MedEd Flashcards
A 26 year old unconscious man is brought into A&E having been found lying alone on the street with needles next to him. The patient’s GCS = 11, RR = 10, BP = 97/65 mmHg and has pinpoint pupils. This patient likely has: Alcohol toxicity Aspirin overdose Opiate overdose Paracetamol overdose Warfarin toxicity
Opiate overdose
A 26 year old unconscious man is brought into A&E having been found lying alone on the street with needles next to him. The patient’s GCS = 11, RR = 10, BP = 97/65 mmHg and has pinpoint pupils. The most appropriate treatment is: IV naltrexone IV naloxone Mechanical Ventilation IV N-Acetyl-Cysteine IV Sodium Bicarbonate
IV naloxone
A 25 year old man is rushed to A&E after presenting with vomiting, hyperventilation and ringing in his ears. ABG shows a respiratory alkalosis.
The most likely cause of his presentation is:
Alcohol toxicity
Aspirin Overdose
Opiate Overdose
Paracetamol Overdose
Warfarin toxicity
Aspirin Overdose
what are different types of opiates
heroin
morphine
codeine
what are risk factors for opiate overdose
IVDU
patients in chronic pain
what is the triad of features in opiate overdose
CNS depression (coma) Respiratory depression Pinpoint pupils
what might patients with opiate overdose have (to do with bowel movements)
constipation
what is used for investigation and management of opiate overdose
IV naloxone
what are associations or risk factors for aspirin overdose
suicide attempts
accidents in children
what are features of aspirin overdose
hyperventilaiton
tinnitus
vomiting
sweating
what are investigations for aspirin overdose
salicyclate levels
ABG
-respiratory alkalosis (early due to hyperventilation)
-metabolic acidosis (late)
what are associations or risk factors with paracetamol overdose
chronic alcohol use (enzyme inducer)
intentional self harm
what are features of paracetamol overdose
asymptomatic - 1st 24hrs
then acute liver failure
-abdominal pain, vomiting, confusion (encephalopathy)
what investigations are completed in paracetamol overdose
paracetamol levels at 4hours post ingestion
ABG for acidosis
when are paracetamol levels at their highest in the plasma
4hours post ingestion
what is the management for paracetamol overdose
IV N-acetyl cysteine
what are features of digoxin overdose
xanthopsia (yellow-green halos)
arrhythmias
hypokalaemia
N+V
what are features of iron overdose
D+V
liver failure
drowsiness + coma
what can causes of hyponatraemia be split into
hypovolaemia
euvolaemia
hypervolaemia
what are hypovolaemic causes of hyponatraemia
- D+V
- diuretics
what are euvolaemic causes of hyponatraemia
- hypothyroidism
- adrenal insufficiency
- SIADH
what are hypervolaemic causes of hyponatraemia
- HF
- cirrhosis
- nephrotic syndrome
how is hyponatraemia caused by diuretics investigated
measure low urine sodium
what is the first line investigation for hyponatraemia
short synacthen test
what is the management for hypovolaemic hyponatraemia
volume replacement with 0.9% saline
stop diuretics
what is the management for euvolaemic hyponatramia
fluid restriction
treat cause
what is the management for hypervolaemic hyponatraemia
fluid restriction
treat cause
what cancer can cause SIADH
small cell lung cancer
what infection can cause small cell lung cancer
pneumonia
what is the presentation of SIADH
confusion, lethargy, N+V, muscle weakness
what is the first line management for SIADH
fluid restriction
what is the management for SIADH
1 fluid restriction 2 demeclocycline (DMCT) -for ADH resistance 3 tolvaptan -V2 receptor antagonist
what is given in severe cases of SIADH (low GCS and seizures)
hypertonic 3% saline
what is a serious complication of SIADH
central pontine myelinolysis
what is central pontine myelinolysis
osmotic demyelination
how does central pontine myelinolysis occur
rapid correction of serum Na which leads to seizures and coma
what can causes of hypernatraemia be split into
hypovolaemia
euvolaemia
what are hypovolaemic causes of hypernatraemia
Losses
- GI losses (D+V)
- Skin losses (burns, sweating)
- Renal losses (osmotic diuresis with hyperglycaemia)
what are euvolaemic causes of hypernatraemia
inability to access water (elderly)
DI (cranial or nephrogenic)
what investigations are competed for DI
1 glucose (exclude DM) 2 high plasma (concentrated) and low urine osmolality (dilute)
how does DI respond to the water deprivation test
urine osmolality does not increase (become more concentrated)
what is the management for DI
fluid replacement
- correct water deficit with 5% dextrose
- correct fluid volume depletion (hypovolaemia) with 0,9% saline
what might persistant diarrhoea in the question indicate
dehydration
what are causes of hypokalaemia
GI - vomiting Renal -diuretics -primary hyperaldosteronism Redistribution into cells -Salbutamol -Alkalosis
what is primary hyperaldosteronism
conns syndrome
what are features of hypokalaemia
muscle weakness
arrhythmias
polyuria
why does alkalosis cause hypokalaemia
potassium moves into cells in an attempt to displace H+ cells out of cells to normalise pH
what happens to the aldosterone: renin ratio in conns
it is increased (higher levels of aldosterone in conns)
what happens to levels of Na and K in conns syndrome
low K and high Na
what happens to levels of Na and K in addisons disease
high K and low Na
what is the treatment for hypokalaemia
treat cause
if K between 3-3.5 give oral potassium chloride
if K below 3 give IV potassium chloride
what is addisons disease
low aldosterone
what are causes of hyperkalaemia
addisons disease (low aldosterone)
drugs (ACEi, ARBs, spironolactone)
renal impairment
when is K released from cells in huge amounts
rhabodomyolysis
acidosis
what is the management for hyperkalaemia
10ml 10% calcium gluconate (cardioprotective)
50ml 50% dextrose + 10units of insulin
nebulised salbutamol
treat cause
what are causes of hypocalcaemia
1 renal failure 2 vit D deficiency -lack of sunlight -malabsorption (IBD) 3 low PTH
what syndrome causes low PTH
di-george syndrome
how does hypocalcaemia present
1 neruomuscular excitability -trousseau's sign -chvostek's sign 2 convulsions 3 paraesthesia
what is seen on ECG with hypocalcaemia
arrhythmias + prolonged QT interval
what investigations should be completed for hypocalcaemia
1 bloods
- Ca first
- PTH
- Vit D, ALP
what is the management for hypocalcaemia
calcium and Vit D replacement
what causes hypercalcaemia
1 PTH suppression
- malignancy
- sarcoidosis
what malignancies commonly suppress PTH and cause hypercalcaemia
multiple myeloma
bone mets
squamous cell lung cancer (PTHrP)
what does sarcoidosis do to PTH
suppresses it and causes hypercalcaemia
when is PTH not suppressed in hypercalcaemia
with primary or tertiary hyperparathyroidism
how does hypercalcaemia present
bones, stones, abdominal groans and psychiatric mones
polyuria and polydipsia
constipation, pain (renal stones)
depression + confusion
what are the investigations for hypercalcaemia
1 bloods
- Ca (first line)
- PTH
what is the management for hypercalcaemia
IV saline rehydration
what is the management for hypercalcaemia caused by malignancy
IV saline rehydration and biphosphonates (pamidronate)
