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Internal medicine (small) > Electrolytes and minerals (Yr 4) > Flashcards

Electrolytes and minerals (Yr 4) Flashcards

1
Q

what are the main electrolytes/minerals?

A

sodium
potassium
calcium
phosphate

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2
Q

what electrolytes/minerals are mainly found inside cells?

A

potassium
phosphorous
magnesium

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3
Q

what electrolytes are mainly found outside cells?

A

sodium
chloride

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4
Q

what is the main cation of extracellular fluid?

A

sodium

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5
Q

what are the main balancing anions of sodium in the extracellular fluid?

A

chloride
bicarbonate

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6
Q

what are the two main processes that regulate sodium?

A

RAAS (controls circulating volume)
ADH (controls osmolarity)

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7
Q

what can trigger RAAS?

A

low blood pressure
low perfusion pressure
renal ischaemia
low sodium in DCT
sympathetic stimulation

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8
Q

what is the rough RAAS pathway?

A

kidney releases renin
renin causes angiotensinogen to form angiotensin 1
angiotensin 1 is converted to angiotensin 2 by ACE in the lungs
angiotensin 2 has many effects… thirst, vasoconstriction, aldosterone release

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9
Q

what is the main function of aldosterone?

A

sodium/water retention
potassium loss

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10
Q

how does ADH control the bloods osmolarity?

A

blood osmotic pressure increases
detected by osmoreceptors in hypothalamus which trigger thirst and ADH release
ADH increase permeability of collecting duct to increase water reabsorption

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11
Q

what are the two main causes of hyponatraemia?

A

lose sodium (GI loss, kidney loss, Addisons, drugs)
gain water (CHF, iatrogenic)

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12
Q

what can cause loss of sodium?

A

GI loss
kidney loss
Addisons disease
drugs (furosemide)

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13
Q

what can cause hypernatraemia?

A

hypotonic fluid loss
free water loss
gain salt

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14
Q

what can cause hypotonic fluid loss (water with a bit of sodium)?

A

GI losses
kidney losses
post-obstructive diuresis

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15
Q

what can cause free water loss leading to hypernatraemia?

A

heat stroke
pyrexia
diabetes insipidus
no water access
adipsia

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16
Q

what is potassium concentration controlled by?

A

aldosterone (and insulin)

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17
Q

why are small changes in potassium so important?

A

most potassium inside cells so you are unable to sample them, hence small changes will have a big impact

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18
Q

what are the clinical signs of hypokalaemia?

A

muscle weakness
PUPD
anorexia
ileus/constipation

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19
Q

what can cause hypokalaemia?

A

decreased intakes (anorexia, fluid therapy)
translocation (from ECF to ICF)
potassium loss (GI and renal)

20
Q

what is the main cause of hypokalaemia?

A

decreased intakes (anorexia)

21
Q

what can cause translocation of potassium from ECF to ICF?

A

insulin therapy
catecholamines

22
Q

what are the clinical signs of hyperkalaemia?

A

muscle weakness
cardiac abnormalities
bradycardia (atrial standstill)

23
Q

what is the specific cardiac sign of hyperkalaemia?

A

bradycardia (fast rhythms possible)

24
Q

what must be ruled out when presented with hyperkalaemia?

A

artifactual increase (EDTA contains a lot of potassium, if you contaminate your biochemistry tube with this) or due to aged samples

25
Q

how can EDTA contamination of a biochemistry sample be recognised?

A

hyperkalaemia
hypocalcaemia
ALP low

26
Q

what are some causes of hyperkalaemia?

A

decreased urinary excretion
translocation
increased intake

27
Q

what can cause decreased potassium excretion from the kidney leading to hyperkalaemia?

A

urethral obstructions
bladder rupture
anuric/oluguric acute kidney injury
Addisons disease
drugs (ACE inhibitors, potassium sparing diuretics such as spironolactone)

28
Q

what can cause translocation of potassium from ICF to ECF leading to a hyperkalaemia?

A

insulin deficiecny
tumour lysis syndrome (mass death to cancer cells from chemotherapy)
extensive reperfusion injuries

29
Q

how is hyperkalaemia treated?

A

IV fluids (saline or hartmanns)
glucose/insulin (drives potassium into cells)
calcium glutinate (if cardiac effects)
treat primary disease

30
Q

what hormone is most important for controlling plasma osmolarity?

A

ADH (anti-diuretic hormone)

31
Q

failure of which organ can lead to hyponatraemia?

A

heart (ascites…)

32
Q

what are the three fractions of calcium in the body?

A

ionised (biologically active)
protein bound (mainly to albumin)
complexed (bound to other anions)

33
Q

what is the largest portion of calcium in the body?

A

ionised (regulated by PTH and vitamin D)

34
Q

what regulates ionised calcium?

A

PTH
vitamin D

35
Q

what is the protein the majority of your protein bound calcium is bound to?

A

albumin

36
Q

what is the main clinical sign of hypercalcaemia?

A

PUPD (can be dehydrated because not drinking enough)

37
Q

what are the most common causes of hypercalcaemia?

A

malignancy (lymphoproliferative disease)
renal failure
primary hyperparathyroidism
addisons
increased vitamin D

38
Q

what is the main cause of hypercalcaemia?

A

lymphoma

39
Q

what are the clinical signs of hypocalcaemia?

A

muscles tremor, twitches, cramps
seizures
restlessness, behavioural changes, scratching, chewing feet…
(overactive muscles)

40
Q

what needs to be ruled out when presented with hypocalcaemia?

A

that the patient doesn’t have hypoalbuminaemia (protein losing enteropathy…)
check for no EDTA contamination

41
Q

what are the main three causes of hypocalcaemia?

A

eclampsia
renal disease
hypoparathyroidism

42
Q

what is the main regulator of phosphate?

A

parathyroid hormone

43
Q

what is the effect of parathyroid hormone on phosphorous?

A

increases excretion

44
Q

what can cause hyperphosphataemia?

A

failure to excrete (decreased GFR, urinary obstruction/rupture)
increased release from bone (young animals)
increased intakes (hypervitaminosis D, high phosphate diet)
hypoparathyroidism
tumour lysis syndrome

45
Q

what can cause hypophospataemia?

A

rarely an issue…
anorexia in cats
primary hyperparathyroidism

46
Q

what proportion of the measured total calcium is ionised?

A

50%

47
Q
A

Internal medicine (small) (33 decks)

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