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Clinical stuff > Fluids and electrolytes > Flashcards

Fluids and electrolytes Flashcards

1
Q

routine maintenance child requirments
1st 10 kg
2nd 10 kg
remainder body weight

A

100ml/kg/day
50ml/kg/day
20ml/kg/day

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2
Q

routine maintenance child requirments
1st 10 kg
2nd 10 kg
remainder body weight

A

100ml/kg/day
50ml/kg/day
20ml/kg/day

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3
Q

Adult fluid requirments - fluid, elec and glucose?

A

25-30ml/kg/day fluids, 1mmol NA, CL, K, / kg/ 24 and 50-100 g glucose/day

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4
Q

crystalloid is?

A

solutions of small molecules in water (e.g. sodium chloride, Hartmann’s, dextrose). Used for resus

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5
Q

colloid is?

A

solutions of larger organic molecules (e.g. albumin, Gelofusine)

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6
Q

obese/frail/ complication adult fluid requirment?

A

use lower end, ie. 25ml\kg’day

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7
Q

male HB range?

A

130-180

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8
Q

female HB range

A

115-165

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9
Q

normal WCC range?

A

4-11

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10
Q

Na normal range?

A

135-145

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11
Q

adjusted Ca normal range?

A

2.1-2.6 (2.9 is hypercalaemia)

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12
Q

Mg normal range?

A

0.70-1

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13
Q

Urea normal range?

A

2-7

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14
Q

Creatinine normal rnage

A

55-120 umol/l

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15
Q

HCO3 normal range?

A

22-28 mmol/l

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16
Q

CK normal range?

A

35-250

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17
Q

ABG normal pCO2?

A

4.5-6Kpa

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18
Q

ABG normal PO2?

A

10-14kPa

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19
Q

normal blood PH?

A

7.35 - 7.45

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20
Q

Normal CRP?

A

<10

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21
Q

Normal ESR for men?

A
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22
Q

normal ESR for women?

A

< age +10 /2

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23
Q

normal PT?

A

10-14

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24
Q

normal APTT?

A

25-35

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25
Q

normal PO4?

A

0.8-1.4

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26
Q

Normal TSH?

A

0.5-5.5 mu/l

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27
Q

Normal serum amylase?

A

70-300 u/l

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28
Q

Microcytic anaemia range?

A

MCV<80, think Fe defciency thalassaemia,

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29
Q

Normocytic anaemia range? what to IX next?

A

MCV 80-100, check reticulocytes.

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30
Q

Normal neutrophil range?

A

2.0-7.0 * 109/l

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31
Q

Normal lymphocyte range?

A

1.0-3.0 * 109/l

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32
Q

normal K+ range?

A

3.5 - 5.0 mmol/l

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33
Q

normal Cr range?

A

55-120 umol/l

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34
Q

Normal bilirubin range?

A

3-17 umol/l

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35
Q

Normal ALT range?

A

3-40 iu/l

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36
Q

normal ALP range?

A

30-100 umol/l

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37
Q

Normal GGT range?

A

8-60

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38
Q

normal AST range?

A

3-30

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39
Q

normal FBG?

A

4-6

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40
Q

normal hba1c

A

<48

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41
Q

normal HDL?

A

> 1

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42
Q

normal LDL?

A

<3

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43
Q

normal cholesterol?

A

<5

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44
Q

normal serum ketones?

A

<0.6

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45
Q

norma vitamin D?

A

> 500

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46
Q

Name the tumour markers?

A

Afetoprotein, Ca-125, bHCG, PSA,

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47
Q

Which clotting marker measures overall clotting factor ? (measured the extrinsic pathway?

A

PT and INR (standardised version). Play Tennis Outside.
affected by TF, factor 7
could signify: liver diease, DIC, vit K deficiency, warfarin

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48
Q

Normal PT?

A

12-13

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49
Q

Normal APTT?

A

35-45 secs

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50
Q

Which clotting factor used to measure intrinsic pathway - indicates factors 7, vWf, 9, 11 overal consumption?

A

APTT Play Table Tennis Inside

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51
Q

abnormal APTT includes?

A 
Haemophilia A (VIII – X-linked recessive)
Haemophilia B (IX – X-linked recessive)
Haemophilia C (XI – autosomal recessive)
von Willebrands disease (as vWF pairs up with factor VIII)
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52
Q

What can cause a high APTT?

A

anti-phospholipid syndrome

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53
Q

Adult fluid requirments - fluid, elec and glucose?

A

25-30ml/kg/day fluids, 1mmol NA, CL, K, / kg/ 24 and 50-100 g glucose/day

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54
Q

crystalloid is?

A

solutions of small molecules in water (e.g. sodium chloride, Hartmann’s, dextrose). Used for resus

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55
Q

colloid is?

A

solutions of larger organic molecules (e.g. albumin, Gelofusine)

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56
Q

obese/frail/ complication adult fluid requirment?

A

use lower end, ie. 25ml\kg’day

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57
Q

male HB range?

A

130-180

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58
Q

female HB range

A

115-165

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59
Q

normal WCC range?

A

4-11

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60
Q

Na normal range?

A

135-145

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61
Q

adjusted Ca normal range?

A

2.1-2.6 (2.9 is hypercalaemia)

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62
Q

Mg normal range?

A

0.70-1

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63
Q

Urea normal range?

A

2-7

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64
Q

Creatinine normal rnage

A

55-120 umol/l

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65
Q

HCO3 normal range?

A

22-28 mmol/l

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66
Q

CK normal range?

A

35-250

67
Q

ABG normal pCO2?

A

4.5-6Kpa

68
Q

ABG normal PO2?

A

10-14kPa

69
Q

normal blood PH?

A

7.35 - 7.45

70
Q

Normal CRP?

A

<10

71
Q

Normal ESR for men?

A
72
Q

normal ESR for women?

A

< age +10 /2

73
Q

normal PT?

A

10-14

74
Q

normal APTT?

A

25-35

75
Q

normal PO4?

A

0.8-1.4

76
Q

Normal TSH?

A

0.5-5.5 mu/l

77
Q

Normal serum amylase?

A

70-300 u/l

78
Q

Microcytic anaemia range?

A

MCV<80, think Fe defciency thalassaemia,

79
Q

Normocytic anaemia range? what to IX next?

A

MCV 80-100, check reticulocytes.

80
Q

Normal neutrophil range?

A

2.0-7.0 * 109/l

81
Q

Normal lymphocyte range?

A

1.0-3.0 * 109/l

82
Q

normal K+ range?

A

3.5 - 5.0 mmol/l

83
Q

normal Cr range?

A

55-120 umol/l

84
Q

Normal bilirubin range?

A

3-17 umol/l

85
Q

Normal ALT range?

A

3-40 iu/l

86
Q

normal ALP range?

A

30-100 umol/l

87
Q

Normal GGT range?

A

8-60

88
Q

normal AST range?

A

3-30

89
Q

normal FBG?

A

4-6

90
Q

normal hba1c

A

<48

91
Q

normal HDL?

A

> 1

92
Q

normal LDL?

A

<3

93
Q

normal cholesterol?

A

<5

94
Q

normal serum ketones?

A

<0.6

95
Q

norma vitamin D?

A

> 500

96
Q

Name the tumour markers?

A

Afetoprotein, Ca-125, bHCG, PSA,

97
Q

Which clotting marker measures overall clotting factor ? (measured the extrinsic pathway?

A

PT and INR (standardised version). Play Tennis Outside.
affected by TF, factor 7
could signify: liver diease, DIC, vit K deficiency, warfarin

98
Q

Normal PT?

A

12-13

99
Q

Normal APTT?

A

35-45 secs

100
Q

Which clotting factor used to measure intrinsic pathway - indicates factors 7, vWf, 9, 11 overal consumption?

A

APTT Play Table Tennis Inside

101
Q

abnormal APTT includes?

A 
Haemophilia A (VIII – X-linked recessive)
Haemophilia B (IX – X-linked recessive)
Haemophilia C (XI – autosomal recessive)
von Willebrands disease (as vWF pairs up with factor VIII)
102
Q

What can cause a high APTT?

A

anti-phospholipid syndrome

103
Q

Thrombin time indicates?

A

10-15 secs. how fast fibrinogen is converted to fibrin

104
Q

Isolated APTT rise and bruising heavy beeling? consider?

A

haemophilias

105
Q

Raised PT/INR, APTT, bleeding time on finger pick and reduced platelet count? consider/

A

DIC disease. also total coagulopathy. give platelets and clotting factors.

106
Q

Who should you never gie platelets to? (3 conditions)

A

ITP/TTP/ HUS

107
Q

Raised bleeding time but low platelet count consider?

A

ITP/TTP/HUS

108
Q

Whats included in basic LFTs?

A 
Alanine transaminase (ALT)
Aspartate aminotransferase (AST)
Alkaline phosphatase (ALP)
Gamma-glutamyltransferase  (GGT)
Bilirubin
Albumin
Prothrombin time (PT)
109
Q

Which LFTs used to distinguish between hepatocellular damage and cholestasis

A

ALT, AST, ALP and GGT

110
Q

Which LFT’s used to assess liver synthetic function?

A

Bilirubin, albumin and PT

111
Q

Where is ALT found and when is it raised?

A

found in high concentrations within hepatocytes and enters the blood following hepatocellular injury.

112
Q

Where is ALP found and when is it raised?

A

particularly concentrated in the liver, bile duct and bone tissues. ALP is often raised in liver pathology due to increased synthesis in response to cholestasis. As a result, ALP is a useful indirect marker of cholestasis.

113
Q

LFT: hepatocellular picture?

A

greater than 10-fold increase in ALT and a less than 3-fold increase in ALP

114
Q

LFT: cholestatic picture?

A

less than 10-fold increase in ALT and a more than 3-fold increase in ALP. (also raised GGT, ALP)

115
Q

Raised ALP and GGT very suggestive of?

A

cholestatic picture

116
Q

Raised GGT can be suggestive of? other causes?

A

biliary epithelial damage and bile flow obstruction. It can also be raised in response to alcohol and drugs such as phenytoin.

117
Q

What drug raised gGT?

A

alcohol, phenytoin

118
Q

Isolated rise in ALP could be caused by? (without GGT)

A 
anything leading to bone breakdown:
Bony metastases or primary bone tumours (e.g. sarcoma)
Vitamin D deficiency
Recent bone fractures
Renal osteodystrophy
119
Q

Patient jaundiced but no rise in ALP/ ALT could mean?

A

Isolated rise in bilirubin, pre hepatic CX of jaundice

120
Q

Isolate bilirubin rise caused by?

A

COMMON: gilbert’s syndrome (no TX necessary)

haemolysis, - check blood film, FBC,reticulocyte count,, haptoglobin, LDH to confirm)

121
Q

liver’s main synthetic functions

A

Conjugation and elimination of bilirubin
Synthesis of albumin
Synthesis of clotting factors
Gluconeogenesis

122
Q

Investigations that can be used to assess synthetic liver function include:

A

Serum bilirubin
Serum albumin
Prothrombin time (PT)
Serum blood glucose

123
Q

Which bilirubin is soluble in urine as urobilinogen?

A

conjugated bilirubin. causes urine to become darker.

124
Q

What level o fbilirubin cauese visable jaundice?

A

> 60

125
Q

dark urine and normal stools CX?

A

hepatic cx

126
Q

Dark urin and pale stools cx?

A

post hepatic/ obstructive CX

127
Q

Causes of conjugated hyperbilirubinaemia

A

Hepatocellular injury

Cholestasis

128
Q

Why would albumin levels fall?

A

Liver disease resulting in a decreased production of albumin (e.g. cirrhosis).

Inflammation triggering an acute phase response which temporarily decreases the liver’s production of albumin.

Protein-losing enteropathies or nephrotic syndrome.

129
Q

ALT > AST is associated with

A

chronic liver disease

130
Q

AST > ALT is associated with

A

cirrhosis and acute alcoholic hepatitis

131
Q

Which function of the liver is usually last to become impaired?

A

Gluconeogenesis

132
Q

Acute Hepatocellular injury?

A

Poisoning (paracetamol overdose)
Infection (Hepatitis A and B)
Liver ischaemia

133
Q

Common causes of chronic hepatocellular injury

A

Alcoholic fatty liver disease
Non-alcoholic fatty liver disease
Chronic infection (Hepatitis B or C)
Primary biliary cirrhosis

134
Q

Less common causes of chronic hepatocellular injury

A

Alpha-1 antitrypsin deficiency
Wilson’s disease
Haemochromatosis

135
Q

What does a typical liver screen include?

viral, antibodies, IG,

A

LFTs
Coagulation screen
Hepatitis serology (A/B/C)
Epstein-Barr Virus (EBV)
Cytomegalovirus (CMV)
Anti-mitochondrial antibody (AMA)
Anti-smooth muscle antibody (ASMA)
Anti-liver/kidney microsomal antibodies (Anti-LKM)
Anti-nuclear antibody (ANA)
p-ANCA
Immunoglobulins – IgM/IgG
Alpha-1 Antitrypsin (to rule out alpha-1 antitrypsin deficiency)
Serum Copper (to rule out Wilson’s disease)
Ceruloplasmin (to rule out Wilson’s disease)
Ferritin (to rule out haemochromatosis)

136
Q

how do you rule out haemochromatosis?

A

Ferritin

137
Q

How do you rule out wildons disease?

A

Ceruloplasmin and serum copper

138
Q

CX of brown urine?

A 
bile pigments (e.g. jaundice) or myoglobin (e.g. rhabdomyolysis) in the urine
antimalarial - chloroquine
139
Q

CX of red urine?

A

(macroscopic haematuria), porphyria, drugs such as rifampicin and certain foods (e.g. beetroot).

140
Q

Cloudy urine and sediment could mean?

A

UTI, renal stones, high protein (ie. nephrotic syndrome)

141
Q

Frothy urine case?

A

significant proteinuria, eg. nephrotic syndrome

142
Q

sweet urine odoru cx?

A

glycosuria, DM,renal tubular disease and some diabetic medications (e.g. SGLT2 inhibitors).

143
Q

High bilirubin in urine could mean?

A

biliary obstruction - pancreatic cancer?

144
Q

CX of ketones in urine?

A

DKA, starvation

145
Q

urinalysis: what is the specific gravity measurement?

A

amount of solute dissolved in the urine. ie. how dilute it is.

146
Q

More dilute urine causes?

A

diabetes insipidus and acute tubular necrosis

147
Q

Less dilute urine causes?

A

dehydration, glycosuria (e.g. diabetes mellitus) and proteinuria (e.g. nephrotic syndrome).

148
Q

Low urine PH cx?

A

starvation, diabetic ketoacidosis and other conditions that cause metabolic acidosis (e.g. sepsis).

149
Q

High urine PH causes?

A

UTI, metabolic alkalosis (e.g. vomiting) and medications (e.g. diuretics).

150
Q

Blood in urine CX?

A

red blood cells, haemoglobin and myoglobin in the urine may indicate urinary tract infection, renal stones, injury to the urinary tract, myoglobinuria (rhabdomyolysis), nephritic syndrome and malignancy of the urinary tract.

151
Q

increase urobilinogen in urine cx?

A

haemolysis (e.g. haemolytic anaemia, malaria).

152
Q

Nitrites in urine cx?

A

UTI (ecoli breakdown product or other gram negative organisms)

153
Q

Leukocyte esterase in urine could mean?

A

WCC in urine, UTI, haematuria causes.

154
Q

Hypoxaemia DX?

with air?

A

on air, Pa)2<10kPA

<8kPA severely ypoxaemia and in resp failure

155
Q

type 1 resp failrue dx?

A

hypoxaemia (PaO2 <8 kPa) with normocapnia (PaCO2 <6.0 kPa).

156
Q

type 2 resp failure dx?

A

hypoxaemia (PaO2 is <8 kPa) with hypercapnia (PaCO2 >6.0 kPa)

157
Q

type 2 resp failure cx?

A

alveolar hypoventilation, which prevents the patient from being able to adequately oxygenate and eliminate CO2 from their blood

158
Q

Why does hypoventilation occur?

A

airway obstuction,
Reduced compliance of the lung tissue/chest wall (e.g. pneumonia, rib fractures, obesity).
Reduced strength of the respiratory muscles (e.g. Guillain-Barré, motor neurone disease).
Drugs acting on the respiratory centre reducing overall ventilation (e.g. opiates).

159
Q

Resp alkalosis DX?

A

normal HC03, high ph >7.45, low c02

160
Q

Resp acidosis dx?

A

normal HC03, low ph <7.35, raised c02

161
Q

Anion gap formula?

A

Na+ – (Cl- + HCO3-)

162
Q

increased anion gap cause?

A 
increased acid production or ingestion
Diabetic ketoacidosis (↑ production)
Lactic acidosis (↑ production)
Aspirin overdose (ingestion of acid)
163
Q

reduced anion gap cx?

A

loss of hc03 or decreased acid excretion
Gastrointestinal loss of HCO3– (e.g. diarrhoea, ileostomy, proximal colostomy)
Renal tubular acidosis (retaining H+)
Addison’s disease (retaining H+)

164
Q

CX of resp alkalosis?

A

Anxiety (i.e. panic attack)
Pain: causing an increased respiratory rate.
Hypoxia: resulting in increased alveolar ventilation in an attempt to compensate.
Pulmonary embolism
Pneumothorax
Iatrogenic (e.g. excessive mechanical ventilation)

Clinical stuff (11 decks)

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