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MSRA metabolic > electrolytes > Flashcards

electrolytes Flashcards

1
Q

what are ECG changes suggestive of hyperkalaemia?

A

tall tented T waves
small P waves
widened QRS leading to sinusoidal pattern + asystole

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2
Q

what are causes of hyperkalaemia?

A

AKI
metabolic acidosis
DKA
addison’s disease
rhabdomyolysis
cell lysis- tissue necrosis, tumour lysis syndrome, trauma, burns
massive blood transfusion
malignant melanomas
drugs: potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin

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3
Q

what are symptoms of hyperkalaemia?

A

weakness
palpitations
n+v
paraesthesia

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4
Q

what investigations do you need for hyperkalaemia?

A

blood tests: UE, Ca, PO4, Mg, digoxin level, VBG

bedside: ECG, fluid balance

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5
Q

how do you manage hyperkalaemia?

A

if >6.5 or ECG changes:

  1. calcium gluconate 10% 10ml IV over 5 minutes
    repeat up to every 15 mins to max 50ml
  2. actrapid 10 units IV + glucose 50% 50ml IV over 10 mins then glucose 5% 1L IV over 12h
  3. salbutamol 5mg nebs
  4. consider calcium resonium resin 15g TDS PO or 30g PR
  5. monitor K+ 2 hourly
  6. low potassium diet
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6
Q

what foods are high in potassium?

A

salt substitutues
bananas
oranges
kiwi
avocado
spinach
tomatoes

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7
Q

what are the causes of hypercalcaemia?

A

hyperparathyroidism- primary or tertiary
hyperthryoidism

malignancy- squamous cell lung ca - PTHrP causes overproduction of ADH; colorectal adenocarcinoma- paraneoplastic syndromes
dehydration

spurious
sarcoidosis
tuberculosis
addison’s disease
drugs - thiazide diuretics, lithium, excess calcium containing antacids, excess vit D, excess ca supplements

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8
Q

what are symptoms of hypercalcaemia?

A

bones: bone pain
stones: renal calculi/abdo pain
groans: constipation/abdo pain, n+v
thrones: polyuria, polydipsia
moans: fatigue, depression, confusion

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9
Q

what are examination findings of hypercalcaemia?

A

dehydration
hyporeflexia
muscle weakness

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10
Q

what are the investigations needed for hypercalcaemia?

A

blood tests: UE, Mg, PO4, albumin, ALP, PTH, vit D, VBG, myeloma screen

ECG: shortening QT interval

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11
Q

what is the management of hypercalcaemia?

A
  1. hold thiazides (+ diuretics if dehydrated)
  2. rv antacids, lithium, ca+ vit d supplements
  3. aggressive fluid resuscitation- 3-6L/day

may use furosemide if cannot tolerate this as well

  1. if refractory or severe neurological or dysrhythmic complications- consider pamidronate 60-90mg IV at 20mg/h (if eGFR<30 then 30mg)
  2. following rehydration- bisphosphonates (take 2-3 days to work, max effect at 7 days)

calcitonin- quicker effect than bisphosphonates

steroids in sarcoidosis, lymphomas or myeloma w heavy proteinuria

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12
Q

what are the causes of hypocalcaemia?

A

vitamin d deficiency/osteomalacia
CKD
refeeding syndrome
rhabdomyolysis (initial stages)
hypomagnesaemia - due to end organ PTH resistance
hypoparathyroidism- post surgery
pseudohypoparathryoidism- target cells insensitive to PTH
acute hyperventilation
osteoblastic metasteses
spurious- hypoalbuminaemia, drip arm
alkalosis
acute pancreatitis
alcoholism
drugs- phenytoin, massive blood transfusion

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13
Q

what are symptoms of hypocalcaemia?

A

tetany: carpopedal spasm, muscle twitch, cramp
fatigue
perioral tingling
paraesthesia
if chronic: depression, cataracts

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14
Q

what are examination findings of hypocalcaemia?

A

chvostek’s sign- percussion over facial nerve triggers facial spasm

trousseau’s sign - carpal spasm if brachial arery occluded (inflate BP cuff); wrist flexion + fingers drawn together

hyperreflexia

spasm

paraesthesia

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15
Q

what are investigations needed for hypocalcaemia?

A

blood tests: UE, Mg, PO4, albumin, ALP, PTH, vit D, VBG

ECG: prolonged QT

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16
Q

how do you manage hypocalcaemia?

A

if <1.9

  1. 10ml 10% calcium gluconate in 100ml 5% dextrose IV over 10 mins
  2. then infusion 100ml 10% calcium gluconate in 1L 0.9% N. Saline (or 5% dex at 50-100ml/hr)
  3. check calcium levels after 6 hours and adjust rate until calcium >1.9

if >1.9
oral replacement- adcal 1.5g 1-2 tablets PO BD

Sandocal 1000 1 tablet PO BD

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17
Q

what is SIADH?

A

syndrome of inappropriate ADH/vasopressin secretion characterised by hyponatraemia secondary to dilutional effects of excessive water retention. euvolaemic

leads to water retention. volume expansion + dilutional hyponatraemia

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18
Q

what are the causes of SIADH?

A

malignancy
neurological
infections
drugs
PEEP
porphyrias

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19
Q

what malignancies can cause SIADH?

A

small cell lung cancer
pancreas
prostate

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20
Q

what are neurological causes of SIADH?

A

stroke
SAH
subdural haemorrhage
meningitis/encephalitis/abscess

21
Q

what infections can cause SIADH?

A

pneumonia
tuberculosis

22
Q

what drugs can cause SIADH?

A

sulfonylureas - glimepiride + glipizide
SSRIs, tricyclics
carbamazepine
vincristine
cyclophosphamide

23
Q

what are investigation results suggestive of SIADH?

A

urine osmolality inappropriately high in relation to serum osmolality (kidneys should normally dilute urine in setting of low serum osmolality) >100mOsm/kg

urine sodium concentration is typically high due to action of ADH on renal tubules ?40mmol/l

24
Q

how do you treat SIADH?

A

slow correction to avoid precipitating central pontine myelinolysis CPM

fluid restriction

demeclocycline- reduces responsiveness of collecting tubule cells to ADH

ADH/vasopression receptor antagonist

25
Q

what are the causes of raised ALP and raised calcium

A

bone metastases
hyperparathyroidism

26
Q

what are the causes of raised ALP and low calcium

A

osteomalacia
renal failure

27
Q

what are the causes of raised alp?

A

LIVER- cholestasis, hepatitis, fatty liver, neoplasia
Paget’s
physiological- pregnancy, growing children, healing fractures

w low ca:
osteomalacia
renal failure

w high ca:
hyperparathyroidism
bone mets

28
Q

what are the causes of hypokalaemia?

A
  1. increased potassium loss:
    drugs- thiazides, loop diuretics, laxatives, glucocorticoids, abx
    GI losses- d + v, ileostomy
    renal causes- dialysis
    endocrine- hyperaldosteronism/conns syndrome, cushing’s syndrome
  2. trans-cellular shift
    insulin/glucose therapy
    salbutamol
    theophylline
    metabolic alkalosis
  3. decreased potassium intake
  4. magnesium depletion
29
Q

what are the symptoms of hypokalaemia?

A

weakness
cramps
n+v
paraesthesia

30
Q

what are the ecg findings in hypokalaemia?

A

prolonged PR
ST depression
flat or inverted T waves
U waves

31
Q

what blood tests are needed in hypokalaemia?

A

UE, Mg, Ca, PO4, VBG
predisposes to digoxin toxicity

32
Q

what is the management of hypokalaemia?

A

severe <2.5 or symptomatic hypoK- IV replacement w cardiac monitoring. infusion rate should not exceed more than 20mmol/hr

mild-moderate 2.5-3.4 0 oral potassium if no ECG changes

33
Q

what are the causes of hypovolaemic hyponatraemia?

A
  1. renal losses
    diuretics
    osmotic diuresis - hyperglycaemia
    addison’s disease
    salt-losing nephropathy
  2. non-renal losses
    d + v
    fistulae
    burns
    bowel obstruction
    heat
34
Q

what are the causes of euvolaemic hyponatraemia?

A

excess salt
polydipsia
severe hypothyroidism

SIADH
- drugs- SSRIs, tricyclics, carbamazepine, opiates, PPI
- lung- infection, tumour
- malignancy
- CNS disease- SOL, infx, inflm

35
Q

what are the causes of hypervolaemic hyponatraemia?

A

heart failure
renal failure
liver failure
nephrotic syndrome

36
Q

what are spurious causes of hyponatraemia?

A

drip arm
lipaemic sample
hyperglycaemia

37
Q

what are the symptoms of hyponatraemia?

A

weakness
cramps
n+v
headache

38
Q

what investigations are needed for hyponatraemia?

A

UE, LFT, TFT, glucose, urinary + serum osmolality, urinary sodium

fluid balance chart

39
Q

what are the causes of hypovolaemic hypernatraemia?

A
  1. water loss
    osmotic diuresis- hyperglycaemia
    sweating, diarrhoea
    diabetes insipidus
    - nephrogenic- hyperCa, hypok, lithium, demecloycline
    - central - pituitary surgery/disease, SOL, HI
  2. poor intake
    reduced thirst- hypothalamic disease
40
Q

what are the causes of euvolaemic hypernatraemia?

A

excess salt
hyperaldolsteronism
cushing’s syndrome
hypertonic dialysis

41
Q

what investigations are needed for hypernatraemia?

A

UE, Ca, glucose, serum + urine osmolalities, urinary Na

gluid balance chart

42
Q

what are the causes of hypophosphataemia?

A

GI loss
- d+v, intestinal malabsorption
drugs
- diuretics, insulin, salbutamol, phosphate binders, theophylline, insulin
refeeding syndrome
alkalosis
hyperparathyroidism
post-DKA treatment
alcoholism

43
Q

what are the symptoms of hypophosphataemia?

A

tremor
muscle twitch
cramps
weakness
parasthesia

44
Q

what investigations are needed for hypophosphataemia?

A

ECG
fluid balance chart
bloods- UE, Mg, Ca, PTH

45
Q

how do you manage hypophosphataemia?

A

0.6-0.8- oral tablets TDS

<0.6/ECG changes- IV phosphate polyfusor up to 50mmol (500ml) over 12-24hrs

46
Q

what are the causes of hypomagnesaemia?

A

GI loss
- diarrhoea, stoma, intenstinal malabsorption
drugs
- diuretics, PPI, aminoglycosides, ciclosporin, insulin
refeeding syndrome
hypoparathyroidism
critical illness
alcoholism

47
Q

what are the symptoms of hypomagnesaemia?

A

tremor
muscle twitch
cramps
weakness
paraesthesia

48
Q

what are the investigations for hypomagnesaemia?

A

ECG
fluid balance chart
bloods- UE, Ca, PO4, PTH

49
Q

how do you manage hypomagnesaemia?

A

> 0.5- PO replacement TDS

<0.5- IV 16-20mmol magnesium sulphate in 100ml 5% dex over 4-6hrs

MSRA metabolic (4 decks)

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