Haematology Flashcards
What are symptoms of hypokalaemia?
Often asymptomatic
Severe:
- Muscle weakness
- confusion
- ECG changes (ST wave depression) - leading to arrhythmias / tachycardia
What are symptoms of hyperkalaemia?
Often asymptomatic
Ventricular fibrillation
Cardiac arrest
What are symptoms of hyponatraemia?
N&V Headache Confusion Drowsiness, fatigue Restlessness / irritability Muscle weakness, spasms or cramps Seizures
What are 6 drug causes of hyponatraemia?
SSRIs Diuretics PPIs Chemotherapies (vincristine) Carbamazepine Sulfonylureas e.g. gliclazide
What are 8 drug causes of hypokalaemia?
Diuretics (Loop and thiazide) Laxatives Insulin Corticosteroids Enemas Theophylline High dose B2 agonists Sodium bicarbonate
Which 6 drugs are associated with hyperkalaemia?
K+ sparing diuretics e.g. spironolactone ACEi Trimethoprim NSAIDs ARBs Potassium-replacement therapy
Should you replace potassium in hypokalaemia caused by diuretics?
Best to just switch to potassium-sparing diuretics.
What are SEs of potassium salt replacement?
N&V
What is classed a severe hyperkalaemia?
> 6.5 mmol/L or the presence of ECG changes
How do you treat acute severe hyperkalaemia?
Calcium gluconate 10%
Soluble insulin with 50mL gluocose 50%
Salbutamol nebs or IV
Correct causative acidosis with sodium bicarb IV
How do you treat hyponatraemia?
Saline IV
Mild/moderate: sodium chloride or bicarb.
What is given for chronic acidotic states, such as uraemic acidosis?
Sodium bicarbonate
What is a never-event associated with IV potassium?
Mis-selection of strong potassium (>10%)
What is the max conc potassium can be given peripherally?
40 mmol/L
What is the maximum rate IV potassium can be given?
20 mmol/hour
How is high strength potassium chloride safety ensured?
Only used pre-mixed bags
Store separately
Clearly identifiable from other strengths
When is calcium requirement higher?
Childhood Pregnancy Lactation Old age Impaired absorption
How do you treat acute severe hypocalcaemia?
Calcium Gluconate 10% (monitor plasma-calcium + ECG)
How do you treat severe hypercalcaemia?
- Correct dehydration first
- Discontinue drugs which cause hypercalcaemia e.g. thiazides + vit D compounds
- Bisphosphonates to inhibit mobilisation of calcium from skeleton - pamidronate best
- Corticosteroids
- Calcitonin can be used if malignancy is cause
How is hypercalciuria managed?
- Identify cause + treat
- Increase fluid intake
3 Bendroflumethiazide
How do you treat severely low phosphate?
Sodium glycerophosphate
What are 3 drugs associated with hypernatraemia?
Lithium, mannitol, amphotericin
What are 2 drugs associated with hypomagnesaemia?
Diuretics
PPIs
What are 3 drugs associated with hypermagnesaemia?
Laxatives
Antacids
Mg supplements
