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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
How does hypocalcaemia affect QT interval?
Prolonged QT interval (can cause torsades de pointes)
26
ECG findings of hyperkalaemia?
- Peaked or 'tall-tented' T waves (occurs first) - Loss of P waves - Broad QRS complexes - Sinusoidal wave pattern - Ventricular fibrillation
27
Symptoms of hypercalcaemia?
- polydipsia, polyuria - depression - anorexia, nausea, constipation - peptic ulceration - pancreatitis - bone pain/fracture - renal stones - hypertension
28
Blood results in hyperparathyroidism?
- raised calcium - low phosphate - PTH may be raised or (inappropriately, given the raised calcium) normal
29
Why may PTH level be normal in primary hyperparathyroidism?
May be inappropriately normal given raised calcium (should be suppressed in normal people).
30
What lead is T wave inversion a normal variant?
Lead III
31
Side effects of amiodarone therapy?
- 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
32
What are the 2 important drug interactions of amiodarone?
1) decreased metabolism of warfarin, therefore increased INR 2) increased digoxin levels
33
What is tumour lysis syndrome?
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.
34
What is needed for the diagnosis of tumour lysis syndrome?
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
35
Adverse effects of methotrexate?
- mucositis - myelosuppression - pneumonitis - pulmonary fibrosis - liver fibrosis
36
What investigations need to be regularly monitored in patients on methotrexate?
FBC, U&Es, and LFTs
37
What should be co-prescribed with methotrexate?
Folic acid 5mg once weekly (taken more than 24 hours after methotrexate dose) Note - methotrexate is taken weekly, rather than daily
38
What is Hydroxychloroquine?
An antimalarial drug commonly used in the treatment of systemic lupus erythematosus (SLE)
39
What is the most significant and potentially serious side effect of hydroxychloroquine?
retinopathy - can lead to permanent vision loss
40
What is secondary hypoparathyroidism?
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
Management of patients with severe hypokalaemia (≥6.5 mmol/L) or with ECG changes?
1) IV calcium gluconate AND 2) IV insulin/dextrose infusion (+/- nebulised salbutamol)
42
What is the relationship between calcium and pancreatitis?
Hypercalcaemia --> cause of pancreatitis Hypocalcaemia --> indicator of pancreatitis severity
43
What are some some common factors indicating severe pancreatitis?
- age > 55 years - hypocalcaemia - hyperglycaemia - hypoxia - neutrophilia - elevated LDH and AST
44
What medication can cause hypercalcaemia?
Thiazide diuretics e.g. bendroflumethiazide
45
What electrolyte abnormality does sarcoidosis cause?
Hypercalcaemia
46
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?
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
When prescribing fluids, what is the potassium requirement per day?
1 mmol/kg/day
48
What is used for the calculation of daily fluid requirements for children & young people?
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
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?
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
When prescribing maintenance fluids, how many ml/kg/day of water is typically required
25-30 ml/kg/day
51
What electolyte abnormality is hypokalaemia often associated with?
Hypomagnesaemia
52
What can the correction of chronic hypernatraemia too fast predispose to?
Cerebral oedema
53
What can untreated, severe hyponatraemia result in?
Cerebral oedema, which can in turn cause brain herniation.
54
What can over-rapid correction of hyponatraemia result in?
Osmotic demyelination syndrome
55
What 4 parameters is the management of hyponatraemia based on?
1) duration: acute or chronic? 2) severity: what is sodium level? 3) symptoms: are they symptomatic? 4) suspected aetiology
56
Define acute hyponatraemia
Develops over a period of <48 hours
57
Define chronic hyponatraemia
Develops over a period of >48h
58
Define mild, mod & severe hyponatraemia
Mild: 130-134 mmol/L Mod: 120-129 mmol/L Severe: <120 mmol/L
59
What are some early symptoms of hyponatraemia?
Headache, lethargy, N&V, dizziness, confusion & muscle cramps.
60
What are some late symptoms of hyponatraemia?
Seizures, coma, respiratory arrest.
61
What are some causes of hypovolemic hyponatraemia?
Renal: - diuretics - osmotic diuresis (glucose, mannitol) - Addisonian crisis - diuretic stage of renal failure Non-renal: - vomiting, diarrhoea - bowel obstruction - sweat - bleeding
62
What are the 2 initial steps in hyponatraemia in ALL patients?
1) exclude a spurious result (e.g. blood taken from a drip arm) 2) review medications that may cause hyponatraemia
63
Management of hypovolaemic hyponatraemia?
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
Management of euvolaemic hyponatraemia?
Fluid restrict to 500–1000 mL/day
65
Management of hypervolaemic hyponatraemia?
1) fluid restrict to 500–1000 mL/day 2) consider loop diuretics 3) consider vaptans
66
Management of acute, severe hyponatraemia (<120 mmol/L) or symptomatic hyponatraemia?
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
What are vaptans?
a new class of drugs developed for the treatment of the hypervolemic and euvolemic forms of hyponatremia.
68
Symptoms of osmotic demyelination syndrome?
- dysarthria - dysphagia - paraparesis or quadriparesis - seizures - confusion - coma - can have 'locked in syndrome'
69
What is osmotic demyelination syndrome also known as?
Central pontine myelinolysis
70
How is osmotic demyelination syndrome avoided?
Na+ levels are only raised by 4 to 6 mmol/l in a 24-hour period
71
When does osmotic demyelination syndrome typically occur after correction of hyponatraemia?
After 2 days, usually irreversible
72
How can acute pancreatitis affect calcium levels?
Hypocalcaemia
73
How can a delay in processing blood samples affect K+ level?
Can cause a pseudohyperkalaemia --> due to RBCs leaking potassium into the serum
74
Features of hypocalcaemia?
- Tetany: muscle twitching, cramping & spasm - Perioral paraesthesia - If chronic: depression, cataracts
75
What is Trousseau's sign?
Carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic --> indicates hypocalcaemia
76
How can UH and LMWH affect potassium?
Can cause hyperkalaemia (this is throught to be caused by inhibition of aldosterone secretion).
77
What is Chvostek sign?
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
How can SSRis affect Na+?
Can cause hyponatraemia by causing SIADH
79
How can thiazide-like diuretics affect K+?
Can cause hypokalaemia
80
Mechanism of thiazide-like diuretics?
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
How does hyperventilation affect calcium & phosphate?
Low calcium and normal phosphate
82
What are some signs of severe hypocalcaemia?
- carpopedal spasm - tetany - seizures - prolonged QT interval
83
Management of severe hypocalcaemia?
IV 10% calcium gluconate over 10 mins
84
What statin dose is indicated for individuals without established CVD but who have a QRISK score exceeding 10%?
Atorvastatin 20mg
85
What statin dose is indicated for individuals with established CVD e.g. post-ischaemic stroke?
Atorvastatin 80mg
86

Yr 4 - ACC (73 decks)

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