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Yr 4 - ACC > Corrections - Electrolyte > Flashcards

Corrections - Electrolyte Flashcards

1
Q

What are the 2 causes of hyponatraemia in ecstasy poisoning?

A

1) SIADH directly from ecstasy poisoning

2) excessive water consumption while under the influence of ecstasy

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2
Q

Clinical features of ecstasy poisoning?

A

1) neurological: agitation, anxiety, confusion, ataxia

2) cardiovascular: tachycardia, hypertension

3) hyponatraemia

4) hyperthermia

5) rhabdomyolysis

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3
Q

Management of ecstasy poisoning?

A

1) supportive

2) dantrolene may be used for hyperthermia if simple measures fail

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4
Q

What does a sinusoidal wave pattern on an ECG indicate?

A

Severe hyperkalaemia

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5
Q

How can cocaine use lead to hyperthermia?

A

This occurs as a result of increased metabolic activity and muscle rigidity, both of which are stimulated by cocaine’s action on the central nervous system.

Hyperthermia may also be exacerbated by the environmental conditions often associated with cocaine use, such as crowded and hot environments.

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6
Q

Mechanism of cocaine?

A

Cocaine blocks the uptake of dopamine, noradrenaline and serotonin.

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7
Q

What is Paget’s disease of the bone?

A

A disease of increased but uncontrolled bone turnover.

Thought to be primarily a disorder of osteoclasts, with excessive osteoclastic resorption followed by increased osteoblastic activity.

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8
Q

What are the most commonly affected bones in Paget’s disease?

A
  • skull
  • spine/pelvis
  • long bones of the lower extremeties
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9
Q

Predisposing factors for Paget’s disease of the bone?

A

1) increasing age
2) male sex
3) northern latitude
4) FH

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10
Q

What is the stereotypical presentation of Paget’s disease of the bone?

A

Only 5% of patients are symptomatic.

  • The stereotypical presentation is an older male with bone pain and an ISOLATED raised ALP.
  • Bone pain (e.g. pelvis, lumbar spine, femur)
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11
Q

What is the key blood test feature of Paget’s disease of the bone?

A
  • isolated raised ALP
  • calcium and phosphate are normal
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12
Q

1st line management of Paget’s disease of the bone?

A

Bisphosphonates (either oral risedronate or IV zoledronate)

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13
Q

What is the max rate of IV potassium infusion that can be conducted without monitoring?

A

10 mmol/hour

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14
Q

How is potassium and pH affected in vomiting vs diarrhoea?

A

Vomiting –> hypokalaemia with alkalosis

Diarrhoea –> hypokalaemia with acidosis

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15
Q

What is a key complication of Kawaski disease?

A

Coronary artery aneurysm –> get an ECHO

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16
Q

Which electrolyte abnormality presents similarly to hypocalcaemia?

A

Hypomagnesaemia

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17
Q

What are some causes of hypernatraemia?

A

1) dehydration
2) osmotic diuresis e.g. hyperosmolar non-ketotic diabetic coma
3) diabetes insipidus
4) excess IV saline

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18
Q

Hypercalcaemia + bilateral hilar lymphadenopathy –> what condition?

A

Sarcoidosis

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19
Q

What are the 3 haracteristic electrolyte disturbances seen in patients with refeeding syndrome?

A

1) hypokalaemia
2) hypophosphataemia
3) hypomagnesaemia

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20
Q

Who should be recommended for an urgent endoscopy for suspected gastric cancer?

A

Urgent referral for all patients with dysphagia or those at least 55 years old with weight loss and one of upper abdominal pain, reflux or dyspepsia, which this patient is experiencing.

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21
Q

What may be seen on an endoscopy in gastric cancer?

A

Signet ring cells

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22
Q

What electrolyte abnormality is caused by muscle death (e.g. compartment syndrome)?

A

Hyperkalaemia (muscle death will result in the release of potassium).

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23
Q

ECG features in hypokalaemia?

A
  • small or absent T waves (occasional inversion)
  • prolonged PR interval
  • ST depression
  • prolonged QT
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24
Q

How does hypercalcaemia affect QT interval?

A

Shortened QT interval (can cause AV block)

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25
Q

How does hypocalcaemia affect QT interval?

A

Prolonged QT interval (can cause torsades de pointes)

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26
Q

ECG findings of hyperkalaemia?

A
  • Peaked or ‘tall-tented’ T waves (occurs first)
  • Loss of P waves
  • Broad QRS complexes
  • Sinusoidal wave pattern
  • Ventricular fibrillation
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27
Q

Symptoms of hypercalcaemia?

A
  • polydipsia, polyuria
  • depression
  • anorexia, nausea, constipation
  • peptic ulceration
  • pancreatitis
  • bone pain/fracture
  • renal stones
  • hypertension
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28
Q

Blood results in hyperparathyroidism?

A
  • raised calcium
  • low phosphate
  • PTH may be raised or (inappropriately, given the raised calcium) normal
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29
Q

Why may PTH level be normal in primary hyperparathyroidism?

A

May be inappropriately normal given raised calcium (should be suppressed in normal people).

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30
Q

What lead is T wave inversion a normal variant?

A

Lead III

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31
Q

Side effects of amiodarone therapy?

A
  • Thyroid dysfunction: both hypo- and hyper-thyroidism
  • Corneal deposits
  • Pulmonary fibrosis/pneumonitis
  • Liver fibrosis/hepatitis
  • Peripheral neuropathy, myopathy
  • Photosensitivity
  • ‘Slate-grey’ appearance
  • Thrombophlebitis and injection site reactions
  • Bradycardia
  • Lengths QT interval
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32
Q

What are the 2 important drug interactions of amiodarone?

A

1) decreased metabolism of warfarin, therefore increased INR

2) increased digoxin levels

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33
Q

What is tumour lysis syndrome?

A

TLS occurs from the breakdown of the tumour cells and the subsequent release of chemicals from the cell.

It leads to a high potassium and high phosphate level in the presence of a low calcium.

It should be suspected in any patient presenting with an AKI in the presence of a high phosphate and high uric acid level.

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34
Q

What is needed for the diagnosis of tumour lysis syndrome?

A

Laboratory tumour lysis syndrome plus one or more of the following:

1) increased serum creatinine (1.5 times upper limit of normal)

2) cardiac arrhythmia or sudden death

3) seizure

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35
Q

Adverse effects of methotrexate?

A
  • mucositis
  • myelosuppression
  • pneumonitis
  • pulmonary fibrosis
  • liver fibrosis
36
Q

What investigations need to be regularly monitored in patients on methotrexate?

A

FBC, U&Es, and LFTs

37
Q

What should be co-prescribed with methotrexate?

A

Folic acid 5mg once weekly (taken more than 24 hours after methotrexate dose)

Note - methotrexate is taken weekly, rather than daily

38
Q

What is Hydroxychloroquine?

A

An antimalarial drug commonly used in the treatment of systemic lupus erythematosus (SLE)

39
Q

What is the most significant and potentially serious side effect of hydroxychloroquine?

A

retinopathy - can lead to permanent vision loss

40
Q

What is secondary hypoparathyroidism?

A

Loss of PTH due to:

a) irradiation of the parathyroid gland
b) surgical removal of the gland
c) low serum magnesium

This would result in low PTH and low calcium.

41
Q

Management of patients with severe hypokalaemia (≥6.5 mmol/L) or with ECG changes?

A

1) IV calcium gluconate

AND

2) IV insulin/dextrose infusion (+/- nebulised salbutamol)

42
Q

What is the relationship between calcium and pancreatitis?

A

Hypercalcaemia –> cause of pancreatitis

Hypocalcaemia –> indicator of pancreatitis severity

43
Q

What are some some common factors indicating severe pancreatitis?

A
  • age > 55 years
  • hypocalcaemia
  • hyperglycaemia
  • hypoxia
  • neutrophilia
  • elevated LDH and AST
44
Q

What medication can cause hypercalcaemia?

A

Thiazide diuretics e.g. bendroflumethiazide

45
Q

What electrolyte abnormality does sarcoidosis cause?

A

Hypercalcaemia

46
Q

A man requires fluid replacement and 1L of 0.9% sodium chloride supplemented with 40 mmol of potassium is prescribed.

What is the shortest time period over which this bag of fluid can be administered safely?

A

4 hours

The maximum recommended rate of potassium infusion via a peripheral line is 10 mmol/hour, whereas rates above 20 mmol/hour require cardiac monitoring.

47
Q

When prescribing fluids, what is the potassium requirement per day?

A

1 mmol/kg/day

48
Q

What is used for the calculation of daily fluid requirements for children & young people?

A

Can use the Holliday–Segar formula for children and young people who do not need an accurate calculation of insensible losses.

10kg –> 100ml/kg/day
Second 10kg –> 50ml/kg
Subsequent kg –> 20ml/kg

49
Q

A 28 kg 7-year-old boy has to fast for an elective surgery.

On examination, he is clinically well and there are no signs of dehydration. His vital signs are normal.

What is the amount of maintenance IV fluid needed by this patient in 24 hours?

A

Calculation for patient weighing 28 kg:
First 10 kg x 100 ml/kg = 1000 ml
Second 10 kg x 50 ml/kg = 500 ml
Last 8 kg x 20 ml/kg = 160 ml

1000 ml + 500 ml + 160 ml = 1660 ml over 24 hours

50
Q

When prescribing maintenance fluids, how many ml/kg/day of water is typically required

A

25-30 ml/kg/day

51
Q

What electolyte abnormality is hypokalaemia often associated with?

A

Hypomagnesaemia

52
Q

What can the correction of chronic hypernatraemia too fast predispose to?

A

Cerebral oedema

53
Q

What can untreated, severe hyponatraemia result in?

A

Cerebral oedema, which can in turn cause brain herniation.

54
Q

What can over-rapid correction of hyponatraemia result in?

A

Osmotic demyelination syndrome

55
Q

What 4 parameters is the management of hyponatraemia based on?

A

1) duration: acute or chronic?

2) severity: what is sodium level?

3) symptoms: are they symptomatic?

4) suspected aetiology

56
Q

Define acute hyponatraemia

A

Develops over a period of <48 hours

57
Q

Define chronic hyponatraemia

A

Develops over a period of >48h

58
Q

Define mild, mod & severe hyponatraemia

A

Mild: 130-134 mmol/L

Mod: 120-129 mmol/L

Severe: <120 mmol/L

59
Q

What are some early symptoms of hyponatraemia?

A

Headache, lethargy, N&V, dizziness, confusion & muscle cramps.

60
Q

What are some late symptoms of hyponatraemia?

A

Seizures, coma, respiratory arrest.

61
Q

What are some causes of hypovolemic hyponatraemia?

A

Renal:
- diuretics
- osmotic diuresis (glucose, mannitol)
- Addisonian crisis
- diuretic stage of renal failure

Non-renal:
- vomiting, diarrhoea
- bowel obstruction
- sweat
- bleeding

62
Q

What are the 2 initial steps in hyponatraemia in ALL patients?

A

1) exclude a spurious result (e.g. blood taken from a drip arm)

2) review medications that may cause hyponatraemia

63
Q

Management of hypovolaemic hyponatraemia?

A

Isotonic saline (0.9% NaCl)

If serum sodium rises –> supports a diagnosis of hypovolemic hyponatraemia

If the serum sodium falls –> alternative diagnosis such as SIADH is likely

64
Q

Management of euvolaemic hyponatraemia?

A

Fluid restrict to 500–1000 mL/day

65
Q

Management of hypervolaemic hyponatraemia?

A

1) fluid restrict to 500–1000 mL/day

2) consider loop diuretics

3) consider vaptans

66
Q

Management of acute, severe hyponatraemia (<120 mmol/L) or symptomatic hyponatraemia?

A

Close monitoring, preferably in an HDU or above setting.

Hypertonic saline (typically 3%) NaCl is used to correct the sodium level more quickly than would be done in patients with chronic hyponatraemia.

67
Q

What are vaptans?

A

a new class of drugs developed for the treatment of the hypervolemic and euvolemic forms of hyponatremia.

68
Q

Symptoms of osmotic demyelination syndrome?

A
  • dysarthria
  • dysphagia
  • paraparesis or quadriparesis
  • seizures
  • confusion
  • coma
  • can have ‘locked in syndrome’
69
Q

What is osmotic demyelination syndrome also known as?

A

Central pontine myelinolysis

70
Q

How is osmotic demyelination syndrome avoided?

A

Na+ levels are only raised by 4 to 6 mmol/l in a 24-hour period

71
Q

When does osmotic demyelination syndrome typically occur after correction of hyponatraemia?

A

After 2 days, usually irreversible

72
Q

How can acute pancreatitis affect calcium levels?

A

Hypocalcaemia

73
Q

How can a delay in processing blood samples affect K+ level?

A

Can cause a pseudohyperkalaemia –> due to RBCs leaking potassium into the serum

74
Q

Features of hypocalcaemia?

A
  • Tetany: muscle twitching, cramping & spasm
  • Perioral paraesthesia
  • If chronic: depression, cataracts
75
Q

What is Trousseau’s sign?

A

Carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic –> indicates hypocalcaemia

76
Q

How can UH and LMWH affect potassium?

A

Can cause hyperkalaemia (this is throught to be caused by inhibition of aldosterone secretion).

77
Q

What is Chvostek sign?

A

Tapping the facial nerve in front of the ear leads to contraction of the facial muscles on the same side of the face –> indicates hypocalcaemia.

78
Q

How can SSRis affect Na+?

A

Can cause hyponatraemia by causing SIADH

79
Q

How can thiazide-like diuretics affect K+?

A

Can cause hypokalaemia

80
Q

Mechanism of thiazide-like diuretics?

A

Block the Na/Cl cotransporter in the distal convoluted tubule.

This results in an increased excretion of sodium and chlorine (and therefore water) in the urine.

81
Q

How does hyperventilation affect calcium & phosphate?

A

Low calcium and normal phosphate

82
Q

What are some signs of severe hypocalcaemia?

A
  • carpopedal spasm
  • tetany
  • seizures
  • prolonged QT interval
83
Q

Management of severe hypocalcaemia?

A

IV 10% calcium gluconate over 10 mins

84
Q

What statin dose is indicated for individuals without established CVD but who have a QRISK score exceeding 10%?

A

Atorvastatin 20mg

85
Q

What statin dose is indicated for individuals with established CVD e.g. post-ischaemic stroke?

A

Atorvastatin 80mg

86
Q
A

Yr 4 - ACC (73 decks)

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