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Medicine > Clinical chemistry > Flashcards

Clinical chemistry Flashcards

1
Q

Hypercalcaemia

A

calcium >2.65mmol/L

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2
Q

Causes of hypercalcaemia

A

Primary/ tertiary hyperparathyroidism
Malignancy
Osteolytic bone lesions
Thyrotoxicosis
Sarcoidosis
Dehydration
Rhabdomyolysis
Immobilisation
Adrenal insufficiency
Pheochromocytoma

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3
Q

Medication/vitamin causes of hypercalcaemia

A

High Vitamin D
High Vitamin A
Lithium
Thiazides
Theophylline toxicity

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4
Q

Hypercalcemia symptoms

A

Renal stones
Pissing thones ( polyuria and thirst)
Painful bones
Abdominal moans ( constipation, cramps , anorexia, nausea)
Listless groans
Psychiatric overtones (Mood disturbance, cognitive dysfunction, confusion and coma)

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5
Q

Hypercalcaemia Mx

A

Aggressive IV Fluids
Bisphosphonates
Calcitonin
Glucocorticoids In lymphoma, other granulomatous diseases or 25OHD poisoning
Calcimimetics
Cinacalcet
Parathyroidectomy
Dialysis

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6
Q

Hypocalcaemia

A

serum calcium level is <2.1mmol/L

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7
Q

Causes of hypocalcaemia

A

Vitamin D deficiency
Malnutrition
Increased loses
Hypoparathyroidism
Hyperphosphatemia
Increased calcitonin

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8
Q

Medication causes of hypocalcaemia

A

Bisphosphonates
PPI (hypomagnesia, Mg required for PTH production/release)

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9
Q

Trousseau’s sign

A

Hypocalcaemia sign
carpopedal spasm that results from ischemia, such as that induced by pressure applied to the upper arm from an in- flated sphygmomanometer cuff

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10
Q

Chvostek’s

A

Hypocalcemia sign
tapping over parotid (CN7) causes facial muscles to twitch

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11
Q

Hypocalcemia clinical features

A

SPASMODIC - Decreased calcium makes nerves more excitable

Spasm
Perioral paresthesia and extremity numbness
Anxiety
Seizure
Muscle tone increase
Orientation impaired
Dermatitis
Impetigo herpetiformis ( pustular psoriasis)
Chvostek’s

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12
Q

Mild Hypocalcaemia Mx
>1.9mmol/L and asymptomatic

A

Oral calcium
Replace vitamin D if low
Consider phosphate binder in CKD patients
Replace magnesium if low

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13
Q

Severe Hypocalcaemia Mx
<1.9mmol/L or symptomatic at any level

A

IV calcium
Ca gluconate or Ca Chloride

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14
Q

Causes of hypoglycaemia

A

EXPLAIN

Exogenous drugs (typically sulfonylureas or insulin)
Pituitary insufficiency
Liver failure
Addison’s disease
Islet cell tumours (insulinomas)
Non-pancreatic neoplasms

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15
Q

Hyperkalaemia

A

blood potassium level ≥ 5.5 mmol/L

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16
Q

Causes of hyperkalaemia

A

Impaired excretion (i.e. renal)
Mineralocorticoid deficiency (i.e. a lack of aldosterone which would normally promote potassium secretion)
Addison’s disease
DKA
Rhabdomyolysis
Insulin deficiency
Massive haemolysis

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17
Q

Medications causing hyperkalaemia

A

Medications that inhibit aldosterone/RAS (i.e. spironolactone, ACEi, NSAID)
Ketoconazole
Ciclosporin, tacrolimus
High dose trimethoprim
Heparin
Beta blockers
Digoxin

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18
Q

Hyperkalaemia clinical features

A

frequently asymptomatic
Fatigue
Generalised weakness
Chest pain
Palpitations - can lead to VF

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19
Q

ECG in patients with hyperkalaemia

A

Peaked or ‘tall tented’ T waves
Flattened P-waves
Prolonged PR interval
Widening of the QRS interval
AV dissociation
Sine wave pattern
Asystole/VF

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20
Q

K>6.5/ECG changes Mx

A

Calcium gluconate (10ml of 10% over 10 mins)
Intravenous insulin in 25g glucose
Nebulised salbutamol 5mg

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21
Q

Hypokalaemia

A

serum potassium concentration <3.5mmol/L

22
Q

Causes of abnormal losses causing hypokalaemia

A

Gut losses (e.g. diarrhoea, vomiting, ileostomy)
Renal losses( mineralocaorticoid XS,RTA, polydypisa, dialysis)
Hypomagnesamiea

23
Q

Abnormal losses Medications causes of Hypokalaemia

A

drugs (loop or thiazide diuretics)
laxatives/enemas
Corticosteroids

24
Q

Transcellular shift causes of hypokalaemia

A

Refeeding syndrome
Increased B2 stimulation eg delirium tremens
alkalosis

25
Q

Redistribution into cell/ transcellular shifts Medications causes of hypokalaemia

A

beta agonists
Insulin
Theophylline,caffeine
decongestants

26
Q

Clinical features of hypokalaemia

A

Absent reflexes
Constipation
Cramps in legs
Muscle Weakness
Tiredness
Arrythmias
Heart failure

27
Q

ECG hypokalaemia

A

Increased pr interval (can cause heart blocks) , t wave inversion or small t waves and u waves , st depression

severe hypokalaemia - supraventricular/ventricular ectopics, VT,VF,Torsades de pointes

28
Q

Mild hypokalameia >3 Mx

A

Oral slow release potassium chloride- SANDO K 2 tablets

29
Q

Severe hypokalaemia <3 Mx

A

IV infusion of 1L 0.9% saline containing 40mmol potassium chloride
Check and correct magnesium (low magnesium causes renal potassium wasting)
Continuous cardiac monitoring

30
Q

Hypernatraemia

A

> 145mmol/L

31
Q

Hypernatraemia causes

A

Excess water loss
Excessive hypertonic fluid
Decreased thirst
Hyperaldosteronism

32
Q

Hypernatraemia Mx

A

fluids (oral or IV)

33
Q

Hyponatremia

A

<135mmol/L

34
Q

Symptoms of hyponatraemia

A

Confusion
Dizziness
Anorexia
N&V
Headache
Lethargy
Muscle weakness and cramps
look for dehydration
late symptoms may include: seizures, coma, and respiratory arrest

35
Q

Causes of Pseudohyponatraemia

A

Hypertriglycidaemia(increase in serum volume)
hyperparaproteinaemia in multiple myeloma

36
Q

Causes of Hypovolaemic hyponatraemia

A

Urinary Na> 20 indicates renal loss: eg
Diuretic use, Osmotic diuresis, Mineralocorticoid deficiency

Urinary Na< 20 indicates extra renal loss: eg burns, Sweating, Diarrhoea

37
Q

Causes of Euvolaemic hyponatraemia

A

Syndrome of inappropriate ADH release
Glucocorticoid insufficiency (cortisol has an inhibitory effect on ADH)

38
Q

Causes of Hypervolaemic hyponataemia

A

Oedematous disorders: eg Renal failure,
Heart failure , Liver failure

39
Q

hypotonic Hypovolaemic hyponatraemia Mx

A

IV normal saline
Stop diuretic use
Treat underlying cause
Steroid replacement therapy for addisons

40
Q

hypotonic Euvoleamic hyponatraemia Mx

A

Fluid restriction
If severe- hypertonic sodium chloride 1.8%
Demeclocycline
Consider vaptans

41
Q

hypotonic hypervolaemic hyponatraemia Mx

A

Fluid restriction
Treat underlying cause
consider loop diuretics
consider vaptans
Sodium restriction

42
Q

Osmotic demyelination syndrome (central pontine myelinolysis)

A

usually occur after 2 days, usually irreversible, dysarthria, dysphagia, paraparesis or quadriparesis, seizures, confusion, and coma
patients are awake but are unable to move or verbally communicate, called ‘Locked-in syndrome’

43
Q

For correcting Na+ too quickly:

A

Low to high - pons will die (myelinolysis)
High to low - brain will blow (oedema)

44
Q

Base excess

A

This is the amount of strong acid which would need to be added or subtracted from a substance in order to return the pH to normal (7.40).

45
Q

anion gap

A

calculated by Na+ – (Cl- + HCO3-)

The normal range is 10-18mmol/L

46
Q

Causes of normal anion gap metabolic acidosis include

A

diarrhoea, renal tubular acidosis, chloride excess and certain medications including acetazolamide.

47
Q

Causes of raised anion gap metabolic acidosis include

A

lactic acidosis, diabetic ketoacidosis and metformin.

An increased anion gap indicates increased acid production or ingestion

48
Q

severe hypophosphataemia can lead to

A

arrythmias

49
Q

Blood markers of re-feeding syndrome include:

A

Low phosphate levels
Low magnesium levels
Low potassium levels
Hyperglycaemia

50
Q

Furosemide therapy can cause

A

hypokalaemia, hyponatraemia, hypocalcaemia and hypomagnesaemia.

51
Q

Tumour lysis syndrome

A

hyperkalaemia, hyperphosphataemia hyperuricaemia
Hypocalcaemia.

Medicine (72 decks)

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