Electrolytes

Question 1

Urine Na+ <20 + hypovolaemia causes

Answer 1

D+V

Question 2

Urine Na+ <20 + euvolaemia causes

Answer 2

Acute fluid overload

Question 3

Urine Na+ <20 + hypervolaemia causes

Answer 3

Congestive HF Liver cirrhosis

Question 4

Urine Na+ >20 + hypovolaemia causes

Answer 4

Diuretics

Question 5

Urine Na+ >20 + euvolaemia causes

Answer 5

SIADH

Question 6

Urine Na+ >20 + hypervolaemia causes

Answer 6

Acute tubular necrosis

Question 7

Drugs that causes hyponatraemia

Answer 7

NSAIDsSSRIsDiuretics APsCarbamazepine

Question 8

S+S hyponatraemia

Answer 8

Asymptomatic If severe: vomiting, drowsy, headache, confusion, seizures

Question 9

Complications of hyponatraemia

Answer 9

Cerebral oedema Falls, gait disturbance, cognitive deficitOsteoporosis Central pontine myelinolysis - if reversed

Question 10

Management of hyponatraemia

Answer 10

0.9% NaCl Stop meds that cause hyponatraemia If chronic: fluid restrict + demeclocyline

Question 11

Causes of hyperkalaemia

Answer 11

AKI Blood transfusions Drugs: potassium sparing diuretics, spironolactone, ACEi or ARBsRhabdomyolysis Metabolic acidosis (DKA)Addisons

Question 12

S+S hyperkalaemia

Answer 12

Asymptomatic S+S >7mmol Paraesthesia, weakness, N+V, palpitations

Question 13

Investigations for hyperkalaemia

Answer 13

Bloods VBG for immediate result ECG

Question 14

ECG changes in hyperkalaemia

Answer 14

Tall tented T waves Prolonged QRS - eventually merges with T wave to form sine wave Decreased p waves Axial deviation + BBB

Question 15

Management of hyperkalaemia

Answer 15

Stabilise cardiac membrane with IV calcium gluconate 10mls of 10% over 10 mins Insulin + dextrose infusion over 15 mins Salbutamol 5mg nebs Calcium resonium, loop diuretics, dialysis to remove potassium

Question 16

Causes of hypoglycaemia

Answer 16

Insulin OD (DM)Post-gastric surgery Alcohol excessBeta blockers

Question 17

S+S hypoglycaemia

Answer 17

Sweating, dizziness, slurred speechConfusion, tachycardia, SOB

Question 18

Investigations for hypoglycaemia

Answer 18

Capillary blood glucose Serum BM

Question 19

Management of hypoglycaemia

Answer 19

Conscious: oral glucose (120ml lucozade) + eat complex carbs Unconscious: IV 100ml 20% glucose stat or 1mg IM glucagon 1L 10% glucose once conscious

Question 20

Causes of hyponatraemia if dehydrated + Na++ in urine

Answer 20

Losing from kidneys: Addisons, renal failure, excess diuretics

Question 21

Causes of hyponatraemia if dehydrated + Na- in urine

Answer 21

Vomit, diarrhoea, burns, CF, obstruction

Question 22

Causes of hyponatraemia if not dehydrated + oedematous

Answer 22

Nephrotic syndrome, HF, renal/ liver failure

Question 23

Causes of hyponatraemia if not dehydrated + not oedematous

Answer 23

SIADH Fluid overload

Question 24

Management of asymptomatic hyponatraemia

Answer 24

Fluid restrict Demeclocycline

Question 25

Management of symptomatic hyponatraemia

Answer 25

0.9% saline Consider furosemide