Data interpretation Flashcards
Hypernatraemia causes
“D”
dehydration
drugs - effervescent tablets or IV with high sodium
drips - IV saline
diabetes insipidus
causes of microcytic anaemia
iron deficiency
thalassaemia
sideroblastic anaemia
normocytic anaemia
chronic disease
acute blood loss
haemolytic anaemia
renal failure
macrocytic anaemia
B12 and folate
excess alcohol
liver disease
hypothyroidism
M haem - myeloproliferative, myelodysplastic, myeloma
high neutrophils
bacterial infection
tissue damage (inflammation, infarct, malignancy)
steroids
low neutrophils
viral infection
chemo or radiotherapy
clozapine
carbimazole
high lymphocytes
viral infection
lymphoma
CLL
low platelets
reduced production: infection viral, drugs like penicillamine, myelodysplasia, myelofibrosis, myeloma
reduced destruction: heparin, hypersplenism, DIC, ITP, haemolytic uraemia syndrome, thrombotic thrombocytopenia purpura
high platelets
reactive: bleeding, tissue damage, post-splenectomy
primary: myeloproliferative
hyponatraemia: hypovolaemia
fluid loss D+V
Addisons
diuretics
hyponatraemia: euvolaemia
SIADH
psychogenic polydipsia
hypothyroidism
hyponatraemia: hypervolaemic
HF
RF
LF - hypoalbuminaemia
nutritional value - hypoalbuminaemia
thyroid failure (hypo can be euvolaemic too)
SIADH causes
Small cell LC
Infection
Abscess
Drugs: carbamazepine, antipsychotics
Head injury
hypokalaemia
DIRE
Drugs: loop and thiazide
Inadequate intake or intestinal loss D+V
Renal tubular necrosis
Endocrine (cushings or conns)
hyperkalaemia
DREAD
Drugs: potassium sparing diuretics, ACEi
Renal failure
Endocrine: Addisons
Artefact: haemolysed sample
DKA
raised urea
kidney injury
upper GI bleed as blood broken down and absorbed
big bloody steak
raised urea with normal creatinine in not dehydrated - check Hb
raised Alkaline phosphatase
ALKPHOS
Any fracture
Liver damage
Kancer
Paget’s disease of bone and Pregnancy
Hyperparathyroidism
Osteomalacia
Surgery
what does raised bilirubin indicate?
pre hepatic jaundice causes
- haemolysis
- gilberts syndrome
What might a bilirubin raise with associated AST/ ALT raise indicate?
intrahepatic liver damage
fatty liver, hepatitis, cirrhosis, malignancy, Wilsons disease, haemachromatosis, heart failure causing hepatic congestion
what might a raised bilirubin and raised ALP suggest?
post hepatic - obstructive jaundice
in lumen: stone, drugs
wall: tumour, primary biliary cirrhosis, sclerosing cholangitis
extrinsic: pancreatic or gastric cancer, lymph node
what are some drugs that cause cholestasis?
like fluclox, co-amox, nitrofurantoin, steroids and suphonylureas
what are some drugs that may cause hepatitis or cirrhosis?
paracetamol
statins
rifampicin
signs of pulmonary oedema
ABCDE
Alveolar oedema (bat wings)
B- lines Kerley (interstitial oedema)
Cardiomegaly
Diversion of blood to upper lobes (upper zone vessels larger than in lower zone)
Effusions
respiratory alkalosis causes
rapid breathing
- disease or anxiety
respiratory acidosis causes
type 2 resp failure causes
COPD, drug overdose, chest wall abnormalities, neuromuscular etc
metabolic alkalosis causes
vomiting
diuretics
conns
metabolic acidosis
lactic acidosis
DKA
renal failure
ethanol, methanol
what are some common drugs with narrow therapeutic indexes and require monitoring?
digoxin
theophylline
lithium
phenytoin
gentamicin
vancomycin
digoxin toxicity
confusion
nausea
visual halos
arrhythmias
lithium toxicity
early - tremor
intermediate - tiredness
late - arrhythmia, seizures, coma, renal failure, diabetes insipidus
phenytoin toxicity
gum hypertrophy
ataxia
nystagmus
peripheral neuropathy
teratogenicity
gentamicin toxicity
ototoxicity
nephrotoxicity
vancomycin toxicity
ototoxicity
nephrotoxicity
how is gentamicin monitored?
- levels measured 6-14h after infusion started
- use nomogram to plot and determine if dosing intervals need changing
- if point on nomogram rests above q48h, repeat gentamicin level and re-dose when conc is <1mg/L
what causes liver damage in paracetamol overdose?
accumulation of toxic NAPQI which depletes glutathione levels which NAC replenishes -> reducing NAPQI formation
what is the normal target INR for patients on warfarin?
2.5 unless recurrent VTE while on it then 3.5
higher than 2.5 in metal valve replacement patients
what to do in major bleed while on warfarin?
stop warfarin
give 5-10mg IV vitamin K
dried prothrombin complex (beriplex)
what to do if INR 5-8?
a) with minor bleed
b) without bleed
a) omit warfarin and give 1-5mg IV vitamin K
b) omit warfarin for 2 days and reduce dose
what to do if INR >8?
no bleed- omit warfarin and give 1-5mg PO vitamin K
minor bleed - omit warfarin and five 1-5mg vitamin K IV!!
