Fluid and Electrolyte Imbalances

Question 1

Give some of the signs and symptoms of hypercalcaemia.

Answer 1

Bone pains, stones, psychiatric issues.

Question 2

What can be used to treat hypercalcaemia?

Answer 2

Cinacalcet.

Question 3

Give some of the signs and symptoms of hypocalcaemia.

Answer 3

Convulsions, arrhythmias, numbness.

Question 4

What can be used to treat hypocalcaemia?

Answer 4

Calcium salts.

Question 5

How does cinacalcet help to reduce serum calcium levels?

Answer 5

It acts as a calcimimetic, reducing the secretion of parathyroid hormone, reducing serum calcium levels.

Question 6

Give some of the signs and symptoms of hypomagnesaemia.

Answer 6

Arrhythmias, hypokalaemia, hypocalcaemia.

Question 7

What can be used to treat hypomagnesaemia?

Answer 7

Magnesium salts.

Question 8

Give some signs and symptoms of hyperphosphatemia.

Answer 8

Ectopic calcification (a pathologic deposition of calcium salts in tissues or bone growth in soft tissues), hyperparathyroidism.

Question 9

What can be used to treat hyperphosphatemia?

Answer 9

Aluminium hydroxide, phosex, sevlamer.

Question 10

Give some signs and symptoms of hypophosphataemia.

Answer 10

Weak muscles, mental issues, blood disorders.

Question 11

How is acute hyperkalaemia treated?

Answer 11

IV soluble insulin with glucose, nebulised salbutamol, calcium gluconate for cardioprotection.

Question 12

How is acute hypokalaemia treated?

Answer 12

Potassium overdose can be fatal. Premixed infusion solution containing potassium should be used where possible. Potassium chloride solution for infusion must be given by slow IV infusion under ECG control, ensuring adequate urine control and careful monitoring of electrolytes.

Question 13

Why should rapid infusions of potassium solutions be avoided?

Answer 13

Rapid infusions can be fatal and lead to cardiac arrhythmias.

Question 14

What is the maximum infusion rate for potassium chloride solution as advised by manufacturers?

Answer 14

20 mmol of potassium per hour.

Question 15

When may an infusion rate of greater than 20 mmol per hour of potassium be given?

Answer 15

Under specialist supervision in severe potassium depletion.

Question 16

Give some signs and symptoms of hyperkalaemia?

Answer 16

Fatigue, numbness, tingling, nausea, vomiting, trouble breathing, chest pain, irregular heartbeat.

Question 17

Which drugs can cause hyperkalaemia?

Answer 17

ACE inhibitors, potassium supplements, NSAIDs, heparins, spironolactone, amiloride.

Question 18

Give some signs and symptoms of hypokalaemia?

Answer 18

Constipation, irregular heartbeat, fatigue, muscle damage, muscle spasms, tingling, numbness.

Question 19

Which drugs can cause hypokalaemia?

Answer 19

Diuretics, beta-2 agonists, insulin, corticosteroids.

Question 20

Give some signs and symptoms of hypernatremia.

Answer 20

Dehydration, thirst, osmotic damage of cells (confusion, muscles twitching or spasms, seizures).

Question 21

Which drugs can cause hypernatraemia?

Answer 21

Corticosteroids, IV abx with sodium, oral contraceptive, sodium bicarb.

Question 22

How is hypernatraemia treated?

Answer 22

Correction of relative water deficit if IV administered via dextrose or saline infusion. Rapid correction can lead to cerebral oedema.

Question 23

Give some signs and symptoms of hyponatraemia.

Answer 23

Nausea and vomiting, headache, confusion, fatigue, loss of appetite, irritability, osmotic damage of cells (confusion, muscle twitching or spasms, seizures).

Question 24

Which drugs can cause hyponatraemia?

Answer 24

Antidepressants, desmopressin, carbamazepine, diuretics, lithium.

Question 25

How is hypovolemic hyponatraemia treated?

Answer 25

IV saline.

Question 26

How is euvolemic hyponatraemia treated?

Answer 26

Fluid restriction and removal of stimuli for ADH.

Question 27

How is hypervolemic hyponatraemia treated?

Answer 27

Address underlying heart or liver faliure.