BLOOD & NUTRITION (key aspects) Flashcards by Izy Mal

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

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HYPOKALAEMIA vs HYPERKALAEMIA?

HYPOKALAEMIA- muscle cramps, arrhythmias
HYPERKALAEMIA- numbness, nausea, SOB, chest pain

both palpitations- heart rate

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HYPONATRAEMIA vs HYPERNATRAEMIA?

HYPONATRAEMIA- nausea, headache, irritability, seizures

HYPERNATRAEMIA- thirst, fatigue, confusion

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HYPOCALCAEMIA vs HYPERCALCAEMIA?

HYPOCALCAEMIA- depressed, forgetful
HYPERCALCAEMIA- nausea, lethargy, arrhythmias

both muscle cramp/confusion

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DRUGS THAT CAUSE HYPOKALAEMIA?

ABCDE I
Aminophylline/Theophylline
Beta-agonists
Corticosteroids
Diuretics (Loop/Thiazides)
Erythromycin/Clarithromycin
Insulin

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DRUGS THAT CAUSE HYPERKALAEMIA?

THANKS, B
Trimethoprim
Heparins
ACE-inhibitors/ARBs
NSAIDs
K-sparing Diuretics
Beta-blockers

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POTASSIUM IMBALANCE RISK?

HYPOKALAEMIA AND DIGOXIN?

POTASSIUM IMBALANCE RISK? Cardiac side-effects- arrhythmias

HYPOKALAEMIA AND DIGOXIN? Toxicity risk

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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

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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

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HYPERKALAEMIA IMPORTANT NOTE- SODIUM BICARBONATE AND CALCIUM SALTS?

DO NOT ADMINISTER IN SAME LINE- RISK OF PRECIPITATION

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HYPERKALAEMIA TREATMENT

MILD-MODERATE HYPERKALAEMIA?

Ion-exchange resins- (Calcium Resonium)

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DRUGS THAT CAUSE HYPONATRAEMIA?

CERTAIN DRUGS DITCH SALT
Carbamazepine
Diuretics
Desmopressin/Vasporessin
SSRIs

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DRUGS THAT CAUSE HYPERNATRAEMIA?

SALTY CEO
Sodium Bicarbonate/Chloride
Corticosteroids
Phenytoin
Lithium side-effect, hypernatraemia in OD
Effervescent Formulations
Oestrogens/Androgens

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HYPONATRAEMIA TREATMENT

Mild-moderate?

Severe?

FLUID RESTRICTION IDEAL THOUGH
Mild-moderate? Oral supplements (NaCl Na2CO3)

Severe? IV NaCl

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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

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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

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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

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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

117. 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