Metabolic Flashcards
What is main problem of hyponatraemia
Cerebral oedema
How treat symptomatic hyponatraemia
Hypertonic saline (3%)
What is cutoff sodium level to have to use hypertonic saline
Below 120mmol/L
What is risk of rapid correction of hypernatraemia
Cerebral oedema
Markers of deydration on bloods
Polycythaemia
Hypernatraemia
Urea raised out of proportion to creatinine
Euvolaemic causes of hyponatraemia
Hypothyroidism
SIADH
Addisons
Causes of hyponatraemia with high urinary sodium
SIADH
Hypothyroidism
Addisons
Diuretics
Preferred form of giving calcium if hypocalcaemic
Calcium gluconate as calcium chloride irritant
When give IV calcium gluconate in hypocalcaemia
Prolonged QT
Tetany
Seizures
Which drugs can cause hyperkalaemia
ACEi
ARB
Spironolactone
Heparin
Criteria for diagnosing FH
Simon broome
Management of asymptomatic hyperuricaemia
No need for allopurinol etc so no treatment
What is methaemoglobinaemia
When there is increased levels of haemoglobin where Fe2+ has been converted to Fe3+ which cant bind oxygen
What are causes of methaemoglobinaemia
Congenital
Acquired- Poppers typically due to nitrate
What causes chocolate coloured blood and chocolate cyanosis
methaemoglobinaemia
Presentation of methaemoglobinaemia
Chocolate cyanosis
SOB, anxiety
Acidosis- arrythmias, confusion, seizures
Normal pO2 but reduced sats
What are pO2 and oxygen sats in methaemoglobinaemia
Normal pO2
Reduced sats
Management of methaemoglobinaemia
IV methylene blue
Causes of hypophosphataemia
Insulin treatment
Liver failure
Refeeding
Hyperparathyroidism
What happens if hypophosphataemic
Red cell haemolysis
Muscle weakness and rhabdo
CNS dysfunction
Messes up WCC and platelets
Management of hypophosphataemia
If mild will resolve
If severe give IV phosphate
What causes hypophosphataemia in DKA
Insulin treatment
Blood gas findings of renal tubular acidosis
Hyperchloraemic metabolic acidosis
Hypokalaemia seen
Normal anion gap
What are the 4 types of renal tubular acidosis and what is pathology for each
Type 1- DCT affected
Type 2- PCT affected
Type 3- DCT and PCT
Type 4- RAAS
Complications of type 1 RTA
Hypokalaemia
Nephrocalcinosis->renal stones
Causes of T1 RTA
idiopathic, RA, SLE, Sjogren’s, amphotericin B toxicity, analgesic nephropathy
Causes of T2 RTA
Fanconi syndrome, Wilson’s disease, outdated tetracyclines, carbonic anhydrase inhibitors
Complications of T2 RTA
Hypokalaemia
Osteomalacia
What is scoring system for malnutrtion
MUST
What is problem of giving statin and macrolide
Can get myopathy leading to elevated CK levels
Who should be on a statin
Established CVD
Q-RISK >10%
T1DM
- nephropathy
- over 40
- had DM >10 years
What is monitoring for statins
LFTs at baseline, 3 months and 12 months
When stop statins based off LFTs
If transaminitis reaches over 3x upper limit
How manage transaminitis from statins
If reaches over 3x upper limit then stop
What is danger of using excess NaCl
Hyperchloraemia metabolic acidosis
When fluid prescribing what is daily requirement for glucose to avoid starvation ketosis
50-100g/day irrespective of weight
Most common cause of primary hyperparathyroidism
Solitary adenoma
Initial hyperkalaemia mangement
Calcium gluconate and insulin/dextrose infusion
How is calcium resonium administered
Enema
Management of primary hyperparathyroidism
Definitively total parathyroidectomy
If not appropriate for parathyroidectomy surgery then give cinacalcet calcimimetic
What can give for primary hyperparathyroidism if not eligible/suitable for surgery
Cinacalcet- calcimimetic as acts on calcium sensor
How calculate anion gap
Sodium+potassium-bicarb- chloride
Why give pyridoxine with isoniazid
To prevent peripheral neuropathy
What causes bone disease in CKD
High phosphate drags calcium from bones
What is STOPP tool
Used in older patients to identify if need a medication
What is START tool
Tool which identifies medications which require additional protective protective medications for example needing a PPI on something which causes ulcers
Vitamin C deficiency presentation
Bruising and bleeding
Joint pain
Weakness and malaise
Causes of normal anion gap metabolic acidosis
Bicarb loss
- diarrhoea
- fistula
Renal tubular acidosis
Addisons
NaCl overdose
Drugs- acetazolamide
Raised anion gap metabolic acidosis
Lactate froms sepsis, shock
Ketones from DKA and alcohol
Uraemia
Salicylates and methanol
Management of salicylates overdose
IV sodium bicarbonate if arrhythmias or widened QRS
Dialysis if pulmonary oedema or metabolic acidosis
What happens to chlorine if vomiting
Goes down a lot
Amyloidosis presentation
Most commonly- SOB and weakness
Nephrotic syndrome- oedema
Macroglossia
Carpal tunnel syndrome
Hepatosplenomegaly
Restrictive cardiomyopathy
Metabolic changes seen in refeeding syndrome
Hypokalaemia
Hypomagnaesaemia
Hypophosphataemia
In refeeding syndrome, what is most likely cause of torsades des pointes
Hypomagnaesaemia
ECG findings of hypomagnaesaemia
Same as hypokalaemia
If have received adequate nutrition but are still hypocalcaemic, what electrolyte are you likely deficient in
Magnesium as vital for PTH release
What is recommended infusion rate for potassium
10mmol/hour
If go above then needs to be done on ITU with cardiac monitoring
In HHS what is desired fluid balance after 12 hours
+3-6 Litres
Causes of SIADH
Drugs
CNS pathlogy- SAH, meningitis, encephalitis
Surgery
Pneumonia
Small cell cancer
Drug causes of SIADH
Carbamazepine
Opiates
TCAs
PPIs
SSRIs
Causes of hypernatraemia
HHS
Diabetes inspidus
Dehydration
Excess saline
Management of severe hypernatraemia
Fluids with dextrose 5% and NaCl
Risk of rapid hyponatraemia correction
Central pontine myelinolysis
Hypokalaemia causes
D&V
Conns and cushings
Alkalosis
RTA
Thiazides and loop
Insulin and salbutamol
Refeeding
Hypokalaemia management
3-3.5= sandoK tablets
Less than 3 or symptomatic= IV KCl
Chvostek vs trousseaus sign
Chvostek= cheek
Trousseaus= blood pressure
Hypocalcaemia causes
Osteomalacia
chronic kidney disease
hypoparathyroidism (e.g. post thyroid/parathyroid surgery)
pseudohypoparathyroidism
rhabdomyolysis
magnesium deficiency
massive blood transfusion
acute pancreatitis
Hypercalcaemia causes
Primary PTH
Tertiary PTH
Cancer
- myeloma
- mets
- PTHrp from squamous lung and RCC
Sarcoid
Thiazides
How calculate osmolarity vs osmolality
Osmolality= osmometer
Osmolarity= 2(Na+K)+Urea+Glucose
