Critical value and management priority Laboratory Emergency

Question 1

what is the key advantage of the POCT ?

Answer 1

turnaround time is the key advantage of point of care testing

Question 2

what is the main cause of diabetes insipidus ?

Answer 2

hyposecretion of ADH

Question 3

what does ADH do ?

Answer 3

causes the kidney to release less water

Question 4

what is the sodium level in DI ?

Answer 4

hypernatremia

Question 5

what is the relationship between ADH and sodium levels ?

Answer 5

inversely proportional

Question 6

what are the classifications of diabetes insipidus ?

Answer 6

cranial - decreased ADH secretion
nephrogenic - resistance to ADH
gestational - degradation of ADH
primary polydipsia - deficit in osmoregulation of thirst

Question 7

what is the presentation of diabetes insipidus ?

Answer 7

polyuria - more than 3 litres a day
chronic thirst
nocturia
bladder can be grossly enlarged and palpable

Question 8

what investigations are required for the diagnosis of diabetes insipidus ?

Answer 8

Biochem: plasma glucose
sodium U+E
urine specific gravity
plasma and urine osmolality

24 hour urine collection

fluid deprivation test

MRI of the pituitary

Renal US

Question 9

what is the normal osmolality of urine ?

Answer 9

300-800

Question 10

if the urine osmolality increases after the desmopressin test what is the most likely diagnosis in relation to DI ?

Answer 10

cranial DI

Question 11

if the urine osmolality does not increase after the desmopressin test what is the most likely diagnosis ?

Answer 11

nephrogenic DI

Question 12

if the urine osmolality is higher than 800 in both the fluid deprivation test and in the desmopressin test what is the most likely diagnosis ?

Answer 12

primary polydipsia

Question 13

what is the level at which we diagnose hypercalcemia ?

Answer 13

more than 2.6 mmol on two occasions following correction of serum albumin concentration

Question 14

what are the different classifications of hypercalcemia ?

Answer 14

mild - 2.6 - 3

moderate - 3.01 - 3.4

severe - more than 3.4

Question 15

what are the most common causes of hypercalcemia ?

Answer 15

malignancy
primary hyperparathyroidism

Question 16

what drugs cause hypercalcemia ?

Answer 16

thiazide diuretics
lithium
vitamin d and a

Question 17

what could affect the calcium levels while taking a blood sample ?

Answer 17

prolonged tourniquet

Question 18

what are the clinical features of hypercalcaemia ?

Answer 18

arrhythmia
ECG
moans
bones
stones
psychic overtones

Question 19

patient comes with chest symptoms, increased serum ACE and hypercalcemia what is the most likely diagnosis ?

Answer 19

sarcoidosis

Question 20

what is the treatment for hypercalcemia ?

Answer 20

IV crystalloids and correction of hypovolemia
bisphosphonates may be used
calcitonin as a second line

Question 21

what are the stages of acute kidney injury?

Answer 21

stage 1 - more than 0.3 increase in create within 48 hours or 1.5 to 1.9 folds increase within 7 days

stage 2 - 2 to 3 fold increase of creatinine from baseline in 7 days

stage 3 - more than 4 mg increase or more than 3 fold increase from baseline in 7 days plus anuria for 12 hours

Question 22

what are the stages of AKI ?

Answer 22

onset phase
oliguric phase
diuretic phase
recovery phase

Question 23

patient complaining of GERD and comes with signs of hypercalcemia what is thee most likely diagnosis ?

Answer 23

milk-alkali syndrome

Question 24

what is the biochemistry in renal AKI vs pre renal AKI ?

Answer 24

in pre renal :
U:Cr - > 40: 1
BUN:Cr - > 20:1

in intrinsic :
U:Cr - < 40:1
BUN:Cr - < 20:1

Question 25

what are the biochemical changes in plasma in AKI ?

Answer 25

everything is increased except sodium bicarbonate and calcium

Question 26

what does an AKI with a negative urinalysis indicate ?

Answer 26

usually indicates a prerenal cause but drugs must still be considered

Question 27

which diuretics cause potassium loss and which don't ?

Answer 27

1- loop cause potassium loss in the urine 2- aldosterone antagonists liike spironolactone cause hyperkalemia

Question 28

what are the main causes of hyperkalemia ?

Answer 28

1- decreased urinary excretion ( drugs, addisons, renal failure ) 2- extracellular shift

Question 29

what are the causes of extracellular shift in hyperkalemia ?

Answer 29

insulin deficiency beta blocker digoxin

Question 30

what drugs cause hyperkalemia ?

Answer 30

ACE inhib ARBS spironolactone

Question 31

what falls under renal failure in the causes of hyperkalemia ?

Answer 31

rhabdomyolysis tumor lysis syndrome

Question 32

what are the ECG changes in hyperkalemia ?

Answer 32

peaked T wave widening of the QRS complex

Question 33

what is the algorithm for investigation of hyperkalemia ?

Answer 33

find if its an artifact first check if the patient is on potassium raising medications AKI or CKD ? if not consider extracellular shifts

Question 34

what are the 3 treatment ideas associated with hyperkalemia ?

Answer 34

cardio-protective causing intra-cellular shift increasing potassium loss

Question 35

what are the treatments for each treatment idea in hyperkalemia ?

Answer 35

cardioprotective - if there are any ECG changes then give calcium gluconate what are the drugs that cause intracellular shift - sodium bicarb, insulin and dextrose, beta 2 agonist ( inhalation ) methods to increase potassium loss - loop diuretic , cation exchange, dialysis

Question 36

hyponatremia with a normal plasma osmolality differential ?

Answer 36

artifactual hyponatremia appropriate hyponatremia

Question 37

what are the risk factors for acute pancreatitis ?

Answer 37

hypertriglyceridemia hypercalcemia ERCP Surgery

Question 38

what is classic presentation of acute pancreatitis ?

Answer 38

epigastric pain radiating to the back which is relieved by leaning forward

Question 39

investigations for acute pancreatitis ?

Answer 39

amylase, lipase (more specific)

Question 40

what is the management of acute pancreatitis ?

Answer 40

fluid resus

Question 41

what is myoxedema coma ?

Answer 41

a severe complication of hypothyroidism

Question 42

what is the classic presentation of myxedema coma ?

Answer 42

An obese elderly woman with yellowish skin, a hoarse voice, a large tongue, thin hair, puffy eyes, ileus, and slow reflexes. anterior neck scar may be present

Question 43

what is the management for myxedema coma ?

Answer 43

L-thyroxine 0.2-0.5 mg IV bolus, followed by 0.1 mg IV OD until oral therapy is tolerated

Question 44

what is the cause of adrenal insufficiency ?

Answer 44

adrenal crisis is due to insufficient cortisol

Question 45

when is adrenal insufficiency seen ?

Answer 45

in addison's

Question 46

what is the clinical picture of adrenal insufficiency ?

Answer 46

increased skin pigmentation hypotension hyponatremia hyperkalemia increased ACTH

Question 47

what are the triggers for adrenal crisis ?

Answer 47

1- following stress 2- sudden withdrawal of adrenocortical hormone 3- bilateral adrenalectomy

Question 48

how is a diagnosis of adrenal insufficiency made ?

Answer 48

An ACTH (Short Synacthen) test avoid hydrocortisone before the test by 8 hours

Question 49

what would be a positive synacthen test ?

Answer 49

normally thee cortisol level should rise to 20 below it keda positive

Question 50

what are the signs associated with acute pancreatitis ?

Answer 50

grey turner's cullen's sign fox signw

Question 51

what are the ABG findings associated with aspirin overdose ?

Answer 51

acute overdose is followed by respiratory alkalosis due to hyperventilation followed by metabolic acidosis

Question 52

what is an important cause of tetany ?

Answer 52

hypomagnesiumenimea

Question 53

what is the most likely cause of tetany in a patient with chronic pancreatitis ?

Answer 53

hypokalemic alkalosis