Fluid and Electrolytes (EXAM Q)

Question 1

F&E - Magnesium

Answer 1

Needed for enzyme generation
- Not well absorbed from GI
- Largest stores of magnesium is from bones
AEs: At high doses Diarrhoea
- Stop treatment and reduce dose if AE occurs

Question 2

Zinc deficiency

Answer 2

Only if evidence for it lacking give zinc otherwise dont.

Happen in ppl with not enough in diet, malabsorption, trauma, burns

Treats Wilsons disease (rare condition affects zincs absorption

Question 3

IV nutrition

Answer 3

TPN - total parenteral nutrition
IV nutrition that is given to;
- Undernourished PTs for surgery
- Chemo
- Radiation surgery
- Major surgery
- Prolong GI issues
- Coma, Trauma, refusal to eat, Pts with renal/kidney failure

TPN incs:
Amino acids, Glucose, fats, lipids, electrolytes, trace elements, vitamins

Question 4

Special diets

Answer 4

A diet modified to allow person to eat with no issues. (eg gluten free)

Phenylketonuria
Inability to break down protein phenylalanine.
- Restrict diet of this protein
- Minimise aspartame products they contain phenylalanine.
SYMPTOMS: Smelly breath, tremors, epilepsy, eczema, brain damage.

Question 5

Electrolytes (EXAM Q)

Answer 5

CHECK TABLE

Question 6

F&E - Phosphorus

Answer 6

Oral phosphate supplements + VIT D needed in small number of PTs with hypophosphatemia vit D resistant rickets.

Phosphate infusion occasionally used in alcohol dependence

Phosphate depletion happen in severe ketoacidosis

Sevelmar & lanthanum listened for treatment of hyperphosphatemia (For PTs on haemodialysis & peritoneal dialysis

Question 7

Acute porphyria

Answer 7

Metabolic issue when not enough haem is made.

Condition typically doesn’t effect until certain meds are given that can cause symptoms like Sever ABDO pain.
- MEDS - Anabolic steroids, antidepressants, sulphonylureas, Contras, HRT, Triazoles

Signs/Symptoms
Sever abdo pain, chest/legs/back pain, Constipation/diarrhoea, NV, red/brown urine, Muscle pain/paralysis

TREATMENT:
Haem arginate IV infusion

Question 8

Vitamin Deficiency

Answer 8

VIT A
Function - boosts immune system, helps vision in dim lights, keeps skin healthy
- cheese, eggs, oily fish, liver (very high)

Pregnancy - Too much vit A can be harmful to babies AVOID in Pregnancy

VIT B TABLE
Rare except B12.
Treat with thiamine (b1), riboflavin (b2), nicotinamide

Wernicke’s encephalopathy/Korsakoff psychosis - severe deficiency states esp. seen in chronic alcoholism (Treat with IV Vit B the oral thiamine long term)

Folic acid + Vit b12 - used for megaloblastic anaemia

Pyridoxine (B6) is rare but can occur during treatment with isoniazid or penicillamine

Folinic acid used in cytotoxic therapy

VIT C (Ascorbic acid)
Needed for scurvy
- Symptoms - bleeding gums

VIT D
Prevents/Treats rickets/Osteoporosis
EG Ergocalciferol (calciferol, VITD2), Colecalciferol (D3, Alfacalcidol, calcitriol)

• Happens with limited sunlight exposure/Diet deficiency

Paricalcitol (synthetic VIT D analogue) Prevent/Treats secondary hyperparathyroidism associated with chronic renal failure

PTs at risk of VIT D deficiency:
- Dark skin - less sensitive to synthesising VIT D
- >65 yrs or <4 yrs
- Low/NO sun exposure
- Pregnant/ BF esp. younger

VIT E
No value

VIT K
Produces blood clotting factors, Proteins for normal bone calcification, fat soluble vitamin (ADEK)
- Menadiol sodium phosphate - orally to prevent VIT K deficiency
- Oral coumarin anticoagulants interfere with VIT K Metabolism - reversed effects by giving VIT K

Question 9

Neural tube defects

Answer 9

Neural tube - tube that forms from the embryo making brain/Spinal cord.
- Defect is when incomplete closure happens 28 days after conception
- 5mg folic acid is given to pregnant to prevent these defects occurring.

Risk factors:
- Folate/B12 deficient mother
- Hx of infant with this issue
- Smoking, obesity, diabetes, use of AED

Supplement with folic acid b4 conception then until 12 week of pregnancy
- High dose used for higher risk ppl (5mg)