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Learning Objectives Stage 2 > General > Flashcards

General Flashcards

1
Q

What is hypovolaemia?

A

Overall fluid deficit in the body

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2
Q

What are three general causes of hypovolaemia?

A
  • Poor fluid intake
  • Excessive fluid loss
  • Third space loss of fluid
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3
Q

What is third space loss of fluid?

A

Where fluid remains in the body but has shifted from the intravascular space to another compartment within the body

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4
Q

What is hypervolaemia?

A

Excess of fluid in the body

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5
Q

What is hypervolaemia also known as?

A

Fluid overload

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6
Q

What are the symptoms of fluid overload?

A
  • Rapid weight gain
  • Pitting oedema in arms, legs and face
  • Swelling in the abdomen
  • SOB secondary to pulmonary oedema
  • High BP
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7
Q

What are the early symptoms of hypovolaemia?

A
  • Headache
  • Fatigue
  • Weakness
  • Thirst
  • Dizziness
  • Sunken eyes
  • Dry, less elastic skin
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8
Q

What are the more severe symptoms of hypovolaemia?

A
  • Oliguria
  • Cyanosis
  • Abdominal and chest pain
  • Hypotension
  • Tachycardia
  • Cold peripheries
  • Altered mental status
  • Weak, thready pulse
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9
Q

What is severe hypovolaemia also known as?

A

Hypovolaemic shock

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10
Q

What is normal urine output for an adult?

A

0.5-2ml/kg body weight per hour

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11
Q

Na concentration in mild hyponatraemia:

A

130mmol/L

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12
Q

Na concentration in moderate hyponatraemia:

A

125-129mmol/L

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13
Q

Na concentration in severe hyponatraemia:

A

<125mmol/L

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14
Q

What are the clinical features of hyponatraemia?

A
  • Gait instability
  • Falls
  • Concentration and cognitive defects
  • Nausea
  • Vomiting
  • Headache
  • Confusion
  • Reduced consciousness
  • Seizures
  • Cardiorespiratory arrest
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15
Q

What is the biggest danger in hyponatraemia?

A

Cerebral oedema

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16
Q

What are the potential causes of hyponatraemia if the urinary Na is >30mmol/L?

A
  • SIADH
  • AVP (ADH)-like drugs
  • Salt-wasting
  • Vomiting
  • Hypoadrenalism
  • Cerebral salt-wasting
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17
Q

What is SIADH?

A

Syndrome of inappropriate ADH secretion (SIADH) is characterised by hyponatraemia secondary to the dilutional effects of excessive water retention.

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18
Q

What are the potential causes of hyponatraemia if the urinary Na is <30mmol/L?

A
  • Heart failure
  • Portal hypertension
  • Nephrotic syndrome
  • Hypoalbuminaemia
  • Third space loss
  • GI loss (D&V)
  • Previous diuretic use
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19
Q

In mild-moderate hyponatraemia you treat with _____ _________.

A

Fluid restriction

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20
Q

What is the management of severe hyponatraemia?

A

1) Give hypertonic saline with close monitoring and serial blood tests
2) After a 5mmol/L rise stop infusion and treat according to the underlying diagnosis

21
Q

Na concentration in hypernatraemia:

A

> 145mmol/L

22
Q

If urine osmolality < plasma osmolality look for ________ ________.

A

Diabetes insipidius

23
Q

What are the causes of low volume hypernatraemia?

A
  • Sweating
  • Vomiting
  • Diarrhoea
  • Diuretics
  • Kidney disease
24
Q

What are some causes of normal volume hypernatraemia?

A
  • Fever
  • Extreme thirst
  • Diabetes insipidus
  • Lithium
25
Q

What are some causes of high volume hypernatraemia?

A
  • Hyperaldosteronism

- Excessive IV saline

26
Q

What are the ECG changes seen in hyperkalaemia?

A
  • Tall-tented T waves
  • Small P waves
  • Widened QRS leading to a sinusoidal pattern and asystole
27
Q

What are the causes of hyperkalaemia?

A
  • AKI
  • Metabolic acidosis
  • Addison’s disease
  • Rhabdomyolysis
  • Massive blood transfusion
  • Burns or other severe injuries
  • Poorly controlled diabetes
28
Q

What drugs can cause hyperkalaemia?

A
  • Beta blockers
  • K sparing diuretics
  • ACE inhibitors
  • Angiotensin II receptor blockers
  • Spironolactone
  • Ciclosponrin
  • Heparin
29
Q

What are the symptoms of chronic hyperkalaemia?

A
  • Muscle weakness
  • Numbness
  • Tingling
  • Nausea
30
Q

What are the symptoms of acute-onset hyperkalaemia?

A
  • Heart palpitations
  • Dyspnoea
  • Chest pain
  • Nausea/vomiting
31
Q

K concentration in hyperkalaemia:

A

> 5.5mmol/L

32
Q

At what levels does hyperkalaemia become an emergency?

A

Greater than 6.5mmol/L

33
Q

What is the treatment for hyperkalaemia in patients with ECG changes?` Why are they used?

A

IV calcium salts to stabilise the resting cardiac membrane potential.

34
Q

How can hyperkalaemia be treated?

A
  • IV calcium salts
  • IV insulin combined with an infusion of glucose
  • Nebulised β-2 adrenoceptor agonists can augment the effects of the insulin and glucose
35
Q

Why does hyperkalaemia tend to be associated with acidosis?

A

Because as K levels rise fewer hydrogen ions can enter the cell.

36
Q

Mild hypokalaemia levels are:

A

<3.5mmol/L

37
Q

Sever hypokalaemia levels are:

A

<2.5mmol/L

38
Q

What are the symptoms of mild hypokalaemia?

A
  • Hypertension

- Abnormal heart rhythm

39
Q

What are the symptoms of severe hypokalaemia?

A
  • Muscle weakness
  • Myalgia
  • Tremor
  • Muscle cramps
  • Constipation
  • Flaccid paralysis
  • Hyporeflexia (absence of reflexes)
40
Q

What are the causes of hypokalaemia?

A
  • Diarrhoea
  • Excessive perspiration
  • Vomiting
  • Pancreatic fistulae
  • Adenoma
  • Drugs
  • Diabetic ketoacidosis
  • Polyuria
  • Magnesium deficiency
  • Primary hyperaldosteronism (Conn’s syndrome)
  • Cushing’s syndrome
  • Renal tubular acidosis
41
Q

What medications cause hypokalaemia?

A
  • Loop diuretics
  • Thiazide diuretics
  • Amphotericin B
  • Cisplatin
  • Acetazolamide
42
Q

What is the management of hypokalaemia?

A
  • Correct any other underlying electrolyte abnormalities such as magnesium deficiency
  • Administer KCL in NaCl solution at a maximum rate of 20mmol/hour
43
Q

What are the likely causes of hypokalaemia when seen with metabolic alkalosis?

A
  • Vomiting
  • Thiazide and loop diuretics
  • Cushing’s syndrome
  • Conn’s syndrome (primary hyperaldosteronism)
44
Q

What are the likely causes of hypokalaemia when seen with metabolic acidosis?

A
  • Diarrhoea
  • Renal tubular acidosis
  • Acetazolamide
  • Partially treated diabetic ketoacidosis
45
Q

What are the likely causes of hypokalaemia when seen with hypertension?

A
  • Cushing’s syndrome
  • Conn’s syndrome (primary hyperaldosteronism)
  • Liddle’s syndrome
  • 11-beta hydroxylase deficiency*
46
Q

What are the likely causes of hypokalaemia when seen with hypotension?

A
  • Diuretics
  • GI loss (e.g. Diarrhoea, vomiting)
  • Renal tubular acidosis (type 1 and 2)
  • Bartter’s syndrome
  • Gitelman syndrome
47
Q

What are the ECG features of hypokalaemia?

A
  • U waves
  • Small or absent T waves (occasionally inversion)
  • Prolonged PR interval
  • ST depression
  • Long QT
48
Q

Rhyme to remember ECG changes in hypokalaemia:

A

In hypokalaemia, U have no Pot and no T, but a long PR and a long QT

Learning Objectives Stage 2 (2 decks)

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