Electrolyte Imbalances

Question 1

Symptoms of hypernatraemia

Answer 1

Headache
Lethargy
Anorexia
Weakness
Confusion
Hallucination
Agitation
Fitting
Coma
Decreased conscious level

Question 2

What must be rememebered in correcting Na?

Answer 2

CNS adapts to levels so correct slowly (unless developed fast ie SAH, then treat fast)

Question 3

What are symptoms of hypercalcaemia?

Answer 3

MOANS GROANS STONES

Abdo pain, vomit, polyuria, polydipsia, weight loss, HTN, confusion, pyrexia

Question 4

What is management of hypercalcaemia?

Answer 4

Bisphosphonates

Question 5

What are symptoms of hypocalcaemia?

Answer 5

Spasms (Trousseau's hand)
Paraesthesia
Chemoathetosis
Seizures
Anxiety
Chvosteks facial nerve sign
Cardiomyopathy

Question 6

What are symptoms of hyperkalaemia?

Answer 6

VF
MI
Weakness
Light headed
Tachycardia

Question 7

How is Hyperkalaemia managed?

Answer 7

Polystyrene sulfonate binds K+ in urgent care
Calcium gluconate stabilises cardiac membrane
Salbutamol nebs
Actrapid Insulin pushes K+ into cells combined with Dexamethasone infusion
Calcium resonium to lower levels
Diuretics/Dialysis
Saline

Question 8

What are ECG signs in Hyperkalaemia?

Answer 8

Tall tented T waves
Small p waves
Wide QRS
VF

Question 9

What are causes of hyperkalaemia?

Answer 9

AKI
Drugs: Potassium sparing diuretics, ACEi, ARBs, Spironolactone, ciclosporin, heparin
Metabolic acidosis
Addison’s disease
Rhabdomyolysis
Tumour Lysis Syndrome
Massive blood transfusion
Foods that are high in potassium:
salt substitutes (i.e. Contain potassium rather than sodium)
bananas, oranges, kiwi fruit, avocado, spinach, tomatoes

Question 10

What causes hypokalaemia?

Answer 10

Iatrogenic
Salbutamol
Cushings
Conns
Diuretics
Diarrhoea
Renal tubular acidosis
Partially treated DKA

Question 11

What are symtoms of hypokalaemia?

Answer 11

Muscle Weakness

Hypotonia

Question 12

What are ECG signs of hypokalaemia?

Answer 12

U waves
Small T waves
Prolonged PR
Depressed ST

Question 13

How is hypokalaemia managed?

Answer 13

Oral K+ or IV K+

Question 14

Hyponatraemia symtoms

Answer 14

Nausea and vomiting.
Headache.
Confusion.
Loss of energy, drowsiness and fatigue.
Restlessness and irritability.
Muscle weakness, spasms or cramps.
Seizures.
Coma.

Question 15

Types & causes of hyponatraemia

Answer 15

HYPOVOL: Poor dietary intake, thiazides
EUVOL: SiADH, Hypothyroid, Addisons
HYPERVOL: Liver cirrhosis, heart failure (fluid overload including iatrogenic)

Question 16

Causes of hypernatraemia

Answer 16

Dehydration (inadequate water intake)
Cushings & mineralo or glucocorticoid excess
GI losses
Central DI
Burns 
Sweating
Alcohol and lithium
(Osmostic diuresis- sarcoid, amyloid, myeloma)

Question 17

HHS

Answer 17

Hyperosmolar Hyoglycaemic state
DKA in an old person therefore no ketosis, but incredibly fluid depleted
OLD PEOPLE & Untreated T2DM (weight gain not loss)
NO INSULIN, but gently increase fluids and electrolytes and think of insulin later.
High mortality due to cerebral oedema etc.