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Phase 2a Concise > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

acromegaly Cx

A

HTN, LVH, IHD, diabetes, sleep apnoea, arthritis, bitemporal hemianopia from pituitary tumour

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2
Q

adrenal insufficiency overview

A

primary AI - impairment of adrenal cortex - low cortisol/aldosterone

secondary AI - low cortisol from low ACTH

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3
Q

AI presentation

A

tanned, tired, toned, tearful

signs

  • vitiligo
  • tanned skin
  • pigmentation (face, neck, palmar creases) - primary AI
  • hypotension - loss of aldosterone
  • dehydrated
  • lean

symptoms

  • lethargy, depression
  • dizzy
  • weight loss
  • nausea/vomiting
  • diarrhoea, constipation, abdo pain
  • impotence/amenorrhea
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4
Q

Conn’s DDx

A

secondary hyperaldosteronism - excess renin and AgII release (renal artery stenosis can cause this)

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5
Q

Cushing’s syndrome overview

A

excess cortisol

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6
Q

Cushing’s disease overview

A

excess cortisol from inappropriate ACTH secretion - pituitary adenoma

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7
Q

Cushing’s Ix

A

Dexamethasone suppression test - usually suppresses cortisol level - failure to suppress is diagnostic

CT/MRI of adrenals/pituitary

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8
Q

DM Ix

A

random plasma glucose >11.1mmol/L

fasting plasma glucose >7mmol/L

OGTT >7mmol/L (>6 for impaired glucose tolerance)

HbA1c >6.5% normal (48mmol/mol)

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9
Q

Which T2DM drugs cause weight loss/gain?

A

Biguianide (metformin) - reduce glycogenolysis, gluconeogenesis, increase muscle uptake of glucose - weight loss

Sulfonylurea (gliclazide) - stimulate insulin release - weight gain, hypo risk

DPP4 inhibitors (sitagliptin) - no weight change

Glitazone (pioglitazone) - weight gain

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10
Q

DM complications

A

Macrovascular - atherosclerosis, stroke, IHD, PAD

Microvascular - diabetic retinopathy, nephropathy, neuropathy, infections

DKA, HHS, hypoglycaemia

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11
Q

DKA causes

A

Lack of insulin, glucose cannot be taken up by cells

FFAs -> acetyl-coA -> ketone bodies

excessive ketonegenesis

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12
Q

HHS/DKA differentials

A

HHS - hypovolaemia, marked hyperglycaemia without acidosis, higher osmolality

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13
Q

Hypoglycaemia

A

plasma glucose <3mmol/L

insufficient glucose to brain

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14
Q

Thyroid carcinoma Mx

A

Radioactive iodine

Levothyroxine (T4) - keep TSH reduced

Chemo

Partial/full thyroidectomy

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15
Q

Hypercalcaemia presentation

A

symptoms
bones - excess bone resorption - pain, fractures, osteoporosis
stones - biliary stones
groans - abdo pain, malaise, polydipsia, nausea
psychiatric moans - depression, anxiety

signs
QT shortening

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16
Q

Hypoparathyroidism

A

Low PTH

Primary - low due to parathyroid gland failure

Secondary - after parathyroidectomy/thyroidectomy

Pseudo - failure of target cell response to PTH

Pseudopseudo - same as pseudo but no Ca abnormalities

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17
Q

Hypoparathyroidism Ix

A

Bloods - calcium low, PTH low (high in pseudo)

ECG - long QT

Parathyroid ABs

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18
Q

SIADH Ix

A

FBC, U+E

Hyponatraemia, low plasma osmolality, high urine osmolality

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19
Q

acromegaly overview

A

excess growth hormone -> overgrowth of all organ systems

gigantism in children

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20
Q

acromegaly causes

A

pituitary adenoma secreting too much GH

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21
Q

acromegaly presentation

A

signs

  • big hands, feet, jaw
  • acral and soft tissue overgrowth
  • big tongue, widely spaced teeth
  • coarse facial features
  • prognathism

symptoms

  • arthralgia
  • acroparaesthesia
  • headache
  • decreased libido
  • acral enlargement
  • wonky bite (malocclusion)
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22
Q

acromegaly DDx

A

pseudo-acromegaly - same physical appearance without elevated GH/IGF-1

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23
Q

acromegaly Ix

A

check IGF-1 levels (not GH, is pulsatile secretion)

oral glucose tolerance test - normally, rise in blood glucose suppresses GH levels

MRI pituitary fossa for adenomas

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24
Q

acromegaly Tx

A

transsphenoidal surgery

somatostatin analogues (IM octreotide)
dopamine agonist (oral cabergoline)
GH antagonist (pegvisomant)

radiotherapy

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25
Q

AI causes

A

primary

  • worldwide, TB
  • in UK - autoimmune adrenalitis (Addison’s disease)
  • adrenal metastases, long term steroid use, opportunistic infections

secondary

  • long term steroid therapy
  • hypothalamic-pituitary disease - tumours, trauma, surgery
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26
Q

AI Ix

A

Bloods - hyponatraemia, hyperkalaemia (low aldosterone), hypoglycaemia (low cortisol)

Synacthen test
measure plasma cortisol before/30min after IM tetracosactide (ACTH analogue), cortisol remains low in primary AI, increases in secondary

Adrenal ABs - 21 hydroxylase AB in Addisons

AXR/CXR

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27
Q

AI Tx

A

primary
acute - IV hydrocortisone, saline, glucose infusion

oral hydrocortisone/prednisolone (glucocorticoids)
oral fludrocortisone (mineralocorticoid)

secondary
oral hydrocortisone

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28
Q

AI Cx

A

Adrenal crisis - acute lack of cortisol (tx hydrocortisone)

Reduced QoL

Osteoporosis (from regular steroids)

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29
Q

Conn’s syndrome overview

A

primary hyperaldosteronism

excess aldosterone production -> increased sodium, water retention

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30
Q

Conn’s causes

A

2/3 - adrenal adenoma

1/3 - bilateral adrenocortical hyperplasia

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31
Q

Conn’s presentation

A

Often asymptomatic

Hypertension
Metabolic alkalosis
Hypokalaemia - weakness/cramps, paraesthesia, polyuria/polydipsia

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32
Q

Conn’s Ix

A

U/E

Spot renin/aldosterone levels - aldosterone raised, renin low

ECG - hypokalaemia

CT/MRI adrenals

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33
Q

Conn’s Mx

A

Aldosterone antagonist - oral spironolactone

Laproscopic adrenalectomy

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34
Q

Conn’s Cx

A

Cx from HTN - stroke, MI, kidney failure

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35
Q

Cushing’s syndrome causes

A

ACTH-dependent (high ACTH)
Cushing’s disease - ACTH-secreting pituitary tumour
ACTH-producing tumour elsewhere

ACTH-independent (low ACTH due to -ve feedback from raised cortisol)
adrenal tumour releasing cortisol
oral steroids

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36
Q

Cushing’s presentation

A 
CUSHING
Cataracts
Ulcers
Skin - striae
Hypertension, hyperglycaemia
Infections increase
Necrosis
Glucosuria
Central obesity, wasted limbs
Moon face
Buffalo hump
Acne, hirsuitism, weight gain
Mood change, gonadal dysfunction, protein wasting
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37
Q

Cushing’s DDx

A

Pseudo-Cushing’s - same presentation, not from pituitary-adrenal axis problems - eg prolonged excess alcohol consumption

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38
Q

Cushing’s Tx

A

Cushing’s disease - transphenoidal removal of pituitary adenoma

Adrenal adenoma - adrenalectomy

Adrenal carcinoma - radiotherapy, adrenolytic drugs (mitotane)

Ectopic ACTH - surgery if tumour located, drugs that inhibit cortisol synthesis (metyrapone, fluconazole)

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39
Q

Cushing’s Cx

A

HTN, metabolic syndrome, diabetes, obesity, coagulopathy, osteoporosis, Nelson’s syndrome

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40
Q

Nelson’s syndrome

A

increase skin pigmentation from ACTH increase from enlarging pituitary tumour after adrenalectomy (remove negative feedback against ACTH)

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41
Q

Diabetes mellitus

A

deficiency/diminished effectiveness of insulin, hyperglycaemia

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42
Q

T1DM

A

body fails to produce sufficient insulin

prone to DKA

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43
Q

T2DM

A

resistance to insulin

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44
Q

Gestational diabetes

A

high blood glucose levels in pregnancy

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45
Q

Maturity-onset diabetes of the young (MODY)

A

autosomal dominant form of T2DM - single gene defect altering beta cell function

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46
Q

secondary diabetes

A

inc pancreatic disease, endocrine…

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47
Q

T1DM causes

A

autoimmune

idiopathic

genetic component

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48
Q

T2DM causes

A

decreased insulin secretion/increased resistance

obesity, lack of exercise, calorie excess

polygenic

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49
Q

T1DM risk factors

A

Northern European, family history, other autoimmune disorders

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50
Q

T2DM risk factors

A

FHx, increasing age, obesity, poor exercise, ethnicity, overweight around abdomen

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51
Q

DM presentation

A

signs
ketonuria (ketoacidosis) - pear drop breath (T1)
complications (eg retinopathy)

symptoms
polyuria/nocturia
polydipsia
weight loss

T1 - leaner than T2

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52
Q

T1DM Mx

A

synthetic human insulin

short acting insulins - eg for before meals

sort-acting insulin analogues - fast onset, eg with evening meal

longer-acting insulins - 12-24hrs

complications - hypoglycaemia, weight gain

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53
Q

T2DM Mx

A

1st line - lifestyle - diet, exercise, weight loss, ramipril/statins/orlistat

2nd - oral metformin

Add sulfonylurea (oral gliclazide)

later - insulin/glitazone (oral pioglitazone) - increase tissue sensitivity to insulin

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54
Q

DKA overview

A

Ketonaemia (/ketonuria)
Hyperglycaemia
Acidosis

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55
Q

DKA presentation

A

signs
Pear drop breath
Kussmaul’s respiration (deep, rapid)
Disturbance of consciousness

symptoms
Vomiting
Drowsiness
Abdo pain
Dehydration - eyes sunken, slow cap refill, tachycardia, weak pulse, hypotension
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56
Q

DKA DDx

A

alcoholic ketoacidosis, hyperosmolar hyperglycaemic state, lactic acidosis

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57
Q

DKA Ix

A

Bloods show: hyperglycaemia, raised plasma ketones, acidaemia, metabolic acidosis with bicarb reduced

Urine stick testing - glycosuria and ketonuria

Check plasma osmolality and anion gap (both elevated, plasma osmolality more elevated in HSS)

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58
Q

DKA Tx

A

ABCDE
Replace fluid loss with 0.9% saline
Restore electrolye (K) loss and acid-base balance
Insulin-glucose

59
Q

DKA Cx

A

Cerebral oedema, pulmonary oedema, hypotension, coma, hypothermia…

60
Q

Hyperosmolar Hyperglycemic State (HHS)

A

Acute

Hyperglycaemia, hyperosmolality, mild/no ketoacidosis

61
Q

HHS causes

A

Uncontrolled T2DM

62
Q

HHS presentation

A 
signs
dehydration
reduced consciousness
bicarb not lowered
tachycardia, hypotension

symptoms
generalised weakness
nausea/vomiting
bed-bound, confused, lethargic

63
Q

HHS Ix

A

Hyperglycaemia
Urine stick - glycosuria
Plasma osmolality high

64
Q

HHS Tx

A

Fluids - saline
Insulin
LMWH - eg enoxaparin - reduce risk of thromboembolism
Restore electrolyte loss (K)

65
Q

HHS Cx

A

Ischaemia/infarction, vascular cx, ARDS, cerebral oedema (rapid lowering of blood glucose)

66
Q

Hyperthyroidism

A

Excess TH

Primary - pathology in thyroid gland

Secondary - thyroid gland stimulated by excessive TSH

67
Q

Primary hyperthyroidism causes

A

Graves disease - autoimmune induced excess TH secretion, diffuse goitre,

Toxic multinodular goitre - nodules that secrete TH

Adenoma

Thyroiditis (De Quervain’s) - transient, inflammation of thyroid

Drug-induced - amiodarone, iodine, lithium

68
Q

Secondary hyperthyroidism causes

A

TSH-secreting pituitary adenoma

TH-resistance syndrome

Gestational thyrotoxicosis

69
Q

Hyperthyroidism presentation

A 
signs
Graves ophthalmopathy - retro-orbital inflammation, protruding eye
diffuse goitre
hyperkinesis
muscle wasting
thin hair
lid lag and stare, lid retraction
onycholysis (nail separation from nail bed)
symptoms
palpitations
diarrhoea
weight loss
oligomenorrhea
heat intolerance
irritability/anxiety
70
Q

Hyperthyroidism Ix

A

TFTs - T4/3 raised (TSH raised in secondary)

ABs against thyroid peroxidase and thyroglobulin (Graves)

Ultrasound thyroid, thyroid uptake scan

inflammatory markers

TSHR-Ab raised - diagnostic of Graves

71
Q

Hyperthyroidism Tx

A

(IV methylprednisolone - for inflammation)

BBs (propanolol)

PTU (propylthiouracil) - stops T4 ->T3

Oral carbimazole - blocks TH synthesis - AGRANULOCYTOSIS risk (sore throat, fevers)

Radioactive iodine

Thyroidectomy

72
Q

Thyroid crisis

A

acute complication - rapid T4 increase

hyperpyrexia, tachycardia…

precipitated by stress

Tx - oral carbimazole, oral propranolol, oral potassium iodide, IV hydrocortisone

73
Q

Hypoglycaemia causes

A

In diabetics - insulin/sulfonylurea tx

Non-diabetics - EXPLAIN
Ex - exogenous drugs, insulin, alcohol
P - pituitary insufficiency
L - liver failure
A - Addison’s disease (lack of anti-insulin hormone function)
I - islets cell tumour, immune hypoglycaemia
N - non-pancreatic neoplasm

74
Q

Hypoglycaemia presentation

A

Sweating, anxiety, hunger, tremor, palpitations, dizziness

Confusion, drowsiness, visual trouble, seizures, coma

(neuroglycopenia)

75
Q

Hypoglycaemia Ix

A

Fingerprick blood test

Bloods - glucose, insulin, C-peptide, plasma ketones

76
Q

Hypoglycaemia Mx

A

Oral sugar, long-acting starch
IV glucose 50%
IM glucagon

77
Q

Hypothyroidism

A

Lack of TH

Primary - thyroid gland disease

Secondary - hypothalamic/pituitary disease

78
Q

Hypothyroidism causes

A

Autoimmine - antithyroid autoantibodies - atrophy, no goitre

Thyroiditis (Hashimoto’s - is autoimmune) - atrophy, goitre

Post-partum thyroiditis

Thyroidectomy/radioactive iodine

Drug-induced - carbimazole, lithium, amiodarone

Iodine deficiency

79
Q

Hypothyroidism presentation

A 
signs - BRADYCARDIC
Bradycardia
Reflexes relax slowly
Ataxia
Dry, thin hair/skin
Yawning/drowsy/coma
Cold hands/temp drop
Ascites
Round puffy face
Defeated demeanour
Immobile/ileus (peristalsis stops)
CCF
symptoms
hoarse voice
goitre
constipation
cold intolerant
weight gain
myalgia
low mood
hair/eyebrow loss
cold pale skin
80
Q

Hypothyroidism Ix

A

TFTs - TSH high in primary, low in secondary, T4 low

Bloods - anaemia…

81
Q

Hypothyroidism Tx

A

Oral levothyroxine (T4)

82
Q

Myxoedema coma

A

Severe hypothyroidism, acute emergency

hypothermia, cardiac failure, hypoventilation, hypoglycaemia, hyponatraemia

IV/oral T3 and glucose infusion

83
Q

Thyroid carcinoma

A

Papillary - local spread

Follicular - spread to lung/bone

Anaplastic - aggressive

Lymphoma - non-Hodgkins

Medullary cell - calcitonin C cells

84
Q

Thyroid carcinoma presentation

A

signs
thyroid nodule
cervical lymphadenopathy

symptoms
dysphagia, hoarseness of voice

85
Q

Thyroid carcinoma Ix

A

Fine needle aspiration cytology biopsy

Bloods - TFTs

Ultrasound thyroid

86
Q

Diabetes insipidus

A

Hyposecretion/insensitivity to ADH

Passage of large volumes of dilute urine

Cranial DI - reduced ADH secretion from pos pit

Nephrogenic DI - impaired response of kidney to ADH

87
Q

Hyposecretion/insensitivity to ADH

Passage of large volumes of dilute urine

Cranial DI - reduced ADH secretion from pos pit

Nephrogenic DI - impaired response of kidney to ADH

A

Cranial
Genetics, hypothalamus disease, tumour, trauma

Nephrogenic
Hypokalaemia, hypercalcaemia, CKD, drugs, renal tubular acidosis, mutation of ADH receptor, pregnancy

88
Q

DI presentation

A

signs
24hr urinary collection >3L/24hr

symptoms
polyuria
polydipsia, chronic thirst
nocturia

89
Q

DI Ix

A

24hr urine collection test

Fluid deprivation test - restrict fluid, measure urine osmolality - if low then DI

Desmopressin:
High urine osmolality - cranial DI
Low - nephrogenic DI

MRI pituitary, hypothalamus

90
Q

DI Tx

A

Cranial - oral desmopressin

Nephrogenic - treat cause, thiazide diuretics (oral bendroflumethiazide) - produce mild hypovolaemia, encourage kidneys to reabsorb Na and water, NSAIDs (ibuprofen) - lower urine vol and plasma Na

91
Q

Hypercalcaemia

A

High Ca serum levels

92
Q

Hypercalcaemia causes

A

Primary hyperparathyroidism

Malignancy - ectopic production of PTH-related peptide, osteolytic hypercalcaemia

93
Q

Hypercalcaemia Ix

A

Raised corrected calcium levels

PTH low in cancer, high in primary hyperparathyroidism

Low albumin

24hr urinary Ca, ECG, CT/MRI

94
Q

Hypercalcaemia Tx

A

Rehydrate with saline

Bisphosphonates - prevent bone resorption - IV pamidronate

Oral prednisolone

95
Q

Hypercalcaemia Cx

A

Osteoporosis, kidney stones, renal failure, abnormal heart rhythm, nervous system problems

96
Q

Hyperparathyroidism

A

Too much PTH secretion

Primary - parathyroid gland makes too much PTH

Secondary - increased PTH secretion in response to low calcium

Tertiary - autonomous secretion of PTH

97
Q

Hyperparathyroidism causes

A

Primary - adenoma, hyperplasia

Secondary - is compensation of hypocalcaemia (from CKD/vit D deficiency)

Tertiary - after many years of secondary - CKD

98
Q

Hyperparathyroidism presentation

A

primary
bones, stones, groans, moans
hypertension, short QT

secondary
like CKD - skeletal/CV complications

tertiary
like primary

99
Q

Hyperparathyroidism Ix

A

Bloods - PTH, calcium, phosphate, ALP

PTH high in all
Calcium high in 1, 3, low in 2
Phosphate high in 2, 3, low in 1
ALP high in all

100
Q

Hyperparathyroidism Mx

A

Surgical removal

Calcimimetic - increases sensitivity of parathyroid to Ca, less PTH secretion - eg oral cinacalcet

Bisphosphonates - alendronate - prevent loss of bone density

101
Q

Hyperparathyroidism Cx

A

Hypocalcaemia, recurrent laryngeal nerve injury (from surgery)

102
Q

Hypocalcaemia

A

Ca deficiency

103
Q

Hypocalcaemia causes

A

HAVOC

Hypoparathyroidism
Acute pancreatitis
Vit D deficiency
Osteomalacia
CKD
104
Q

Hypocalcaemia presentation

A

SPASMODIC

Spasms - Trousseau's sign
Perioral paraesthesia (+cramps/tetany)
Anxious, irritable, irrational
Seizures
Muscle tone increases in SM, wheeze
Orientation impaired and confusion
Dermatitis
Impetigo herpetiformis
Chvostek's sign, cataract, cardiomyopathy - long QT
105
Q

Hypocalcaemia Ix

A

Low serum Ca
Serum urine and creatinine, eGFR - test for renal disease
ECG

106
Q

Hypocalcaemia Mx

A

Acute - IV calcium gluconate

Vit D deficiency - oral colecalciferol/ADCAL

Hypoparathyroidism - calcium supplements + calcitriol (active vD)

107
Q

Hypoparathyroidism causes

A

1 - parathyroid gland failure - autoimmune

2 - after (para)thyroidectomy, radiation, hypomagnesaemia

Pseudo - end-organ resistance to PTH

108
Q

Hypoparathyroidism presentation

A

SPASMODIC

dry, scaly, puffy skin, brittle nails, coarse hair

Pseudo - short stature, short 4/5 metacarpals, subcut calcification

109
Q

Hypoparathyroidism Mx

A

Acute - IV calcium

calcium supplements and calcitriol

110
Q

Hypoparathyroidism Cx

A

Due to hypocalcaemia

laryngospasms, neuromuscular irritability (cramps/tetany), arrhythmias, stunted growth…

111
Q

Pheochromocytoma

A

Catecholamine secreting tumour

112
Q

Pheochromocytoma causes

A

Inherited (more noradrenaline)

Spontaneous (more adrenaline)

113
Q

Pheochromocytoma presentation

A 
signs
hypertension
postural hypotension
tremor
tachycardia
symptoms
headaches
palpitations
sweating
tremor
anxiety/nausea
114
Q

Pheochromocytoma Ix

A

24hr urine collection for catecholamines and metabolites

Blood tests

CT/MRI - locate tumour

115
Q

Pheochromocytoma Mx

A

Surgery

Alpha blocker (phenoxybenzamine), beta blocker

116
Q

Prolactinoma

A

benign, prolactin-producing tumour of pituitary gland

117
Q

Hyperprolactinaemia causes

A

pituitary tumour

antidopaminergic drugs, antidepressants

head injury

118
Q

Prolactinoma presentation

A

Tumour - headaches, bitemporal hemianopia

menstrual irregularity
infertility
galactorrhoea
hypogonadism

119
Q

Prolactinoma Ix

A

check serum prolactin levels

120
Q

Prolactinoma Tx

A

dopamine agonist - cabergoline

transsphenoidal pituitary resection

121
Q

Prolactinoma Cx

A

Vision loss, osteoporosis (from hypogonadism)

122
Q

Carcinoid tumours

A

Tumours of neuroendocrine/enterochromaffin cells - secrete serotonin/bradykinin

In gut, gallbladder, kidney …

123
Q

Carcinoid syndrome

A

hepatic involvement of carcinoid tumours

124
Q

Serotonin effects

A 
bowel function
mood
clotting
nausea
bone density
vasoconstriction
increase force of contraction and HR
125
Q

Carcinoid tumours presentation

A

Most asymptomatic, maybe weight loss, pain, palpable mass

signs
CCF

symptoms
neck/face flushing
bronchocontriction/bronchospasm
appendicitis/obstruction
RUQ pain
diarrhoea
126
Q

Carcinoid tumours Ix

A

Liver ultrasound

Urine - high conc of 5-hydroxylindoleacetic acid (metabolite of serotonin)

X-ray/CT/MRI

127
Q

Carcinoid tumours Mx

A

Octreotide/lanreotide - somatostatin analogs - block serotonin release

Surgical resection

128
Q

Carcinoid crisis

A

Tumour outgrows blood supply/is handled too much in surgery - mediators flow out

Tx - octreotide high dose

129
Q

Hyperkalaemia

A

Serum K >5.5mmol/L

130
Q

Hyperkalaemia causes

A

Renal - AKI, CKD, K-sparing diuretics, drugs that interfere with RAAS (NSAIDs)

Increased circulation of K - exogenous/endogenous - eg trauma, mass loss of K from cells

Shift from IC to EC space - acidosis, medications

Pseudo - eg tourniquet on too long

131
Q

Hyperkalaemia presentation

A

Cardiac arrest might be first presentation

Maybe associated with metabolic acidosis

signs
bradycardia, tachypnoea
muscle weakness, flaccid paralysis
depressed tendon reflexes

symptoms
weakness, fatigue, muscular paralysis, SOB, palpitations/chest pain

132
Q

Hyperkalaemia Ix

A

Bloods - high K

ECG - absent P, long PR, wide QRS, tall tented T - go, go long, go wide, go tall = gonner, sine wave pattern

133
Q

Hyperkalaemia Mx

A

IV calcium gluconate - reduces excitability of cardiac myocytes

Insulin-glucose infusion - drive K into cells

Non-urgent - calcium polystyrene sulfonate resin - reduces K gut uptake

134
Q

Hypokalaemia

A

Serum K <3.5mmol/L

135
Q

Hypokalaemia causes

A

Increased renal secretion - thiazide/loop diuretics, increased aldosterone secretion (Cushing’s/Conn’s)

Exogenous mineralocorticoids

Redistribution to cells

GI losses

Reduced dietary intake/inadequate K replacement in fluids

136
Q

Hypokalaemia presentation

A

usually asymptomatic

signs
muscle weakness
hypotonia
hyporeflexia
tetany
symptoms
constipation
palpitations
light-headedness
cramps
137
Q

Hypokalaemia Ix

A

Bloods - low serum levels

ECG - small/inverted T waves, ST depression, U waves (PR prolongation)

138
Q

Hypokalaemia Mx

A

Treat underlying cause

mild - oral K supplements (oral Sando-K)

Severe - IV K

139
Q

SIADH

A

Syndrome of inappropriate secretion of ADH

too much ADH

dilute plasma, excess BV, hyponatraemia

140
Q

SIADH causes

A

Neurological - eg trauma, tumour

Pulmonary - cancer, pneumonia…

Malignancy

Drugs - thiazide diuretics, SSRIs, PPIs

141
Q

SIADH presentation

A

signs
GCS reduction, confusion, drowsiness
fits/coma
concentrated urine

symptoms
anorexia/nausea, malaise
weakness/aches

142
Q

SIADH Tx

A

Underlying cause, restrict fluids

Hypertonic saline

Oral tolvaptan - vasopressin antagonist

Salt and loop diuretic - oral furosemide - if severe

143
Q

SIADH Cx

A

Cx of hyponatraemia - gait disturbance, falls, cerebral oedema

Phase 2a Concise (9 decks)

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