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Flashcards: Year 5 > Chemical Pathology - Management > Flashcards

Chemical Pathology - Management Flashcards

1
Q

Hypovolaemic hyponatraemia

A

Volume replacement with 0.9% saline

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2
Q

Euvolaemic hyponatraemia

A

Fluid restriction

Treat underlying cause

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3
Q

Hypervolaemic hyponatraemia

A

Fluid restriction

Treat underlying cause

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4
Q

SIADH

A

Demeclocycline - reduces responsiveness of the collecting tubule cells to ADH.
Tolvaptan - V2 receptor antagonist.

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5
Q

Hypernatraemia

A

Correct water deficit using 5% dextrose
Correct extracellular fluid volume depletion using 0.9% saline
Serial sodium measurements every 4-6 hours

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6
Q

Osteoporosis

A 
Lifestyle - smoking cessation, reduce alcohol intake, weight-bearing excercise
Vitamin D and calcium
Bisphosphonates (e.g. alendronate)
Teriparatide (PTH derivative)
Strontium
Oestrogens (HRT)
SERMs (e.g. raloxifene)
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7
Q

Hypercalcaemia

A

Fluids (0.9% saline, 1L over 1 hour then re-assess)
Frusemide (avoid thiazides) to remove calcium via urine
Bisphosphonates (e.g. alendronate)
Treat underlying cause

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8
Q

Hypocalcaemia

A

Calcium

(Activated) Vitamin D

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9
Q

Paget’s disease of bone

A

Bisphosphonates (for pain)

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10
Q

Hyperkalaemia

A

10ml 10% calcium gluconate (stabilises myocardium) - if potassium > 6.5mmol/L or with ECG changes
50ml 50% dextrose (or equivalent) with 10 units of insulin
Nebulised salbutamol
Treat underlying cause

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11
Q

Hypokalaemia

A

Serum potassium 3.0-3.5mmol/L:
Oral potassium chloride
Re-check serum potassium

Serum potassium < 3.0mmol/L:
IV potassium chloride (maximum rate 10mmol/hour)
Treat underlying cause

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12
Q

Prolactinoma

A

Dopamine agonists (to shrink it) - cabergoline or bromocriptine
Surgery
Radiotherapy

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13
Q

Acromegaly

A

Octreotide/lanreotide - somatostatin analogues
Cabergoline/bromocriptine - dopamine agonists
Pegvisomant - GH antagonist
Surgery
Radiotherapy

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14
Q

Phaeochromocytoma

A

Urgent alpha blockade (phentolamine/phenoxybenzamine/doxazocin)
Non-urgent beta blockade
Surgery (adrenalectomy)

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15
Q

Post-renal AKI

A

Relieve the obstruction

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16
Q

Renal bone disease (osteitis fibrosa cystica, osteomalacia, adynamic bone disease, mixed osteodystrophy)

A

Phosphate control - dietary or phosphate binders
Vitamin D receptor activators - 1-alpha calcidol or paracalcitol
Direct PTH suppression - cinacalcet

17
Q

Sarcoidosis

A

Steroids

18
Q

Hypoglycaemia (in adults)

A

Alert and orientated:
Oral carbohydrates - rapid acting (juice/sweets) and longer acting (sandwich)

Drowsy and confusion, with swallow intact:
Buccal glucose e.g. hypostop/glucogel
Consider IV access

Unconscious or concerned about swallow:
20% glucose IV

NOTE: If deteriorating, refractory, insulin-induced or difficult IV access - consider 1mg IM/SC glucagon.

19
Q

Paracetamol overdose

A

N-acetylcysteine

20
Q

Alcoholic hepatitis

A

Supportive
Stop alcohol
Nutrition - especially vitamin B1 (thiamine) replacement (pabrinex)
? steroids (reduce inflammation)

21
Q

Phenylketonuria (PKU)

A

Dietary advice - help to avoid phenylalanine.

22
Q

Hyperbilirubinaemia in a baby

A

Mild (above 350 in term baby, or 120 in premature) = phototherapy
Severe (above 450 in term baby, or 230 in premature) = exchange transfusion
Treat underlying cause

23
Q

Osteopenia of prematurity

A

Phosphate and calcium supplements

? 1-alpha calcidol

24
Q

Acute intermittent porphyria (HMB synthase deficiency)

A

Avoid precipitants for attacks (stress, reduced caloric intake, ALA synthase inducers (steroids, ethanol etc.))
IV carbohydrate - inhibit ALA synthase and turn off the haem synthetic pathway
IV haem arginate - giving haem reduces the need for the haem synthesis pathway

25
Q

Obesity

A 
Diet and exercise
Orlistat 120-360mg daily - inhibits pancreatic lipase, so fat doesn't get absorbed as well
Bariatric surgery (if BMI > 40) - gastric banding, roux-en-Y gastric bypass, biliopancreatic diversion
26
Q

Acute gout

A

NSAIDs (e.g. diclofenac)
Colchicine
Glucocorticoids (if other measures are unsuccessful)

27
Q

Interval (between acute episodes) gout

A

Keep hydrated
Reverse factors which increase rate (e.g. remove diuretics)
Allopurinol - reduces synthesis of urate by inhibiting xanthine oxidase
Uricosuric drugs (e.g. probenecid) - enhance tubular excretion of urate

28
Q

Hypothyroidism

A

Levothyroxine

29
Q

Acute hyperthyroidism (thyrotoxic crisis)

A 
Propylthiouracil
Propranolol
IV hydrocortisone - inhibits peripheral conversion of T4 to T3
Rehydrate
Treat underlying cause
30
Q

Hyperthyroidism

A

Antithyroid drugs - propylthiouracil or carbimazole
Radioactive iodine
Surgery

31
Q

Viral (De Quervain’s) thyroiditis

A

NSAIDs
Corticosteroids
Thyroxine (in stage when thyroid function is low)

Flashcards: Year 5 (6 decks)

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