Data Interpretation Flashcards
Give some causes of microcytic anaemia
Iron Deficiency Anaemia
Thalassaemia
Sideroblastic anaemia
Give some causes of normocytic anaemia
Anaemia of chronic disease
Acute blood loss
Haemolytic anaemia
Renal failure
Give some causes of macrocytic anaemia
B12/folate deficiency (megaloblastic) Excess alcohol Liver disease Hypothyroidism Myeloproliferative and myelodysplastic disorders Multiple myeloma
What can cause hypernatraemia?
D’s
Dehydration
Drips (IV saline)
Drugs - effervescent tablets or IV with high sodium
Diabetes insipidus
What can cause hyponatraemia?
Hypovolaemic - fluid loss (D&V), Addisons, diuretics
Euvolaemic - SIADH, psychogenic polydipsia, hypothyroid
Hypervolaemic - Heart failure, renal failure, liver failure, nutritional failure, thyroid failure (hypo)
What can cause neutrophilia (high neutrophils)?
Bacterial Infection
Tissue damage - inflammation, infarction, malignancy
Steroids
What can cause neutropenia?
Viral infection
Chemo/radio
Clozapine
Carbimazole
What can cause lymphocytosis (high)?
Viral infection
Lymphoma
Chronic Lymphocytic Leukaemia
What causes thrombocytopenia?
Low production: - Infection - Drugs - penicillamine - Myelodysplasia, myelofibrosis, myeloma Destruction: - Heparin - Hypersplenism - DIC - ITP - Haemolytic uraemic syndrome/TTP
What causes thrombocytosis?
Reactive:
- Bleeding
- Tissue damage - infection, inflammation, malignancy
- Post-splenectomy
Primary
- Myeloproliferative disorders
What causes hypokalaemia?
DIRE: Drugs - loop and thiazide diuretics Inadequate intake/intestinal loss Renal tubular acidosis Endocrine - cushings/conn's
What causes hyperkalaemia?
DREAD: Drugs - potassium sparing diuretics and ACE inhibitors Renal failure Endocrine - addisons Artefact DKA
What can a raised urea indicate?
Kidney Injury
Upper GI bleed - raised urea with normal creatinine in pt. who isn’t dehydrated –> check Hb, if low, likely upper GI bleed
What can cause pre-renal AKI?
Dehydration - sepsis, blood loss etc.
Renal artery stenosis
How does a pre-renal AKI appear biochemically?
Urea rise > creatinine rise
What can cause an intrinsic/renal AKI?
INTRINSIC: Ischaemia - causes acute tubular necrosis Nephrotoxic abx - gentamicin, vancomycin and tetracyclines Tablets - ACE inhibitors/NSAID's Radiological contrast Injury - rhabdomyolysis Negative birefringent crystals - gout Syndromes - glomerulonephritis Inflammation - vasculitis Cholesterol emboli
How does a Renal AKI appear biochemically?
Urea rise < Creatinine rise
Bladder/hydronephrosis not palpable
What can cause a post renal AKI?
In Lumen - stone, sloughed papilla
Wall - tumour (RCC), fibrosis
External pressure - BPH, prostate cancer, lymphadenopathy, aneurysm
How does a post-renal AKI appear biochemically?
Urea rise < creatinine rise
Bladder/hydronephrosis may be palpable
Which blood results would you use to assess for hepatocyte injury or cholestasis?
Look at:
- Bilirubin
- ALT (and AST less commonly)
- Alk Phos
Which blood results would you use to assess the synthetic function of the liver?
- Albumin
- Vitamin K dependent clotting factors - PT/INR
What can cause a raised alkaline phosphatase?
- Fractures
- Post-hepatic liver damage
- Cancer
- Paget’s disease of bone
- Pregnancy
- Hyperparathyroidism
- Osteomalacia
- Surgery
What causes pre-hepatic liver function derangement?
Haemolysis
Gilbert’s and Crigler-Najjar syndrome
What causes hepatic liver function derangement?
Fatty liver Hepatitis Cirrhosis Malignancy Metabolic - Wilson's/Haemochromatosis Heart Failure
What causes post hepatic LFT derangement?
Lumen - gallstone, drugs causing cholestasis
Wall - tumour (cholangiocarcinoma), PBC, PSC
Extrinsic - pancreatic/gastric cancer, lymph node
What drugs cause cholestasis?
Flucloxacillin Co-amoxiclav Nitrofurantoin Steroids Sulphonylureas
What are the signs of pulmonary oedema seen on X-ray?
Alveolar oedema (bat wings) Kerly B Lines Cardiomegaly Enlarged blood vessels in upper zone Pleural effusions
Which drugs commonly require monitoring?
Digoxin Theophylline Lithium Phenytoin Gentamicin
What is typically done when drug’s are monitored?
Assess clinical state
Measure serum drug level
What are the features of digoxin toxicity?
Confusion
Nausea
Visual halos
Arrhythmia
What are the features of lithium toxicity?
Early - tremor
Intermediate - tiredness
Late - arrhythmia, seizure, coma, renal failure, diabetes insidious
What are the features of phenytoin toxicity?
Gum hypertrophy Ataxia Nystagmus Peripheral neuropathy Teratogenicity
What are the features of gentamicin and vancomycin toxicity?
Ototoxicity
Nephrotoxicity
What is the dose range of gentamicin normally and in infective endocarditis?
Peak (1h post dose) :
IE - 3/5mg/L
Others - 5-10mg/L
Trough (just before next dose):
IE - <1mg/L
Others - <2mg/L
What are the three treatments recommended for drug toxicities (generic)?
1 Stop drug
2 Supportive measures - IV fluids
3 Give antidote if available
What factors help you determine the gentamicin dose?
Patient weight and renal function
What is the typical dose for gentamicin?
5-7mg/kg OD
What is the typical dose for gentamicin in pt. with renal failure or infective endocarditis? (severe creatinine clearance <20mL/min)
Divided daily dosing 1mg/kg
- every 12 hr in renal failure
- every 8 hr in infective endocarditis
What does gentamicin monitoring entail?
- Measure levels at particular times - 6-14hr after infusion
- Use nomogram to determine level and adjust dosing accordingly
How is a gentamicin dose adjusted?
You change the frequency of the dose rather than the dose itself - need to reach therapeutic level
What is the management for a paracetamol overdose?
N-Acetyl Cysteine if over the line on nomogram
Supportive measures
How is a warfarin OD managed in a major bleed?
- Stop Warfarin
- 5-10mg IV Vit K
- Prothrombin complex (beriplex)
How is a warfarin OD managed if there is no bleed?
INR <6 - Reduce warfarin dose
INR 6-8 - Omit warfarin for 2 days then reduce dose
INR >8 - Omit warfarin and give 1-5mg oral vit K
How is a warfarin OD managed if there is minor bleeding?
INR>5 IV Vit K 1-3mg and omit warfarin
How is warfarin monitored?
Monitor INR
Target 2.5 normally
Target 3.5 if:
- Recurrent thromboemboli
- Metal replacement heart valve
