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Electrolyte Emergencies Flashcards

1
Q

What is hypoglycemia more common in?

A

T1DM and late-stage T2DM

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2
Q

What are the components of Whipple’s triad?

A
  • Sx of hypoglycemia
  • Plasma glucose concentrations <3.0 mmol/L
  • Resolution of Sx after plasma glucose concentration is raised
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3
Q

What is the normal reference range for fasting glucose?

A

4.0 - 5.8 mmol/L

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4
Q

What are autonomic symptoms of hypoglycemia?

A
  • Palpitations
  • Sweating
  • Anxiety
  • Hunger
  • Tremors
  • Paraesthesia
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5
Q

What plasma glucose level is associated with autonomic symptoms?

A

<3.3 mmol/L

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6
Q

What are neuroglycopenic symptoms of hypoglycemia?

A
  • Slurred speech
  • Concentration difficulties
  • Vision changes
  • Confusion
  • Coma
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7
Q

What plasma glucose level is associated with neuroglycopenic symptoms?

A

<2.8 mmol/L

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8
Q

What are the differential diagnoses for hypoglycemia?

A
  • Hyperinsulinemic hypoglycemia
  • Drugs
  • Deficiency of counter-regulatory hormones
  • Critical illness
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9
Q

What can cause hyperinsulinemic hypoglycemia?

A
  • Insulin overdose
  • Insulin agent not matched by food intake
  • Excessive exercise
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10
Q

What drugs can induce hypoglycemia?

A
  • Oral antiglycemic agents (sulphonylureas)
  • Alcohol
  • Aspirin / paracetamol
  • Haloperidol
  • Beta-blockers
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11
Q

What deficiencies can lead to hypoglycemia?

A
  • ACTH
  • Cortisol
  • GH
  • Glucagon
  • Adrenaline
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12
Q

What is the treatment threshold for glucose using a point-of-care glucometer?

A

<4 mmol/L

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13
Q

What defines hypoglycemia in terms of blood glucose level?

A

Blood glucose <3.0 mmol/L

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14
Q

What is the treatment for a conscious and cooperative hypoglycemic patient?

A

Oral glucose (e.g. 150 ml orange juice)

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15
Q

What is the treatment for an uncooperative hypoglycemic patient?

A

1.5 - 2 tubes of GlucoGel

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16
Q

What is the IV treatment for an unconscious hypoglycemic patient?

A

100 ml 20% dextrose IV over 15 minutes (20 g)

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17
Q

What should be administered if there is no IV access in an unconscious hypoglycemic patient?

A

Glucagon 1 mg IM

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18
Q

What condition makes glucagon ineffective?

A

Malnutrition or chronic alcoholism

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19
Q

What should be considered for malnourished patients receiving glucagon?

A

IV thiamine

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20
Q

What should be done if the patient is still hypoglycemic after 5 minutes?

A

Repeat treatment if still <4 mmol/L

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21
Q

What should be provided once the patient is stable after hypoglycemia?

A

Long-acting carbohydrates (e.g. 2 slices of toast, 2 biscuits)

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22
Q

What should not be increased based on rebound hyperglycemia?

A

Insulin dose

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23
Q

What are the classic symptoms of hypercalcemia?

A

Stones, bones, abdominal groans, psychic moans

Includes renal colic, bone pain, gastrointestinal symptoms (constipation, nausea, vomiting), psychiatric symptoms (depression, dementia, fatigue, psychosis), and other symptoms like polydipsia, polyuria, corneal calcification, short QT interval, and hypertension.

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24
Q

Name three drugs that can cause hypercalcemia.

A

Vitamin D, Calcium supplements, Thiazides

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25
What is a common non-drug-related cause of hypercalcemia?
Dehydration
26
Which respiratory condition can cause hyperparathyroidism and hypercalcemia?
squamous cell carcinoma (SCC) | can produce PTHrP
27
What endocrine disorders are associated with hypercalcemia?
Acromegaly Thyrotoxicosis Addison’s Paget’s disease of the bone
28
Which malignancies are commonly associated with hypercalcemia?
Myeloma squamous cell carcinoma (SCC)
29
List the blood tests used to investigate hypercalcemia.
* FBC * U&E * TFTs * Bone profile (calcium, magnesium, phosphate) * PTH * ALP (bone profile) * Vitamin D
30
What is the initial treatment for hypercalcemia?
Fluid replacement with IV normal saline ## Footnote Typically 200-500 ml/hr, up to 6L/day.
31
What medication is commonly used to manage hypercalcemia?
Bisphosphonates | IV pamidronate or zoledronic acid ## Footnote Calcitonin mimetics (Fortical/Miacalcin) are an alternative (quicker acting)
32
What additional treatments should be considered for severe hypercalcemia?
* Dexamethasone (for hematological malignancies and sarcoidosis) * Plasmapheresis * Dialysis * Urgent parathyroidectomy (severe hypercalcemia + raised PTH)
33
Treatment of Primary Hyperparathydroidism?
Tx of primary hyperparathyroidism: ● Surgical Tx: excision of adenoma or total parathyroidectomy ● Medical Tx: cinacalcet (calcimimetic)
34
What are common symptoms of hypocalcaemia?
Symptoms include: * Tetany (muscle cramps and spasms) * Perioral or peripheral paraesthesia * Depression * Visual problems (cataracts) * Prolonged QT ## Footnote These symptoms may vary in severity and presentation.
35
Which medications can contribute to hypocalcaemia?
Medications include: * PPIs * Loop diuretics ## Footnote These drugs may affect calcium metabolism and absorption.
36
What is Chvostek’s sign?
Chvostek’s sign is the twitching of the facial muscles on percussion of the ipsilateral facial nerve. ## Footnote It is a clinical sign associated with hypocalcaemia.
37
What is Trousseau’s sign?
Trousseau’s sign is a carpopedal spasm secondary to inflation of a BP cuff to >20 mmHg over their SBP for 3 minutes. ## Footnote It indicates latent tetany and is associated with hypocalcaemia.
38
What laboratory tests are used to diagnose hypocalcaemia?
Key laboratory tests include: * U&E * Bone profile (Ca2+, magnesium, phosphate) * PTH * Vitamin D * ECG (long QT) ## Footnote These tests help assess calcium levels and underlying causes.
39
What is the initial treatment for mild to moderate hypocalcaemia?
Ca2+ and vitamin D supplements ## Footnote This approach helps restore calcium levels gradually.
40
How is severe hypocalcaemia treated?
Severe hypocalcaemia is treated with: * Slow push 10 ml 10% calcium gluconate IV over 10 minutes * Followed by 10 vials 10% calcium gluconate in 1L 0.9% NaCl over 10 hours * ECG monitoring recommended Further management: * Tx underlying cause * Mg2+ replacement
41
What are the causes of hypocalcaemia?
Causes include: * Vitamin D deficiency (CKD, Dietaryt Deficiency) * Parathyroid axis pathology * Acute pancreatitis * Rhabdomyolysis (phosphate binds C2+ initially) * Massive blood transfusion (RBCs are stored with anticoagulant citrate) * Reduced absorption / increased excretion (PPI's/Loops, Diarrhoea respectively) ## Footnote Understanding these causes is crucial for effective management.
42
What is the treatment for hypocalcaemia in chronic kidney disease (CKD)?
Treatment includes: * Active vitamin D supplements (alfacalcidol or calcitriol) * Reduce phosphate: low phosphate diet, oral phosphate binders (sevelamer) Other treatments: * Calcimimetics * Bisphosphonates * Oral bicarbonate (correct metabolic acidosis) * Parathyroidectomy
43
What is hyponatraemia defined as?
Serum sodium <135 mmol/L
44
What are common symptoms of hyponatraemia?
* Asymptomatic * Nausea and vomiting * Ileus * Headache * Lethargy * Confusion * Noncardiogenic pulmonary edema * Neurological symptoms (ataxia, seizure, coma)
45
What is the most common precipitating factor for hyponatraemia?
Surgery
46
Medications that can cause hyponatraemia.
Directly: * Diuretics * IV dextrose (or other hypotonic fluids) Can cause SIADH leading to hyponatraemia. * Sulfonylureas * SSRIs * TCAs * Carbamazepine * Vincristine * Cyclophosphamide
47
What factors determine the treatment of hyponatraemia?
* Chronicity of the hyponatraemia (acute or chronic) * Presence or severity of symptoms * Fluid status of the patient (hypovolemic, euvolemic, or hypervolemic) * Cautiousness regarding rate of Na+ correction
48
What should be excluded before treating hyponatraemia?
Pseudohyponatremia (e.g., hypertriglyceridemia, hyperlipidemia, hyperglycemia)
49
What is the recommended treatment for acute symptomatic hyponatraemia?
Hypertonic 3% saline: 2-4 ml/kg given in 100 ml increments over 10 minutes until symptoms improve Test serum sodium every 2 hours to guide Tx until stabilisation occurs and hypertonic saline is no longer required
50
What is the maximum recommended rate of sodium correction to prevent myelinolysis?
<8 mmol/L/day ## Footnote Cerebral oedema occurs more frequently in acute hyponatraemia. Sx of cerebral edema include N&V, altered mental status, somnolence, seizures, and coma.
51
What are symptoms of cerebral edema in acute hyponatraemia?
* Nausea and vomiting * Altered mental status * Somnolence * Seizures * Coma
52
What can occur due to rapid correction of severe hyponatraemia?
Osmotic demyelination syndrome | Slowly normalize serum sodium to prevent myelinolysis
53
What are common symptoms of hyperkalemia?
General weakness, fatigue, paraesthesias, muscle weakness, nausea and vomiting, palpitations, angina, shortness of breath.
54
Name some potential causes of hyperkalemia related to internal distribution.
* Drugs (e.g., Digoxin, ACEi or ARBs, BBs, calcineurin inhibitors, K+-sparing diuretics, heparin) * DKA (Diabetic Ketoacidosis) ## Footnote Internal distribution can lead to increased potassium levels in the blood.
55
What are the causes of decreased potassium excretion leading to hyperkalemia?
* Chronic Kidney Disease (CKD) * Increased input (fluids or transfusion) ## Footnote A decrease in the kidney's ability to excrete potassium can lead to hyperkalemia.
56
What is pseudohyperkalemia and what can cause it?
* Haemolysis * EDTA contamination * Blood taken from drip arm ## Footnote Pseudohyperkalemia can result in falsely elevated potassium levels in lab tests.
57
What cardiovascular exam findings may indicate hyperkalemia?
* Bradycardia * Haemodynamic compromise ## Footnote Cardiovascular effects can be serious and require urgent attention.
58
What neurological exam findings are associated with hyperkalemia?
Depressed or absent deep tendon reflexes. ## Footnote Neurological manifestations can indicate severe hyperkalemia.
59
What ECG findings are indicative of mild hyperkalemia (5.5 - 6.5 mmol/L)?
* Tall tented T waves * Prolonged PR interval ## Footnote ECG changes can help assess the severity of hyperkalemia.
60
What ECG findings are indicative of moderate hyperkalemia (6.5 - 7.5 mmol/L)?
* Flattened P wave * Prolonged QRS ## Footnote These changes reflect worsening cardiac conduction due to elevated potassium levels.
61
What ECG findings are indicative of severe hyperkalemia (>7.5 mmol/L)?
* Progressive widening of the QRS * Merging with T wave to form sine wave pattern * Possible degeneration into ventricular fibrillation or asystole * Axial deviation and bundle branch blocks ## Footnote Severe hyperkalemia can significantly affect cardiac function and lead to life-threatening arrhythmias.
62
What laboratory tests are used to confirm hyperkalemia?
* VBG (Venous Blood Gas) * FBC (Full Blood Count) * U&E (Urea and Electrolytes) * ABG (Arterial Blood Gas) * +/- digoxin level * +/- serum cortisol ## Footnote These tests help rule out other conditions and confirm hyperkalemia.
63
What are the mild, moderate, and severe potassium levels in U&E?
* Mild: 5.5 - 5.9 mmol/L * Moderate: 6.0 - 6.4 mmol/L * Severe: >6.5 mmol/L ## Footnote Understanding potassium levels is crucial for determining treatment urgency.
64
What is the non-urgent treatment for hyperkalemia?
* Treat the cause * Stop IV K+ supplements and review medications * Calcium resonium (polystyrene sulfonate resin) - reduce K+ over days ## Footnote Non-urgent management focuses on addressing underlying issues.
65
What is the urgent treatment for hyperkalemia when myocardial instability is present?
* 30 ml of 10% calcium gluconate over 10 minutes * 50 ml 50% glucose + 10U fast-acting insulin * Salbutamol 5 mg nebulizer * Calcium resonium 15 g PO or 30 g PR * Diuretics * Haemodialysis as a last resort ## Footnote Urgent treatment aims to stabilize the heart and lower potassium levels quickly.
66
What should be monitored when administering glucose and insulin for hyperkalemia?
Monitor glucose levels for hypoglycemia. ## Footnote Treatment can lead to hypoglycemia in 10-20% of patients.
67
What are the potential side effects of salbutamol used in hyperkalemia treatment?
Tachycardia and arrhythmia. ## Footnote Salbutamol should be used with caution due to its cardiovascular effects.
68
What are the limitations of calcium resonium in treating hyperkalemia?
* Poorly tolerated (constipation) * Slow onset of action ## Footnote Although it promotes potassium excretion, its side effects may limit its use.
69
Causes of hyperkalaemia:
70
What is the definition of Hypokalemia?
K+ <3.5 mmol/L ## Footnote Hypokalemia refers to low potassium levels in the blood.
71
What are common symptoms of Hypokalemia?
* Palpitations * Muscle weakness ## Footnote These symptoms indicate potential complications from low potassium levels.
72
Which drugs can contribute to Hypokalemia?
* Insulin * Salbutamol * Theophylline * Digoxin ## Footnote Digoxin toxicity can worsen or be precipitated by hypokalemia.
73
What are the focused examination findings for Hypokalemia?
* Hypotonia * Hyporeflexia ## Footnote These findings reflect neuromuscular effects of low potassium.
74
What ECG changes are associated with Hypokalemia?
* Prolonged PR interval * Flat or inverted T waves * Prominent U waves * ST depression * Prolonged QT progressing to torsade de pointes ## Footnote These changes are critical for diagnosing and assessing the severity of hypokalemia.
75
What does VBG show in a patient with Hypokalemia?
K+ <3.5 ## Footnote A venous blood gas test can confirm potassium levels.
76
What is the treatment for mild Hypokalemia (K+ 2.5-3.5)?
Oral K supplements ## Footnote Care must be taken to discontinue these medications to avoid hyperkalemia.
77
What is the treatment for severe Hypokalemia (K+ <2.5 and dangerous symptoms)?
* IV KCl * 10 mmol/hr maximum rate * Give centrally * Never give as a bolus ## Footnote Higher infusion rates require cardiac monitoring in HDU or ICU due to the risk of arrhythmias.
78
What additional treatment may be considered in severe Hypokalemia?
+/- Mg2+ replacement ## Footnote Magnesium levels may need to be addressed concurrently with potassium replacement.
79
What monitoring is required for patients on K+ replacement treatment?
Daily bloods ## Footnote Regular blood tests are essential to ensure safe potassium levels.
80
Causes of hypokalaemia?

Clinical Emergencies (31 decks)

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