
B12 (hydroxocobalamin)? Megaloblastic anaemia
found in? meat/cereals/vegetables, so vegans lack it!
Pamidronate sodium?
Hypercalcaemia of malignancy
- A 58-year-old female has atypical signs of hyperthyroidism. You are the practice pharmacist conducting a structured medication review and recognise the patient is taking a nutritional supplement that can result in a false diagnosis of thyrotoxicosis. Below is a list of her regular medication:
• Propylthiouracil 50mg twice a day
• Ramipril 2.5mg daily
• Atorvastatin 20mg daily
VITAMIN B1?
There may be false assay results due to the ingestion of the over-the-counter supplement biotin - this may cause spuriously low TSH levels and elevate T4 and T3 levels.
Additional information: B vitamins and their medical names
- Thiamin (Bl)
- Riboflavin (B2)
- Niacin {B3)
- Pantothenic acid (BS)
- Pyridoxine (B6)
- Biotin (B7)
- Folic acid (B9)
- Cyanocobalamin {B12)
HYDROXOCOBALAMIN DOSING?
Initially 1 mg 3 times a week for 2 weeks, then 1 mg every 2–3 months
