Metabolic Flashcards
What electrolyte disturbance is seen in type I renal tubular acidosis?
Hypokalaemia
What lab results suggest SIADH?
Hyponatremia, hypo-osmolar serum and hyper-osmolar urine with increased urinary sodium
What blood tests are performed 3 months after starting a statin?
Lipid profile and LFTs
What fluid replacement is indicated in patients with acute, severe, symptomatic hyponatraemia (< 120 mmol/L)?
Hypertonic saline (3% NaCL)
What is the first line management of hypercalcaemia secondary to malignancy?
Lifestyle advice e.g. maintaining good hydration (drinking 3-4 L of fluid per day), provided there are no contraindications (such as severe renal impairment or heart failure
What are the features of type 2 renal tubular acidosis?
Hypokalaemia, osteomalacia
What electrolyte disturbance is seen in type 4 renal tubular acidosis?
Hyperkalaemia
What are the causes of a raised ALP?
- Liver: cholestasis, hepatitis, fatty liver, neoplasia
- Paget’s
- Osteomalacia
- Bone metastases
- Hyperparathyroidism
- Renal failure
- Physiological: pregnancy, growing children, healing fractures
Describe the management of a patient with deficiencies in both magnesium and potassium, with evidence of clinical and biochemical dehydration
Intravenous magnesium replacement first then potassium replacement
What is a potential complication of correcting hyponatraemia too rapidly?
Osmotic demyelination syndrome
What is a potential complication of correcting hypernatraemia too rapidly?
Cerebral oedema
What are the differentials for hypertension with low potassium?
Conn’s, Cushing’s, renal artery stenosis and Liddle’s
What is the most appropriate first line investigation for hypertension with low potassium?
Plasma renin and aldosterone levels
Quantifying the renin and angiotensin levels will help to distinguish the cause, before going on to more specialised tests
What pathologies are associated with a low renin and a high aldosterone level?
Cushing’s and Conn’s
What pathology is associated with a low renin and a high aldosterone level?
Renal artery stenosis
Marked hyponatremia alongside a low serum osmolality and high urine osmolality
What is the diagnosis?
SIADH
What is the short-term treatment of SIADH?
Fluid restriction
What drugs can lead to hypokalaemia?
Thiazide and loop diuretics
What ABG results are associated with renal tubular acidosis?
Hyperchloraemic, normal anion gap metabolic acidosis
What ECG results are associated with hyperkalaemia
Tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern and asystole
What are the drug causes of SIADH?
Carbamazepine, sulfonylureas, SSRIs, tricyclics
Patient with acute severe hyponatramia becomes unconscious.
What complication has occured?
Cerebral oedema
What findings on ABG are associated with vomiting?
Hypokalaemia with alkalosis
Raised ALP in the presence of normal LFT’s should raise suspicion of what diagnosis?
Malignancy, particularly bone cancer/metastases
A 56-year-old presents to the emergency department with a 1-month history of worsening exertional breathlessness, orthopnoea, and ankle swelling. They are hyponatraemic.
What is the most likely underlying cause?
Heart failure
Management of low phosphate in DKA?
Parenteral phosphate replacement therapy
Most appropriate fluid replacement in patients with ssuspected hypovolemic hyponatraemia?
Isotonic normal saline
What blood findings are normal in early pregnancy?
Mild anaemia and elevated ALP
What electrolyte imbalances is most likely to be found in acute pancreatitis?
Hypocalcemia
What ABG results are seen in renal tubular acidosis?
Hyperchloraemic, normal anion gap metabolic acidosis
First line management in euvolemic and hypervolemic hyponatraemic patients who don’t have severe symptoms?
Fluid restriction
Name one complication of type 1 renal tubular acidosis
Renal stones
What is the first line management of patients with suspected hypercalcaemia?
IV fluids
What is the most common ECG change in hypocalcaemia?
Prolonged QTc interval
