Data interpretation Flashcards
Sodium
Normal range: 135-145 mmol/L
- Hyponatraemia: assess patient’s fluid status (hypovolaemic, euvolaemic, hypervolaemic)
- Hypernatraemia: D’s
Hypernatraemia
- Drugs = IV preparations w/ high sodium content
- Drips = too much IV saline
- Diet = too much Na
- Diabetes insipidus
Anaemia
Can be categorised into macrocytic, microcytic and normocytic
- Look at Hb (if low = anaemia)
- Look at MCV (if high - macrocytic, if normal - normocytic, if low - microcytic)
Microcytic anaemia
SLIT
- Sideroblastic
- Lead poisoning
- IDA
- Thalassemia
Normocytic anaemia
CARDPMH
Neutrophilia
- Bacterial infection
- Tissue damage (inflammation/infarct/malignancy)
- Steroids
Neutropenia
- Viral infection
- Chemo/radiotherapy
- Clozapine (AP)
- Carbimazole (anti-thyroid)
Lymphocytosis
- Viral infection
- Lymphoma
- Chronic lymphocytic leukaemia
Neutropenic sepsis
Pts undergoing radiotherapy and/or chemotherapy are at risk of neutropenia (or pancytopenia) in response to infection
- Carries much higher mortality rate = must be given urgent IV broad spectrum abx
Thrombocytopenia
1) Reduced production
2) Increased destruction
Reduced platelet production
- Infection (usually viral)
- Drugs = penicillamine (RA Rx)
- Myleodysplasia, myelofibrosis, myeloma
Increased platelet destruction
- Heparin
- Hypersplenism
- DIC
- ITP
- HUS/TTP
Thrombocytosis
May be reactive or primary
Reactive thrombocytosis
- Bleeding
- Tissue damage (infection/infarct/malignancy)
- Post-splenectomy
Primary thrombocytosis
Myeloproliferative disorders
SIADH causes
S = small cell lung tumours I = infection A = abscess D = drugs (carbamazepine + APs) H = head injury
HyperK+ causes (DREAD)
D = drugs (K+ sparing diuretics, ACEI) R = renal failure E = endocrine (Addison's disease) A = artefact (v. common, clotted sample, venepuncture on for too long, taken from drip arm) D = DKA
HypoK+ causes (DIRE)
D = drugs (loop, thiazide diuretics) I = inadequate intake/intestinal losses R = renal tubular acidosis E = endocrine (Cushing's and Conn's syndrome)
Hyponatraemia
- Hypovolaemic
- Euvolaemic
- Hypervolaemic
Hypovolaemic
- Fluid loss (D+V)
- Addison’s disease
- Diuretics
Euvolaemic
- SIADH
- Psychogenic polydipsia
- Hypothyroidism
Hypervolaemic
- Heart failure
- Renal failure
- Liver failure (hypoalbuminaemia)
- Nutritional failure (hypoalbuminaemia)
- Thyroid failure
Raised urea?
- Kidney injury
- Upper GI haemorrhage
- Raised urea w/ normal Cr in a patient wh is not dehydrated (no pre-renal failure) - prompt a look at Hb (if low probably due to GI bleed)
Types of AKI
- Pre-renal
- Renal
- Post-renal
Pre-renal AKI
- Urea rises more than Cr
- Dehydration/shock and renal artery stenosis
- 70%
Renal
- Urea rises less than Cr rise
- Bladder/hydronephrosis not palpable
- Causes can be remembered as INTRINSIC
- 10%
INTRINSIC
I = Ischaemia (prerenal AKI, causing ATN) N = Nephrotoxic abx e.g. gentamycin, vancomycin, tetracyclines T = Tablets (ACEi, NSAIDs) R = Radiological contrast I = Injury (rhabdomyolysis) N = Negatively birefringent crystals (gout) S = syndromes (GN) I = Inflammation (vasculitis) C = Cholesterol emboli
Post-renal
- Urea rises less than Cr rise
- Bladder/hydronephrosis may be palpable, depending on level of obstruction
- Can be due to obstruction in lumen, in wall or because of external pressure
- 20%
Post-renal AKI - luminal causes
- Stone
- Sloughed papilla
Post-renal AKI - wall causes
- Tumour (RCC, transitional cell)
- Fibrosis
Post-renal AKI - external pressure causes
- BPH
- Prostate Ca
- Lymphadenopathy
- Aneurysm
LFTs
1) Hepatocyte injury/cholestasis - bilirbun, ALT/AST, ALP
2) Synthetic function - albumin, vit K dependent clotting factors (INR)
Vit K dependent CFs
2, 7, 9, 10
Causes of raised ALP
ALKPHOS A - Any fracture L - Liver damage (post-hepatic) K - 'K'ancer P - Paget's disease of bone/Pregnancy H - Hyperparathyroidism O - Osteomalacia S - Surgery
