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Emergency Medicine > Electrolyte Imbalances > Flashcards

Electrolyte Imbalances Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What to give with hyperkalaemia + tall tented T waves?

A

Calcium gluconate to stabilise myocardium
Salbutamol 5mg neb
Insulin dextrose (10 units in 50ml 50% dextrose) IV over 20mins
Haemodialysis if not responding

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2
Q

ECG signs of hyperkalaemia

A 
Flattened P waves 
Broad bizarre QRS
Sloping ST
Tented T waves 
Sine wave ECG
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3
Q

Causes of hypoglycaemia in non-diabetics

A 
EXPLAINS H
Exogenous drugs (BB, hypoglycaemics, valproate, salicylate) 
Pituitary insufficiency 
Post prandial – after GI surgery 
Liver disease 
Addisons 
Islet cell tumours  + infection 
Non pancreatic neoplasms  - SCC producing IGF-2 
Starvation 
Hypothyroidism
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4
Q

What causes hypercalcaemia?

A

Hyperparathyroidism
Malignancy
Sarcoidosis

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5
Q

What are the S+S of hypercalcaemia?

A

Confusion, weakness, abdo pain, hypotension, arrhythmias

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6
Q

What ECG changes occur with hypercalcaemia?

A

Short QT, prolonged QRS, flat T waves, AV block

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7
Q

How do you treat hypercalcaemia?

A

IV fluids, furosemide, hydrocortisone, bisphosphonates

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8
Q

What causes hypocalcaemia?

A

CKD, pancreatitis, rhabdomyolysis, tumour lysis syndrome

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9
Q

What are the S+S of hypocalcaemia?

A

Paraesthesia, tetany, seizures, AV block

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10
Q

What ECG changes occur with hypocalcaemia?

A

Long QT, T wave inversion, heart block

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11
Q

How do you treat hypocalcaemia?

A

Treat with calcium chloride + magnesium sulphate

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12
Q

What causes hypermagnesemia?

A

CKD

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13
Q

What are the S+S of hypermagnesemia?

A

Confusion, weakness, resp depression, AV block

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14
Q

What are the ECG changes with hypermagnesemia?

A

Prolonged PR + QT, T wave peak, AV block

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15
Q

How do you treat hypermagnesemia?

A

Calcium chloride + resp support

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16
Q

What causes hypomagnesemia?

A

GI loss, polyuria, alcoholism

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17
Q

What are the S+S of hypomagnesemia?

A

Tremor, ataxia, nystagmus, seizures, arrhythmia

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18
Q

What are the ECG changes with hypomagnesemia?

A

Prolonged PR + QT, ST depression, T wave inversion, flat P waves, long QRS, torsades de pointes

19
Q

Causes of hyperkalaemia

A

CKD, drugs, rhabdomyolysis, metabolic acidosis, infection

20
Q

S+S of hyperkalaemia

A

Asymptomatic, weakness, flaccid paralysis, arrhythmias

21
Q

ECG changes with hyperkalaemia

A

Prolonged PR, flat P waves, tented Tt waves, ST depression, sine waves, wide QRS, bradycardia, AV block

22
Q

Causes of hypokalaemia

A

GI + renal loss, Cushings, metabolic alkalosis, low magnesium

23
Q

ECG changes with hypokalaemia

A

U waves, flat T waves, ST changes, arrhythmias

24
Q

S+S of hypokalaemia

A

Fatigue, weakness, cramps, rhabdomyolysis, ascending paralysis

25
Q

Causes of metabolic alkalosis

A

Addition of base
Chloride depletion (diuretics, D+V)
Laxative abuse
Potassium depletion (hyperaldosteronism, Cushings)

26
Q

Causes of resp alkalosis

A

Stimulated resp drive
Pneumonia
PE
Asthma

27
Q

Causes of resp acidosis

A

Decreased resp drive or chest wall movement

COPD

28
Q

Causes of metabolic alkalosis: addition of base to ECF

A

Milk-alkali syndrome
Excessive NaHCO3 intake
Recovery phase from acidosis
Massive blood transfusion

29
Q

Causes of metabolic alkalosis: chloride depletion

A

Loss of gastric acid
Diuretics
Post-hypercapnia
Excess faecal loss

30
Q

Causes of metabolic alkalosis: potassium depletion

A

Hyperaldosteronism
Cushings
Excess liquorice
Bartter’s syndrome

31
Q

Causes of respiratory alkalosis: stimulated respiratory drive

A 
CNS = CVA, ICH
Hypermetabolic = hyperthyroidism, pregnancy, sepsis, anxiety, hyperthermia, aspirin OD, progesterone, liver failure
32
Q

Causes of respiratory alkalosis: hypoxaemia induced

A

Pneumonia, PE, asthma
Congenital heart disease
Altitude compensation
Metabolic acidosis compensation

33
Q

Causes of respiratory acidosis: decreased respiratory drive

A

CVA, tumour, encephalitis, haemorrhage

Narcotics + sedatives

34
Q

Causes of respiratory acidosis: decreased chest wall movement

A

NM disorders, myasthenia gravis, GB
Muscle relaxants
Trauma, chest wall deformity
Tension pneumothorax, airway obstructive

35
Q

Causes of respiratory acidosis: obstructive pulmonary disease

A

COPD, asthma

36
Q

Normal anion gap metabolic acidosis causes

A 
USED CARP 
Ureteric diversion 
Small bowel fistula 
Extra chloride (fluids)
DKA 
Carbonic anhydrase inhibitors
Addisons 
Renal tubular acidosis 
Pancreatic fistula
37
Q

Increased anion gap metabolic acidosis causes

A 
MURKLE SEPTIC 
Methanol, metformin 
Uraemia 
Renal failure 
Ketoacidosis 
Lactic acidosis 
Ethanol 
Salicylates 
Ethylene glycol 
Paraldehyde 
Toluene 
Iron 
Cyanide + CO
38
Q

Low anion gap causes of metabolic acidosis: Increase in unmeasured cations

A 
Lithium toxicity 
Hypercalcaemia 
Hypermagnesaemia 
Hyperkalaemia 
IgG (multiple myeloma)
39
Q

Low anion gap causes of metabolic acidosis: decreased unmeasured anions

A

Hypoalbuminaemia

Hypophosphatemia

40
Q

Low anion gap causes of metabolic acidosis: chloride over-estimation

A

Increased chloride
Iodide toxicity
Hypercholesterolemia

41
Q

How does hyperkalaemia affect the heart?

A

Suppresses SAN impulse generation + reduces conduction by AVN + Purkinje fibres
Causes bradycardia = conduction blocks = arrest

42
Q

What is the order of ECG changes that occur with increasing K?

A 
Peaked T waves 
P wave widens + flattens
PR prolongation 
P waves disappear 
Broad QRS 
Sine wave appearance 
VF
43
Q

Management of hyperkalaemia

A

10% calcium gluconate 10ml over 10 mins
50% glucose 50ml IV with 10 units Actrapid over 10 mins
4mg salbutamol nebs back to back
15mg calcium resonium PO QDS

Emergency Medicine (24 decks)

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