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Renal > Electrolyte Abnormalities > Flashcards

Electrolyte Abnormalities Flashcards

1
Q

What is K normally excreted for

A

Exchange for Na

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2
Q

What is a fatal level of K

Sequelae [4]

A

> 7

Cause fatal arrhythmias - asystole / VF / cardiac arrest

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3
Q

What can cause hyperkalaemia? [3]

A

Decreased excretion
Increased release of intracellular K
Endocrine

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4
Q

What causes decreased excretion? [4]

A

Renal failure - AKI or CKD
ACEI / ARB
NSAID
Spironolactone (K sparing diuretic)

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5
Q

What causes increased K out of cells? [4]

A

Tumour lysis
Rhabdomyolysis
Metabolic acidosis
BB

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6
Q

What are endocrine causes?

A

Addison’s (hypo adrenal)

  • Increased K as decreased excretion
  • Low Na as decreased reabsorption
  • Low BP as low Na
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7
Q

What are other causes? Hyperkalaemia

A

Massive blood transfusion

Type 4 renal tubular acidosis seen with DM or CKD

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8
Q

What are symptoms of hyperkalaemia? [3]

A

Weakness, Dizzy
Fast irregular pulse
Chest pain, SOB, palpitations

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9
Q

What do you need if symptomatic [2]

A

U+E

Urgent dialysis / haemofiltration

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10
Q

How do you investigate [4]

A

DRABC
Bloods - U+E
ABG / VBG for K - repeat
ECG for arrhythmia

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11
Q

What does ECG show [5]

A 
Sinus brady or slow AF
Tall tented T waves
P wave widens then disappears
Broad QRS
AV block
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12
Q

What should you do if haemodynamically unstable

A

Dialysis

Haemofiltration

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13
Q

When do you treat [2]

A

K >6.5

ECG + K>6

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14
Q

How do you treat [4]

A

Stop cause / drugs
Calcium gluconate / chloride
Insulin dextrose
Salbutamol

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15
Q

What dose calcium gluconate

A

10% 10 mls IV injection

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16
Q

What does calcium gluconate do

A

Stabilise myocardium if ECG changes

Gives 30-60 minute protection

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17
Q

What dose of insulin dextrose

A

50ml 50%10 units insulin dextrose

Then infusion

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18
Q

What does insulin do

A

Shift K internally
Dextrose counteract sugar loss
Must monitor for hypo

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19
Q

What dose of salbutamol

A

5-10mg neb

Tachy can limit use

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20
Q

What can you use if K not that high [2]

A

Calcium resonium

Used more in CKD to bring down over a few days

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21
Q

What do you do if this fails [2]

A

Dialysis / anion exchange

Need to cure cause by getting patient to diuresis potassium out of body

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22
Q

Why are diuretics not really used

A

Hypovolaemia

DO NOT use unless overloaded as well

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23
Q

How do you prevent [3]

A

Low K
Stop ARB / spironolactone
Treat underlying cause

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24
Q

How do you treat renal tubule acidosis [2]

A

HCO3

Fludrocortisone

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25
Q

What is emergency hypokalaemia

A

<2.5

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26
Q

What is most common causes of hypokalaemia (usually associated alkalosis but can be due to acidosis) [3]

A

D+V
Diuretic
Incorrect IV fluid replacement

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27
Q

What causes increased loss [4]

A

Diuretic
D+V
Laxatives
Pyloric stenosis

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28
Q

What are endocrine causes [2]

A

Cushing’s

Conn’s

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29
Q

What are other causes [7] hypokalemia

A 
Alkalosis
Insulin / salbutamol excess
Steroid use
Type 1 and 2 renal tubular acidosis 
Tubular defect - Barter
Mg deficiency 
Hypokalamic periodic paralysis
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30
Q

What are the symptoms of hypokalaemia [6]

A 
Weakness, Cramps
Hypotonia, Hyporeflexia
Tetany
Palpitations
Light headed
Constipation
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31
Q

What does hypokalaemia predispose you too [2]

A

Digoxin toxicity

Careful if on diuretic

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32
Q

What does ECG show? [4] hypokalemia

A

U wave
Prolonged QT and PR
ST depression
Absent T

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33
Q

What will urine potassium show

A

If renal loss = high

If extra renal e.g. D+V then low

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34
Q

What should you do if renal loss

A

BP

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35
Q

If BP high

A

Endocrine
Renin-angiotensin ratio
Measure cortisol / creatinine

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36
Q

If BP normal

A

HCO3 levels

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37
Q

Acidosis

A

Tubular acidosis

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38
Q

Alkalosis

A

Tubular defect

Diuretic

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39
Q

How do you treat [5] hypokalemia

A 
Correct cause
Oral K if mild 
IV K if severe
Monitor in cardiac area 
Consider K sparing diuretic
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40
Q

When would you not give K [2]

A

If oligouria

Or as fast bolus - no more than >20mmol / hour

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41
Q

What is best indication of long standing low K on diuretic

A

HCO3

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42
Q

What is most common cause of hypernatraemia [4]

Other causes [3]

A

Water loss > Na loss
Dehydration
Fluid loss with no replacement - D+V / burns
Incorrect IV fluids

Others:

  • DI - decreased ADH so increased water loss
  • Osmotic diuresis in diabetic coma
  • Primary aldosteronism as increased reabsorption
43
Q

What are symptoms of hypernatraemia [6]

A 
Lethargy, Irritable
Weakness
Thirst, Dehydration
Confusion
Coma
Seizure
44
Q

What is important in bloods [4]

A

Increased Na
Increased albumin
Increased urea
Urine osmolarity

45
Q

What else should you do

A

Water deficit calculator to work out

46
Q

What will dehydration have

A

High urine osmolality as trying to conserve water

47
Q

What will DI have

A

Low osmolarity

48
Q

How do you treat hypernatraemia [2]

A

Oral rehydration
Glucose 5% slow IV guided by output and plasma Na
0.9% saline if hypovolaemia

49
Q

What should you avoid

A

Hypertonic

50
Q

What do you need to do with regards to fluid and how fast do you go and why [3]

A

Replace deficiency
Replace ongoing loss and insensible
Replace slowly no > than 0m5 as risk of cerebral oedema (seizure / coma / death)

51
Q

When would you suspect primary aldosteronism [3]

A

K down
BP up
Alkalosis

52
Q

What does dehydration always have [2]

A

High Na

Not the same as hypovolemia

53
Q

What is most common

A

Hyponatraemia <130mmol

Either water excess or sodium depletion

54
Q

What is important with regards to hyponatraemia? [2]

A

FLUID STATUS
Doesn’t mean Na depletion
Can just be overloaded so dilutes

55
Q

What causes hypovolaemic (dehydrated) hyponatraemia ? [4]

Urine Na >20

A

Diuretic
Addison’s
Renal failure
Osmolar diuresis -hyperglycaemia

56
Q

What causes hypovolaemic (Dehydrated) but urine Na <20 so lost other than kidney as kidney tried to hold on to Na / osmolarity high

A 
D+V
Fistula
Burn, Trauma
Obstruction - 3rd space loss
CF
Heat in extra sport = ongoing ADH release
57
Q

What can D+V cause

A

Low or high Na

58
Q

What drugs should you consider stopping in hyponatremia [4]

A

Diuretic
SSRI
PPI - omeprazole
ACEI

59
Q

What causes hypervolaemic hyponatraemia - diluted NA [5]

A 
Nephrotic
HF
Liver cirrhosis
Renal failure
Polydipsia
60
Q

What causes euvolaemic hyponatremia [3]

A

SIADH
Severe hypothyroid
Glucose-corticoid insufficiency

61
Q

What suggests SIADH

A

High urine osmolality

Think known cancer

62
Q

What are symptoms of hyponatremia [6]

A 
Confusion, Headache
Anorexia
Nausea
Malaise, Irritable
Weakness, CNS distubrance
Seizure, Encephalopathy
63
Q

What is a medical emergency

A

Rapid changes or acute

64
Q

How should you investigate [3]

A

Fluid balance
Urine osmolarity
Serum osmolarity

65
Q

What are baseline bloods for cause of hyponatremia [7]

A 
Glucose
Lipids
TFT 
LFT 
Cortisol for Addison 
Urine Na+K
Urine osmolality
66
Q

How do you test for Addison [2]

A

Cortisol low

Short synacthen

67
Q

How do you treat hyponatraemia [2]

A

Correct cause

Replace Na and water at same rate

68
Q

What do you do for asymptomatic and chronic hyponatremia [4]

A

Fluid restriction
ADH antagonist
Diuretic
Hypertonic saline

69
Q

What do you do for acute severe symptomatic [4]

A

Cautious rehydration
Hypertonic 3% saline or Hartman
150ml over 15 min
Repeat if no improvement

70
Q

What should you not do

A

Correct more than 10mmol/l in 24 hours

71
Q

When would you consider furosemide

A

Not hypovolaemic

72
Q

If hypovolaemic

A

0.9% saline

73
Q

If hypervolaemic [2]

A

Treat cause- CF / liver /r renal

Have fluid intake < output if oedema / SIADH / renal failure

74
Q

What do you do if seizure or coma [2]

A

Hypertonic (1.8%) saline + furosemide

Aim for gradual increase to 125

75
Q

What may happen if Na corrected rapid [3]

A

HF
Central pontine myelinolysis
Osmotic demyelination syndrome

76
Q

What does ADH antagonist do (Tolvaptan) [3]

A

Promote water excretion
No loss of electrolyte
Effective if hypervolaemic or euvolaemic but expensive

77
Q

What can cause inappropriate ADH secretion

A 
Tumour - SCLC / pancreas / gut 
Empyema 
CF
Pneumonia / TB
Drugs
CNS - meningitis / encephalitis / abscess / haemorrhage / stroke 
Head trauma
78
Q

How do you Dx

A 
Assess fluid balance - euvolaemic 
Hypotonic hyponatraemia
Urine osmolarity high - high urine Na 
CXR
CT head 
CAP 
Bronchoscopy
79
Q

What is Furst formula

A

Used to see if fluid restriction would be helpful in Rx

<1 = restrict

80
Q

How does metabolic acidosis cause hyperkalaemia

A

K and H ions fight to be exchanged for Na in distal tubule

81
Q

What is hypokalaemia associated with [2]

A

Alkalosis

So K loss

82
Q

What can hypokalemia be associated with

A

Acidosis e.g. renal tubular

83
Q

Symptoms of osmotic demyelination syndrome [6]

A 
Dysthria
Dysphagia
Paresis
Seizure
Confusion
Coma
84
Q

When should fluid intake be less than output in treatment of hyponatraemia [4]

A

Oedematous states
SIADH
Renal failure
Psychogenic polydipsia

85
Q

Why should you replace fluid slowly in hypernatremia

A

Risk of cerebral oedema (seizure / coma) as brain loses electrolytes quickly whilst lowering of other electrolytes and water occurs more slowly

86
Q

What causes hypo phosphate [6]

A 
Alcohol
Acute liver failure
DKA
Refeeding
Primary hyperparathyroid
Osteomalacia
87
Q

What are the consequences of hypophosphate [5]

A 
RBC haemolysis
WBC / platelet dysfunction
Muscle weakness
Rhabdomyolysis
CNS dysfunction
88
Q

What causes raised ALP physiological [3]

A

Growing child
Pregnancy
Healing fracture

89
Q

What causes pathological raised [6]

A 
Liver 
Osteomalcia
Bone mets
Pagets
Renal failure
Hyperparathyroid
90
Q

What causes high Ca [2]

A

Bone mets

Hyperparathyroid

91
Q

What causes with low Ca [2]

A

Osteomalacia

Renal failure

92
Q

What are causes of hypocalcaemia

A 
Vit D deficiency (osteomalacia) 
CKD 
Renal failure
Hypoparathyroid (surgery / thyroiditis)
Pseudohypoparathyroid (insensitive) 
Rehabdomyolysis
Mg deficiency 
Massive blood transfusion
Acute pancreatitis
93
Q

What is calcium needed for

A

Muscle and nerve function

94
Q

What does hypoca cause [5]

A 
Tetany
Parathesia 
Increased QT
Trosseau
Chvostek's
95
Q

What is tetany [3]

A

Twitching
Cramping
Spasm

96
Q

If chronic hypoca[2]

A

Depression

Cataracts

97
Q

What is trousseau [2]

A

Carpal spasm when brachial artery occluded when BP cuff above systolic
Wrist flexion and fingers drawn in

98
Q

What is Chvostek

A

Tapping facial nerve causes facial muscles to twitch

99
Q

How do you treat hypoercalcaemia [3]

A

IV calcium gluconate 10ml 10% 10 minutes if severe
ECG
Treat cause

100
Q

How do you treat hypercalcaemia [3]

A

Rehydration
Normal saline
3-4l per day

101
Q

What can be used after [2]

A

Biphosphonates

Calcitonin - works quicker

102
Q

What do you give if caused by sarcoid

A

Steroids

103
Q

What can be used but careful

A

Loop diuretics if can’t tolerate fluid but may worsen other electrolyte imbalances

Renal (29 decks)

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