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Anaesthetic FRCA Primary - eLFH Data Interpretation > eLFH - Biochemistry > Flashcards

eLFH - Biochemistry Flashcards

1
Q

Classification of hyponatraemia

A

Hypovolaemia

Euvolaemia

Hypervolaemia

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2
Q

Causes of Hypovolaemic hyponatraemia

A

Diarrhoea

Vomiting

Burns

Diuretics

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3
Q

Causes of Euvolaemic hyponatraemia

A

SIADH

Hypothyroidism

Addison’s

Post-surgical

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4
Q

Causes of Hypervolaemic hyponatraemia

A

Renal failure

Cardiac failure

Liver failure

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5
Q

Non clinical differentiation between type of hyponatraemia

A

Hypovolaemia - Urinary Na+ < 20 mmol/L

Hypervolaemia - Urinary Na+ > 20 mmol/L

SIADH - urine osmolality > plasma osmolality

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6
Q

Classification of Hypernatraemia

A

Reduced water intake

Increased water loss

Sodium excess

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7
Q

Causes of hypernatraemia secondary to reduced water intake

A

Impaired thirst

Deficient intake

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8
Q

Causes of hypernatraemia secondary to increased water loss

A

Diabetes insipidus

Osmotic diuresis

Loss from skin / lungs

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9
Q

Causes of hypernatraemia secondary to sodium excess

A

Iatrogenic

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10
Q

Classification of hypokalaemia

A

Increased renal excretion

GI losses

Redistribution

Reduced intake

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11
Q

Causes of increased renal excretion hypokalaemia

A

Diuretics

Hyperaldosteronism

Mineralocorticoids

Renal disease

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12
Q

Causes of GI losses hypokalaemia

A

Vomiting

Diarrhoea

Ileostomies

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13
Q

Causes of redistribution hypokalaemia

A

Beta agonists

Alkalosis

Insulin

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14
Q

Causes of reduced intake hypokalaemia

A

Iatrogenic

Dietary deficiency

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15
Q

Classification of hyperkalamia

A

Reduced renal excretion

Release from cells

Increased K+ load

Spurious

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16
Q

Causes of reduced renal excretion hyperkalaemia

A

Renal failure

Drugs - ACEi, aldosterone antagonists, NSAIDs

Addison’s

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17
Q

Causes of release from cells hyperkalaemia

A

Acidosis

DKA

Rhabdomyolysis

Suxamethonium

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18
Q

Causes of increased K+ load hyperkalaemia

A

Potassium chloride

Blood transfusions

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19
Q

Causes of spurious hyperkalaemia

A

Blood sample from same arm as infusion fluid

Haemolysis of sample

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20
Q

Causes of isolated increase in Urea levels (normal creatinine)

A

High protein diets

Tissue catabolism - trauma, surgery, infection

GI haemorrhage

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21
Q

Chronic kidney disease staging

A

CKD 1: GFR >90 but evidence of kidney damage

CKD 2: GFR 60 - 90

CKD 3: GFR 30 - 60

CKD 4: GFR 15 - 30

CKD 5: GFR <15 - end stage renal failure

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22
Q

Investigations for renal failure

A

Urine dip

Urine electrolytes

Bloods - usuals + Ca2+, phosphate, uric acid, electrophoresis, autoantibodies, ANCA

Renal imaging

Renal biopsy

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23
Q

Causes if obstructive LFT picture

A

Gallstones

Drugs

Pancreatic tumour

PBC

PSC

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24
Q

Causes of hepatic LFT picture

A

Cirrhosis

Viral hepatitis

Drugs

NASH

Ischaemic liver injury

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25
Causes of raised bilirubin
Haemolysis - bilirubin is breakdown product of haem metabolism Defective bilirubin metabolism - Gilbert's, Hepatobiliary disease
26
Causes of elevated Amino-transferases
Hepatocellular damage ALT more specific to liver AST also present in skeletal muscle and heart
27
Causes of elevated Alkaline phosphatase
Release from cells lining biliary ducts - cholestasis Also present in bone and placenta Hence rise in pregnancy, Paget's and bony metastases
28
Causes of elevated gamma GT
Liver microsomal enzyme - induced by alcohol and enzyme inducing drugs Rises with cholestasis too
29
Causes of low albumin
Reduced with impaired synthetic function Chronic inflammatory disease Sepsis Nephrotic syndrome
30
How is toxic metabolite of paracetamol usually cleared
Normally inactivated by conjugation in liver
31
Categories of causes of respiratory failure
Respiratory centre depression Airway obstruction Neuromuscular causes Chest wall abnormalities Increased small airways resistance Decreased lung compliance
32
Causes of respiratory centre depression
Sedative / narcotic drugs CNS injury CNS infection
33
Causes of airway obstruction
OSA Ludwig's angina Tracheal stenosis
34
Causes of neuromuscular disease
GBS Myasthenia gravis Motor neurone disease Post-polio
35
Causes of chest wall abnormalities
Burns Flail segment Kyphoscoliosis
36
Causes of increased small airways resistance
COPD Severe asthma Bronchiolitis
37
Causes of decreased lung compliance
ALI Pneumonia Pulmonary oedema
38
Classification of metabolic acidosis
High anion gap metabolic acidosis Normal anion gap metabolic acidosis
39
Anion gap calculation
Anion gap = [Na+] + [K+] - [Cl-] - [HCO3-]
40
Normal range of anion gap
6 to 12 mmol/L
41
Causes of high anion gap metabolic acidosis
CAT MUD PILES Carbon monoxide poisoning Alcoholic / starvation ketoacidosis Toluene Methanol / Metformin Uraemia DKA Paracetamol Isoniazid Lactic acidosis Ethylene glycol Salicylates
42
Types of lactic acidosis
Type A - tissue hypoxia Type B - metabolic abnormalities
43
Causes of type A lactic acidosis
Shock Hypoxia CO poisoning
44
Causes of type B lactic acidosis
Sepsis Liver failure Paracetamol poisoning Metformin
45
Causes of normal anion gap metabolic acidosis
GI bicarb loss Renal bicarb loss Reduced renal H+ excretion Increased HCl production
46
Causes of GI bicarbonate loss
Diarrhoea Ileostomy
47
Causes of renal bicarbonate loss
Acetazolamide Type 2 renal tubular acidosis Hyperparathyroidism
48
Causes of reduced renal H+ excretion
Type 1 and Type 4 renal tubular acidosis
49
Causes of increased HCl production
Ammonium chloride ingestion
50
Causes of respiratory alkalosis
Hyperventilation In acute setting either a response to hypoxaemia or to compensate for metabolic acidosis
51
Causes of chronic respiratory alkalosis
Pregnancy High altitude Neurotrauma
52
Categories of metabolic alkalosis
Renal H+ loss / HCO3- gain GI H+ loss Exogenous HCO3-
53
Causes of renal H+ loss / bicarbonate gain
Response to rise in PaCO2 Loop / Thiazide diuretics Cushing's syndrome Hyperaldosteronism
54
Causes of GI H+ loss
Vomiting Pyloric stenosis Villous adenoma
55
Causes of exogenous bicarbonate
Sodium bicarbonate administration Sodium citrate
56
Normal CarboxyHb levels in rural areas
< 1%
57
Normal COHb levels in urban areas
< 5%
58
Normal COHb levels in smokers
< 10%
59
How much higher is Hb affinity for CO compared to O2
CO binds to Hb with 210x the affinity that O2 does
60
Clinical features of carbon monoxide poisoning
Headache Confusion Coma Seizures Pulmonary oedema Arrhythmias

Anaesthetic FRCA Primary - eLFH Data Interpretation (6 decks)

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