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Finals > Metabolic > Flashcards

Metabolic Flashcards

1
Q

What is main problem of hyponatraemia

A

Cerebral oedema

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2
Q

How treat symptomatic hyponatraemia

A

Hypertonic saline (3%)

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3
Q

What is cutoff sodium level to have to use hypertonic saline

A

Below 120mmol/L

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4
Q

What is risk of rapid correction of hypernatraemia

A

Cerebral oedema

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5
Q

Markers of deydration on bloods

A

Polycythaemia
Hypernatraemia
Urea raised out of proportion to creatinine

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6
Q

Euvolaemic causes of hyponatraemia

A

Hypothyroidism
SIADH
Addisons

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7
Q

Causes of hyponatraemia with high urinary sodium

A

SIADH
Hypothyroidism
Addisons
Diuretics

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8
Q

Preferred form of giving calcium if hypocalcaemic

A

Calcium gluconate as calcium chloride irritant

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9
Q

When give IV calcium gluconate in hypocalcaemia

A

Prolonged QT
Tetany
Seizures

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10
Q

Which drugs can cause hyperkalaemia

A

ACEi
ARB
Spironolactone
Heparin

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11
Q

Criteria for diagnosing FH

A

Simon broome

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12
Q

Management of asymptomatic hyperuricaemia

A

No need for allopurinol etc so no treatment

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13
Q

What is methaemoglobinaemia

A

When there is increased levels of haemoglobin where Fe2+ has been converted to Fe3+ which cant bind oxygen

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14
Q

What are causes of methaemoglobinaemia

A

Congenital
Acquired- Poppers typically due to nitrate

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15
Q

What causes chocolate coloured blood and chocolate cyanosis

A

methaemoglobinaemia

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16
Q

Presentation of methaemoglobinaemia

A

Chocolate cyanosis
SOB, anxiety
Acidosis- arrythmias, confusion, seizures
Normal pO2 but reduced sats

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17
Q

What are pO2 and oxygen sats in methaemoglobinaemia

A

Normal pO2
Reduced sats

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18
Q

Management of methaemoglobinaemia

A

IV methylene blue

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19
Q

Causes of hypophosphataemia

A

Insulin treatment
Liver failure
Refeeding
Hyperparathyroidism

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20
Q

What happens if hypophosphataemic

A

Red cell haemolysis
Muscle weakness and rhabdo
CNS dysfunction
Messes up WCC and platelets

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21
Q

Management of hypophosphataemia

A

If mild will resolve
If severe give IV phosphate

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22
Q

What causes hypophosphataemia in DKA

A

Insulin treatment

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23
Q

Blood gas findings of renal tubular acidosis

A

Hyperchloraemic metabolic acidosis
Hypokalaemia seen
Normal anion gap

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24
Q

What are the 4 types of renal tubular acidosis and what is pathology for each

A

Type 1- DCT affected
Type 2- PCT affected
Type 3- DCT and PCT
Type 4- RAAS

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25
Q

Complications of type 1 RTA

A

Hypokalaemia
Nephrocalcinosis->renal stones

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26
Q

Causes of T1 RTA

A

idiopathic, RA, SLE, Sjogren’s, amphotericin B toxicity, analgesic nephropathy

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27
Q

Causes of T2 RTA

A

Fanconi syndrome, Wilson’s disease, outdated tetracyclines, carbonic anhydrase inhibitors

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28
Q

Complications of T2 RTA

A

Hypokalaemia
Osteomalacia

29
Q

What is scoring system for malnutrtion

A

MUST

30
Q

What is problem of giving statin and macrolide

A

Can get myopathy leading to elevated CK levels

31
Q

Who should be on a statin

A

Established CVD
Q-RISK >10%
T1DM
- nephropathy
- over 40
- had DM >10 years

32
Q

What is monitoring for statins

A

LFTs at baseline, 3 months and 12 months

33
Q

When stop statins based off LFTs

A

If transaminitis reaches over 3x upper limit

34
Q

How manage transaminitis from statins

A

If reaches over 3x upper limit then stop

35
Q

What is danger of using excess NaCl

A

Hyperchloraemia metabolic acidosis

36
Q

When fluid prescribing what is daily requirement for glucose to avoid starvation ketosis

A

50-100g/day irrespective of weight

37
Q

Most common cause of primary hyperparathyroidism

A

Solitary adenoma

38
Q

Initial hyperkalaemia mangement

A

Calcium gluconate and insulin/dextrose infusion

39
Q

How is calcium resonium administered

A

Enema

40
Q

Management of primary hyperparathyroidism

A

Definitively total parathyroidectomy
If not appropriate for parathyroidectomy surgery then give cinacalcet calcimimetic

41
Q

What can give for primary hyperparathyroidism if not eligible/suitable for surgery

A

Cinacalcet- calcimimetic as acts on calcium sensor

42
Q

How calculate anion gap

A

Sodium+potassium-bicarb- chloride

43
Q

Why give pyridoxine with isoniazid

A

To prevent peripheral neuropathy

44
Q

What causes bone disease in CKD

A

High phosphate drags calcium from bones

45
Q

What is STOPP tool

A

Used in older patients to identify if need a medication

46
Q

What is START tool

A

Tool which identifies medications which require additional protective protective medications for example needing a PPI on something which causes ulcers

47
Q

Vitamin C deficiency presentation

A

Bruising and bleeding
Joint pain
Weakness and malaise

48
Q

Causes of normal anion gap metabolic acidosis

A

Bicarb loss
- diarrhoea
- fistula
Renal tubular acidosis
Addisons
NaCl overdose
Drugs- acetazolamide

49
Q

Raised anion gap metabolic acidosis

A

Lactate froms sepsis, shock
Ketones from DKA and alcohol
Uraemia
Salicylates and methanol

50
Q

Management of salicylates overdose

A

IV sodium bicarbonate if arrhythmias or widened QRS
Dialysis if pulmonary oedema or metabolic acidosis

51
Q

What happens to chlorine if vomiting

A

Goes down a lot

52
Q

Amyloidosis presentation

A

Most commonly- SOB and weakness
Nephrotic syndrome- oedema
Macroglossia
Carpal tunnel syndrome
Hepatosplenomegaly
Restrictive cardiomyopathy

53
Q

Metabolic changes seen in refeeding syndrome

A

Hypokalaemia
Hypomagnaesaemia
Hypophosphataemia

54
Q

In refeeding syndrome, what is most likely cause of torsades des pointes

A

Hypomagnaesaemia

55
Q

ECG findings of hypomagnaesaemia

A

Same as hypokalaemia

56
Q

If have received adequate nutrition but are still hypocalcaemic, what electrolyte are you likely deficient in

A

Magnesium as vital for PTH release

57
Q

What is recommended infusion rate for potassium

A

10mmol/hour
If go above then needs to be done on ITU with cardiac monitoring

58
Q

In HHS what is desired fluid balance after 12 hours

A

+3-6 Litres

59
Q

Causes of SIADH

A

Drugs
CNS pathlogy- SAH, meningitis, encephalitis
Surgery
Pneumonia
Small cell cancer

60
Q

Drug causes of SIADH

A

Carbamazepine
Opiates
TCAs
PPIs
SSRIs

61
Q

Causes of hypernatraemia

A

HHS
Diabetes inspidus
Dehydration
Excess saline

62
Q

Management of severe hypernatraemia

A

Fluids with dextrose 5% and NaCl

63
Q

Risk of rapid hyponatraemia correction

A

Central pontine myelinolysis

64
Q

Hypokalaemia causes

A

D&V
Conns and cushings
Alkalosis
RTA
Thiazides and loop
Insulin and salbutamol
Refeeding

65
Q

Hypokalaemia management

A

3-3.5= sandoK tablets
Less than 3 or symptomatic= IV KCl

66
Q

Chvostek vs trousseaus sign

A

Chvostek= cheek
Trousseaus= blood pressure

67
Q

Hypocalcaemia causes

A

Osteomalacia
chronic kidney disease
hypoparathyroidism (e.g. post thyroid/parathyroid surgery)
pseudohypoparathyroidism
rhabdomyolysis
magnesium deficiency
massive blood transfusion
acute pancreatitis

68
Q

Hypercalcaemia causes

A

Primary PTH
Tertiary PTH
Cancer
- myeloma
- mets
- PTHrp from squamous lung and RCC
Sarcoid
Thiazides

69
Q

How calculate osmolarity vs osmolality

A

Osmolality= osmometer
Osmolarity= 2(Na+K)+Urea+Glucose

Finals (29 decks)

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