Electrolytes Flashcards
1
Q
hypokalaemia ecg changes
A
- u waves
- tall tented p waves
- increased pr interval
2
Q
hypokalaemia presentation
A
- muscle cramps and weakness
- lethargy
- palpitations
3
Q
hypokalaemia drug causes
A
- insulin
- salbutamol
- loop and thiazide diuretics
- laxatives
- steroids
4
Q
hypokalaemia other causes
A
- cushings
- conns
- d and v
- villous adenoma
- gitelmans syndrome
- barterrs syndrome
- liddles syndrome
5
Q
hypokalaemia management
A
- greater than 2.5 oral replacement
- less than 2.5 iv replacement
6
Q
hyperkalaemia ecg changes
A
- tall tented t waves
- sine wave appearance
- absent/small p waves
- broad qrs
- vf
7
Q
hyperkalaemia presentation
A
- arrhythmias
- palpitations
- chest pain
- constipation
- weakness
8
Q
hyperkalaemia drug causes
A
- spironolactone
- ace inhibitors
- suxamethonium
- blood transfusion
- excessive replacement
9
Q
hyperkalaemia other causes
A
- addisons disease
- dm with metabolic acidosis
- rhabdomyolysis
- renal tubular acidosis types 1 and 2
- burns
10
Q
hyperkalaemia management
A
- stabilise myocardium
- drive potassium in to cells
- sodium bicarbonate
- careful fluid resuscitation
11
Q
hyponatraemia presentation
A
- nausea and malaise
- headache
- irritability
- confusion
- seizures
- coma and death
12
Q
hyponatraemia causes (hypervolaemic)
A
- nephrotic syndrome
- cardiac failure
- liver cirrhosis
- renal failure
13
Q
hyponatraemia causes (euvolemic - urine osmolality >100)
A
- siadh
14
Q
hyponatraemia causes (euvolemic - urine osmolality <100)
A
- water overload
- severe hypothyroidism
- glucocorticoid insufficiency
15
Q
hyponatraemia causes (hypovolaemic - urinary sodium >20mmol/l)
A
- renal failure
- diuretic excess
- osmolar diuresis (increased glucose/urea)
16
Q
hyponatraemia causes (hypovolemic - urinary sodium <20 mmol/l)
A
- diarrhoea
- vomiting
- fistulae
- small bowel obstruction
- cardiac failure
17
Q
hyponatraemia management
A
- involve seniors, endocrine team and itu early on
dependent on cause; - hypovolaemia; 0.9% saline slowly. check u and es bd and aim not to exceed increasing sodium by greater than 10mmol in 24 hours
- hypervolaemia; fluid restrict and give furosemide
- euvolaemic; fluid restrict and consider further drugs
- risk of central pontine myelinosis if sodium level falls fast/replacement too quick so monitor gcs
18
Q
hypernatraemia presentation
A
- lethargy
- thirst
- weakness
- irritability
- confusion
- seizures
- coma and death
19
Q
hypernatraemia causes
A
- diarrhoea, vomiting, burns
- diabetes insipidus
- diabetic coma
- iatrogenic; excessive saline
20
Q
hypernatraemia management
A
- oral water
- if hypovolaemic can give 0.9% saline slowly, or consider 5% dextrose with senior
- risk of central pontine myelinosis if sodium level falls fast/replacement too quick so monitor gcs
21
Q
hypocalcaemia ecg changes
A
- prolonged qt interval
22
Q
hypocalcaemia presentation
A
- spasms; trousseau’s sign
- perioral paraesthesia
- anxious, irritable, irrational
- seizures
- muscle tone increased; smooth muscle wheeze
- orientation impairment
- dermatitis
- impetigo herpeteformis
- chvostek’s sign/cataracts/cm/choreoathetosis
23
Q
hypocalcaemia management
A
- mild symptoms; oral calcium
- kidney disease and vitamin d deficiency; alfacalcidol
- severe symptoms; 10ml 10% calcium gluconate over 20 minutes
- monitor patient with ecg
24
Q
hypocalcaemia causes
A
- drugs; furosemide
- hypoparathyroidism
- pseudohypoparathyroidism
- vitamin d deficiency
- acute pancreatitis
- acute rhabdomyolysis
25
hypercalcaemia ecg changes
nil specific
26
hypercalcaemia presentation
- bone pain and fractures
- renal stones
- polydipsia
- polyuria
- depression and irritability
- abdominal pain
- constipation
- spasms
27
hypercalcaemia causes
- drugs; thiazide diuretics and vitamin d
- malignancy
- primary hyperparathyroidism
28
hypercalcaemia management
- correct dehydration
- bisphosphonates 60 mg pamidronate infusion
- furosemide; although dehydration may worsen hypercalcaemia
- monitor patient with ecg
- early involvement of endocrine team
