Metabolic Flashcards
Vit A def
Retinoids
Night blindness
Vit B1
Thiamine
Polyneuropathy
Wernicke/ Korsakoff
Heart failure
VIT b3
Niacin
Pellagra
- dermatitis
- diarrhea
- Dementia
Vit B6
Pyridoxine
Anemia, irritability, seizures
Vit B7
Biotin
Dermatitis, seborrhoea
B9
Folic acid
Megaloblasitc anaemia
NTD
Vit C
Ascorbic acid
Scurvy
- gingivitis
- bleeding
Vit D
Rickets, osteomalacia
Vit E
Mild hemolytic Anaemia in newborn infants, ataxia and peripheral neuropathy
Vit K
Haemorrhagic disease of the newborn,
Bleeding, diathesis
SIADH def
Syndrome of inappropriate ADH secretion
Characterized by hyponatraemia secondary to the dilutional effects of excessive water retention
Causes SIADH
Malignancy- small cell lung cancer, pancreas, prostate
Neurological- stroke, SAH, Subdural haemorrhage, meningitis, abscess
INfection- TB, pneumonia
Drugs- sulfonylurea, SSRI- citalopram, TCA, carbamazepine, vincrisine, cyclophosphamide,
Mgmt SIADH
Correction must be done slowly to avoid precipitating central pontine myelinolyisis
Fluid restriction
Demeclocycline- reduces the responsiveness of the collecting tubule cells to ADH
ADH receptor antagonisits
Secondary causes of hyperlipidaemia
Causes of elevated TAG DM 1&2 Obesity Alcohol CKD Drugs- thiazides, beta blockers, unopposed oestrogen Liver disease
Causes of elevated cholesterol
Nephrotic syndrome
Cholestasis
Hypothyroidism
Hyponatraemia
May be caused by water excess or sodium depletion.
Causes of pseudohyponatraemia
Hyperlipaedmia
Taking blood from a drip arm
Urinary sodium >20mmol/l
Sodium depletion, renal loss (patient often hypovolaemic)
Diuretics
Addison’s
Diuretic stage of renal failure
Patient often euvolaemic
SIADH
Hypothyroidism
Urinary sodium <20mmol/l
Sodium depletion moo, extra renal loss
Diarrhea, vomiting, sweating
Burns, Adenoma of the rectum
Water excess (patient often hypervolaemic)
Secondary hyperaldosteronism; heart failure, cirrhosis
Reduced GFR renal failure
IV DEXTROSE, Psychogenic polydipsia
ECG change sin hypocalcamia
Corrected QT interval prolongation
Rare; a fib or tornado de pointes
Hypocalcaemia features
Extra cellular calcium conc are important for muscle and nerve function - features of low ca seen as a result of neuromuscular excitability
Tetany; muscle twitching, cramping, spasm Perioral paraesthesia If chronic; depression and cataracts ECG prolonged QT Trousseau sign Chovstek’s sign
Trousseasu’s sign
Carpal spasm of the brachial artery occluded by inflating the BP cuff and maintaining pressure above systolic
Wrist flex ion and fingers drawn together
Seen in 95% with hypocal
Chvostek’s sign
Tapping over the parotid causes facial muscles to twitch
Seen in 70% with hypocal
Mgmt of hypercalcaemia
Rehydration with normal saline 3-4L/day
Following rehydration use bisphosphates
Typically take 2-3 days to work- max effect at 7days
Other options
Calcitonin- quicker effect than bisphos
Steroids in sarcoidosis
Loop diuretics sometimes used in hypercalcaemia - particularly if patients cant tolerate aggressive fluid rehydration
Mgmt of hypercalcaemia at home
Rehydration at home
Don’t need a low calcium diet as small intestine abs is already reduced
Avoid drugs and vitamin supplements that could exacerbate hypercal
Mobilization
Hyperkalaemia
Associated with metabolic acidosis
Causes of hyperkalaemia
AKI Drugs- potassium sparing, ACEi, ARB’s, spironolactone, cyclosporine, heparin, *beta blockers Metabolic acidosis Addison’s Rhabdomyolysis Massive blood transfusion
Foods high in potassium
Salt substitutes
Bananas, kiwi, oranges, avocado, spinach, tomatooe
ECG changes in hyperkalaemia
Broad QRS
Tall tented t waves
