General

Question 1

Causes of hyponatraemia

Answer 1

Drugs: thiazides, loop diuretics
Diseases: addison’s, heart failure, SIADH, hypothyroidism

Question 2

Causes and treatment of hypernatraemia

Answer 2

Sodium loading (diet, infusion)
Un replaced water loss (dehydration, sweating, diabetes insipidus... 

Treat with hypotonic solution (IV dextrose 5%)

Question 3

Hypokalaemia level and ECG findings

Answer 3

<3. 5 mmol/L. T wave inversion and flattening, QT prolongation, prolonged PR, U wave, mild ST depression

Question 4

Hyperkalaemia level and ECG findings

Answer 4

> 5.5 mmol/L. ECG shows tall tented T wave, shortened QT, PR elongation

Question 5

Causes of hyperkalaemia

Answer 5

Drugs: ACE inhibitors, K+ sparing diuretics, spironolactone.
Other causes include failure, addisons, severe acidosis, hypovolaemia

Question 6

Management of hyperkalaemia

Answer 6

If less than 6mmol/l: stop offending drugs, change diet.
If more than 6.5mmol/l: IV calcium gluconate, IV insulin (5-10units with 50ml glucose over 5-15min. Salbutamol nebulised may also be used

Question 7

Management of hyponatraemia

Answer 7

Treatment is 0.9% saline if hypovolaemic. Do not raise Na by more than 8mmol/l per day due to risk of central pontine myelinolysis
If euvoleumic (SIADH), fluid restrict to 600-700 ml a day. 
If hypervolaemic, restrict fluid and salt, consider loop diuretic. 

Do not exceed 8 mmol reduction per day due to risk of osmotic demyelination

Question 8

Mechanism behind diabetic acidosis

Answer 8

Occurs mostly in type I diabetics. Body thinks not enough glucose so it produces glucose and ketones. These can be buffered by the kidneys for a while until it can’t leading to high levels of ketones and glucose in the blood

Question 9

Symptoms and signs of diabetic ketoacidosis

Answer 9

Confusion, polyuria, polydipsia, blurred vision, vomiting, acetone breath smell, kussmal respiration, tachycardia and hypotension

Question 10

Investigation results in diabetic ketoacidosis: VBG, ketones, glucose, U&E (K and Na)

Answer 10

VBGs will show a metabolic acidosis with raised anion gap. Bloods will show high ketones, high glucose. U&E shows hyperkalaemia (due to lack of insulin and shifting of K+ out of cells) or hypokalaemia (in severe DKA due to diuresis loss).

Question 11

Management of diabetic ketoacidosis

Answer 11

Give fluid replacement (normal saline) with fixed insulin infusion until K+ back to normal. Then, give potassium replacement (not more than 10 mmol/h)

Question 12

Hyperosmolar hyperglycaemic state

Answer 12

Most,y in type II. A hyperglycaemia without ketosis because insulin is still produced. It leads to volume depletion and in HHS this is not corrected by water intake to due inability to communicate or drinking sugary drinks. More gradual onset than DKA.

Question 13

Lab results (fluid balance) and Management of hyperosmotic hyperglycaemic state

Answer 13

You see hyperglycaemia (above 30) with hypovolaemia and hyperosmolaroty. Fluid resuscitation 1L normal saline over 1-2h. If not better, give insulin