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ACC > Electrolyte disturbance > Flashcards

Electrolyte disturbance Flashcards

1
Q

What are some clinical features of hyponatraemia?

A 
Nausea and vomiting 
Headache 
Confusion 
Lethargy 
Fatigue 
Anorexia 
Irritability 
Muscle weakness
Cramps 
Seizures
Drowsiness 
Coma
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2
Q

A lot of the symptoms of hyponatraemia are cerebral in nature, why is this?

A

When there is low sodium in the blood the osmotic pressure changes and water starts to move into tissues. Due to the fixed pressures in the skull this causes compression and symptoms to occur much sooner
CEREBRAL OEDEMA

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3
Q

What are some common causes of hyponatraemia?

A 
IATROGENIC - Inappropriate fluid replacement 
Burns 
Excessive exercise w/o replacing electrolytes 
Diarrhoea
Polydipsia 
Taking ecstasy 
SIADH 
Nephrotic syndrome 
Renal impairment 
Hepatic cirrhosis
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4
Q

If someone is symptomatically hyponatraemic what investigations should you do?

A

FBC
U&E
CT head and neck
ECG

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5
Q

How should hyponatraemia be treated?

A

If mild then just fluid restriction
If neurological symptoms start to occur people will need SODIUM BOLUS - 200mL 2.7% NaCl over 30 mins
IF Na <120mmHg THIS IS ASSOCIATED WITH BRAIN HERNIATION

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6
Q

Why is it important to know whether the hyponatraemia is acute or chronic?

A

If hyponatraemia is CHRONIC then you shouldn’t replace it too quickly - can lead to CENTRAL PONTINE MYELINOLYSIS (particularly in patients with low k+ or alcoholics)
Do NOT treat faster than 10mmol/L over 24h

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7
Q

What are the main symptoms of hypernatraemia and why do they occur?

A

Confusions
Muscle twitching
Seizures
Comas

Occurs because as Na cones increase osmotic pressure is such that water moves out of brain tissue and the brain shrinks?

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8
Q

What are some common causes of hypernatraemia and who does it commonly occur in?

A

Poor fluid intake - leads to increased concentration in the blood. Happens in the ELDERLY
Excessive water loss e.g. due to glycosuria
Diarrhoea and vomiting
Hypetonic fluid replacement
Cushing’s syndrome
Diuretics

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9
Q

What are some common complications of hypernatraemia?

A

Seizures, extra-dural and sub-dural haemorrhage, ischaemic strokes and dural sinus thrombosis

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10
Q

What investigations should be done if someone has hypernatraemia?

A

FBC, U&E and any investigations relevant to their symptoms (possibly CT head or MRI)

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11
Q

How should hypernatraemia be corrected?

A

SLOWLY. No more than a 1mmol/L drop every hour

Use a 0.9%NaCL fluid to correct hypovolaemia and when the patient is euvolaemic use 0.45% saline

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12
Q

How do we classify hyperkalaemia?

A

MILD (5.5-6.0mmol.L)
MODERATE (6.1 - 6.9mmol/L)
SEVERE (>7.0mmol/L)

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13
Q

What are some symptoms of hyperkalaemia?

A
  • Muscle weakness/cramps
  • Parasthesia
  • Hypotonia (floppy like a banana)
  • Focal neurological deficits
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14
Q

What are some common causes of hyperkalaemia?

A
  • IATROGENIC - giving too much K+ in fluids (although quite often the sample is wrong - if someone is having an infusion into that arm do not take bloods from the same side)
  • AKI
  • K sparing diuretics (spironolactone and amilioride)
  • Cell injury (crush injuries, rhabdomyolysis, burns, tumour cell necrosis)
  • ACIDOSIS FROM ANY CAUSE (causes IC>EC K shift)
  • Suxamethonium and B-blockers
  • Hypoaldosteronism (Addison’s)
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15
Q

What are some relevant investigations if you suspect someone is hyperkalaemic?

A

Bloods:FBC, U+E, Blood glucose

ECG

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16
Q

When do you treat hyperkalemia?

How should hyperkalaemia be treated?

A

HYPERKALAEMIA (rule of 10s)
**URGENT TREATMENT REQUIRED if K >6.5mmol/L
or >6 with ECG changes

  1. 10% IV Calcium glutinate (over 5 mins)
    - cardiac monitoring
    - can repeat in 5-10 mins
  2. 10 UNITS act rapid in 50ml of 50% glucose over 15 mins
  3. 10mg SALBUTAMOL

*can give calcium resonium to mop up if didnt work
Correct volume deficiencies
Correct acidosis
Contact renal team

17
Q

What are some signs of hypocalcaemia?

A

Neuromuscular excitability
Numbness around the mouth and peripheral limb parasthesia
Hyper-reflexia
Carpopedal spasm
Focal or generalise seizures
Hypotension and bradycardia
Tetanic contractions
Chvostek’s sign - tapping the facial nerve just behind the ear leads to facial spasm
Trousseau’s sign - inflate BP cuff to just above SysBP and mild ischaemia, hyperexcitability and carpospasm will be seen

18
Q

What investigations should be done in hypocalcaemia?

A 
Plasma Ca, Po4 and albumin 
Plasma Mg 
U&amp;E 
ECG
Plasma PTH (parathyroid hormone)
19
Q

How should hypocalcaemia be managed?

A

Management based around helping symptoms rather than correcting calcium
10mls 10% calcium gluconate for frank tetany - slow IV over 10mins
Oral calcium and vitamin D

20
Q

What are some causes of hypocalcaemia?

A 
Vitamin D deficient 
Hypoparathyroidism 
Chronic renal failure 
Acute pancreatitis 
Hyperphosphataemia 
Magnesium deficiency 
Sepsis 
burns
21
Q

What are some causes of hypercalcaemia?

A 
Hyperparathyroidism 
Hyperthyroidism
Sarcoidosis 
Immobilisation (Paget's disease)
Pheochromocytoma 
Adrenal failure 
Rhabdomyolysis 
Drugs - Lithium, thiazide like diuretics, theophylline toxicity
22
Q

What are some presenting features of hypercalcaemia?

A

Depression, weakness, tiredness, fatigue
Constipation, anorexia, N&V and weight loss
Renal calculi, polydipsia and polyuria
Anxiety, depression, coma or obtundation
Hypertension or cardiac dysarrythmias

23
Q

When should urgent treatment be given in hypercalcaemia?

A

If Ca is >3.5mmol/L
IF there is clouding of the consciousness or confusion
If there is hypotension
If there is severe dehydrations

24
Q

How should hypercalcaemia be managed?

A

REHYDRATE with 0.9% NaCl
If the patient does not pass urine for 4h then put in a catheter
DIURETICS - once you are confident the patient is rehydrated then give them furosemide
Monitor K and Mg levels respectively
BISPHOSPONATES can be considered - they inhibit osteoclast activity therefore reducing further increase in Ca

25
Q

What ECG changes would you see in hyperkalemia?

A

Hyperkalemia

  • Flat P waves
  • Broad bizarre QRS (can lead to VT)
  • Slurring of ST segment
  • Tall tented T waves
26
Q

What condition can cause hyperK?

A

Rhabdomyalis> muscle breakdown> hyperK and CK> AKI

27
Q

How do ace inhibitors work?

What are the electrolyte side effects of ace inhibitors?

A

ACE INHIBITORS

  • inhibit ACE1>ACE2>aldosterone
  • therefore ↑K HYPERKALEMIA (no aldosterone-similar to addisons)
28
Q

How do thiazides work?

What are the electrolyte side effects of thiazides?

A

THIAZIDES

  • inhibit the Na/Cl cotransporter at distal convoluted tubule (prevent Na and water resorption)
  • ↓Na and ↓K HYPONATREAMIA and HYPOKALEAMIA
29
Q

How does spironolactone work?

What are the electrolyte side effects of spironolactone?

A

SPIRONLACTONE

  • aldosterone antagonist (inhibit aldosterone action)
  • ↑K HYPERKALEMIA (no aldosterone-similar to addisons)
30
Q

Which calcium channel blockers should you NOT give if someone is on a beta blocker? why?

A
  • DO NOT give non dihydro CCB if already on BB (diltiazem or veremapil)
  • this could precipitate heart block
  • give amlodipine or nifedipine instead
31
Q

When do you treat hyperkaleamia?

A

Treat when potassium > 6.5 OR >6 with ECG changes!

ACC (23 decks)

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