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BNF > Chapter 9 - Blood And Electrolytes > Flashcards

Chapter 9 - Blood And Electrolytes Flashcards

1
Q

What’s included in chapter 9?

A

Different types of anaemia
Blood and Electrolytes
Vitamins

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2
Q

Different types of anaemia

A 
Sickle Cell Anaemia
G6PD deficiency 
Hypolastic
Haemolytic
Aplastic
Iron deficiency anaemia 
Megaloblastic
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3
Q

Sickle cell anaemia

A

Might need folate supplements

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4
Q

Hydoxycarbamide

A

Reduce frequency of sickle cell crisis which would lead to hospitalisation

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5
Q

G6PD

A

More common in men

Mostly seen in Asian, African and south European Union

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6
Q

Some drugs cause risk of haemolysis in G6PD deficiency

A

Quinolones like ciprofloxacin
Nitrofurantoin
Sulfonamide such as co-trimoxazole

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7
Q

Drugs with higher risk in G6PD deficiency

A

Aspirin
Quinine
Sulfonylurea

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8
Q

Hypoblastic and haemolytic anaemia

A

Can be treated with anabolic steroids

Various corticosteroids and pyridoxine

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9
Q

Aplastic anaemia

A

Treated with anti-lymphocyte immunoglobulin

Given IV through central line - 12 to 18 hours each day for 5 days; can cause severe reaction first two days and immunosupression can occur

Rate response may increase if ciclosporin given as well

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10
Q

Anaemia associated with erythopoietic deficiency

A

Can be seen in patients with chronic kidney failure

Treatment option eproietin

Eproietin beta - neonates with low birth weight (non benzoyl alcohol version)

Darbopretin long half life don’t have to administer frequently

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11
Q

Iron deficiency anaemia

A

Quiet common

Important not underlying conditions like GI cancer or gastric erosion

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12
Q

Prophylaxis with Iron

A

Menorraghea
Pre-term neonates with low birth weight
Pregnancy

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13
Q

Iron

A

Oral version and m/r versions

Therapeutically m/r has no benefit except u can take once a day

Parenteral versions - iron dextrose, iron sucrose: when oral version ineffective or can’t rake; main side effect hypersensitivity anaphylaxis, eczema and asthma patients at higher risk

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14
Q

Iron side effects

A

Constipation
Diarrhoea in patients with IBD taking m/r preparation
Discolour stools (black stools)

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15
Q

Iron administration

A

On an empty stomach because absorbs better that way
But if can’t tolerate side effects it’s fine to take after food
Advise patient to take with orange juice rather than water because it absorbs better with vitamin c

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16
Q

Megaloblastic anaemia

A

Usually due to lack of vitamin b12 also known as cyanocobalamine or folate

Establish underlying cause - pernicious anaemia causes malabsorption of vitamin b 12

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17
Q

Total gastectomy or total iliolresection

A

B12 prophylactically

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18
Q

Cyanocobalamin for b12 deficiency

A

Needs to be endorsed SLS

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19
Q

Cyanocobalamin replaced by

A

Hydroxycobalomine because it can be retained longer in the body

Maintenance treatment usually up to 3 months by IM injections

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20
Q

Folate deficiency

A

Due to pregnancy
Poor nutrition
Or even some antiepileptic medication

Folic acid treatment usually 4 months

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21
Q

Folic acid use in

A

Methotrexate therapy as folate antagonist

Also folinic acid but to do with cytotoxic therapy

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22
Q

Iron overload

A

Repeated blood transfusions

Treatment repeated venesection but if that’s contraindicated then iron chelating compound e.g desferrioxamine mesilate with ascorbic acid given separate from food and should be avoided in patients with cardiac dysfunction

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23
Q

In what situations would we need to give someone fluid and electrolytes

A

Vomiting
Diarrhoea
Particularly sodium and water in these states

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24
Q

Hyperkalaemia treatment >6.5mmol/l

A 
Calcium gluconate 10% 
Soluble insulin 
Glucose 50%
Calcium polystyrene sulfonate
Salbutamol injection/nebuliser
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25
Q

Oral potassium <3.5
Potassium bicarbonate
Potassium chloride

A

Digoxin therapy
Anti-arrhythmic
Chronic diarrhoea
Laxatives

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26
Q

Sodium bicarbonate

A 
Chronic acidosis state 
Metabolic acidosis
Renal tubular acidosis 
Dyspepsia 
Increasing pH of urine
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27
Q

Calcium supplementation

A

In children
Pregnancy
Osteoporosis

28
Q

Hypocalcaemia

A

Calcium + vitamin D

In the form of:
Calcium carbonate or
Calcium chloride

29
Q

Hypercalcaemia treatment

A 
Bisphosphonates
Corticosteroids 
Calcitonin
Phosphate salts 
Pamidronate
Cinacalcet

Dietary restrict calcium

Medicines - thiazides and vitamin D contribute

30
Q

Hyperparythyroidism

A

Cinacalcet
Paricalcitol
Parathyroidectomy

31
Q

What causes hypomagnesia

A

Diarrhoea or even alcoholism

Can cause secondary hypocalcaemia and hypokalamia

32
Q

Treatment for hypomagnesia

A

Magnesium sulphate injection

33
Q

Phosphate supplements

A

Severe diabetic ketoacidosis
Alcohol dependency
Ricketts

34
Q

Hyperphosphataemia

A

Calcium containing preparation

  • Sevelamer
  • Lanthanum
35
Q

Acute Porphyria

A

Hereditary condition
Certain medication unsafe - antihistamines, anabolic steroids, antidepressant, contraceptives, HRT, phenytoin, rifampicin, valproate plus many more

36
Q

Trace element deficiency

A

Selenium

Zinc - zinc sulphate (trauma or burns)

37
Q

Nutrition

A

IV infusion in addition to tube feeding

Reason for tube feeding - renal or liver dysfunction, severely ill, major surgery

38
Q

Parenteral feeding

A

Amino acids, glucose, fat, vitamins

39
Q

Parenteral nutrition complications

A

Gall bladder slodging and colistasis

40
Q

Phenylketonuria

A

Body can’t metabolise phenylalanine

Restrict dietary intake but still give sufficient small amount

41
Q

Special diets

A

Cealiac disease - gluten free

42
Q

Bleeding of gums

A

Scurvy causes bleeding of gums - lack of vitamin c

43
Q

DEAK

A

Fat soluble vitamins

44
Q

Water soluble vitamins

A

B and C

45
Q

Retinol

A

Vitamin A

46
Q

Lack of vitamin leads to ocular defects

Helps with night vision

A

Vitamin A

47
Q

Avoid in pregnancy

A

Vitamin A

48
Q

Where can you find vitamin A

A

Eggs
Butter
Fish oils

49
Q

Thiamine

A

Vitamin B1

50
Q

Riboflavin

A

Vitamin B2

51
Q

Pyridoxine

A

Vitamin B3

52
Q

Cyanocobalamin

A

Vitamin B12

53
Q

Thiamine given to

A

Alcoholics
Wernicks encephalopathy
Parenteral form pabrinex

54
Q

Thiamine found

A

Cereal
Bread
Energy metabolism

55
Q

Riboflavin

A

Energy metabolism:

Milk
Cereal

56
Q

Pyridoxine

A

Used in protein metabolism
Fish
Meat

57
Q

Cyanocobalamin

A

Red blood cell formation

Vegans lacks in - meat, milk and cheese

58
Q

Ascorbic acid

A

Vitamin C

Orange juice
Citrus fruit

Antioxidant

59
Q

Lacking vitamin c

A

Scurvy:

Gingival bleeding
Bleeding margins
Petechia of skin

60
Q

Vitamin D

A

Calciferol
Ergocalciferol
Cholecalciferol
Alfacalcidol (Renally impaired)

Too much lead to hypercalcaemia, too little rickets and osteomalacia

61
Q

Vitamin E

A

Antioxidant

Little evidence of benefit

Found in whole grain

62
Q

Blood clotting factors

A

Vit K

Green leafy vegetables, nuts and fruits

Given to newborn

Can get water soluble version

63
Q

Nicotinic acid

A

Inhibit synthesis of cholesterol and triglycerides

64
Q

Protein and energy metabolism

Found in kidneys and liver

A

Biotin

65
Q

Beta-carotene

A

Carrot and peaches

Antioxidants

66
Q

Folate/folic acid

A

Kidney, liver and vegetables and helps with red blood cell formation

Low risk of neural tubule defects - till 12 weeks

Child at risk - family history, diabetes, cealiac disease, antiepileptic medicines

BNF (3 decks)

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