Metabolic Medicine Flashcards

1
Q

What are causes of raised ALP?

A

Cholestasis

Paget’s disease - isolated ALP

Osteomalacia - raised ALP, low calcium+phosphate

Bone mets - raised ALP + calcium

Hyperparathyroidism - raised ALP + calcium

Renal failure - raised ALP + low calcium

Pregnancy

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2
Q

What are the 2 main cause of hypercalcaemia?

A

Primary hyperparathyroidism + Malignancy (bone mets, myeloma, squamous cell lung cancer)

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3
Q

What are other causes of hypercalcaemia other than the 2 main causes?

A
Sarcoidosis
Vitamin D intoxication
Acromegaly
Thiazide-like diuretics
Addison's disease
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4
Q

What ECG finding is seen in hypercalcaemia?

A

Short QT

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5
Q

How does hypercalcaemia present?

A

Stones, groans, bones, moans

Bone pain
Renal stones
Depression

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6
Q

How is hypercalcaemia treated?

A

IV Sodium Chloride 0.9%

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7
Q

What are causes of hypocalcaemia?

A
Vitamin D deficiency (osteomalacia)
CKD
Hypoparathyroidism
Pseudohypoparathyroidism
Magnesium deficiency
Acute pancreatitis
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8
Q

What are signs of hypocalcaemia?

A

Tetany - muscle twitching/cramping/spasm
Perioral parasthaesia

Trousseau’s sign
Chvostek’s sign

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9
Q

What is Trousseau’s sign?

A

Carpal spasm if brachial artery is occluded with blood pressure cuff

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10
Q

What is Chvostek’s sign?

A

Tapping the parotid causes the facial muscles to twitch

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11
Q

How is hypocalcaemia managed?

A

10ml calcium glutinate 10% over 10 mins

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12
Q

What ECG changes are seen in hyperkalaemia?

A

Tall tented T waves
Widened QRS
Small P waves
Prolonged PR interval

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13
Q

What are causes of hyperkalaemia?

A

AKI
Addison’s disease
Rhabdomyolysis

Drugs: ACEi, ARB, Spironolactone

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14
Q

How is the cardiac membrane stabilised in hyperkalaemia?

A

IV calcium gluconate

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15
Q

How is hyperkalaemia treated?

A

IV insulin - shifts potassium back into cells

oral calcium resonium - removes potassium

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16
Q

What are causes of hypokalaemia with ACIDOSIS?

A

Diarrhoea
Renal tubular acidosis
Acetazolamide
Partially treated DKA

17
Q

What are causes of hypokalaemia with ALKALOSIS?

A
Vomiting
Thiazide diuretics
Loop diuretics
Salbutamol
Cushing's syndrome
Hyperaldosteronism
18
Q

What is seen on ECG in hypokalaemia?

A
Small/absent T waves
Prolonged PR interval
Prolonged QT interval
ST depression
U waves
19
Q

How is hypokalaemia managed?

A

Potassium infusion - maximum of 10mmol an hour

20
Q

What are causes of hypernatraemia?

A
Dehydration
Osmotic diuresis e.g. HHS
Diabetes insipidus
Excess IV saline
Cushing's
Hyperaldosteronism
21
Q

How is hypernatraemia managed?

A

Mild hypernatraemic dehydration: (146-149)
• Manage underlying cause

Moderate hypernatraemic dehydration (150-169)
• Slow fluid resus – avoid rapid infusion due to risk of cerebral oedema

22
Q

What is the most important investigation for determining the cause of hyponatraemia?

A

Serum and urine osmolality

23
Q

What are causes of hyponatraemia with a HIGH urine osmolality?

A

If patient is hypovolaemic.. think sodium depletion (renal)
Diuretics (thiazide, loop)
Addison’s

If patient is euvolaemic.. think…
SIADH
Hypothyroidism

24
Q

What are causes of hyponatraemia with a LOW urine osmolality?

A

If patient is hypovolaemic.. think sodium depletion (non-renal)
Diarrhoea, vomiting, sweating, burns

If patient is euvolaemic/oedematous.. think water excess...
Heart failure
Liver cirrhosis
Nephrotic syndrome
Psychogenic polydipsia
25
Q

How is hypovolaemic hyponatraemia managed?

A

IV saline – 0.9% Sodium Chloride

If serum sodium rises - supports diagnosis of hypovolaemic hyponatraemia

26
Q

How is euvolaemic hyponatraemia managed?

A

SIADH –> Tolvaptan, Sodium, furosemide
Hypothyroidism –> levothyroxine

Fluid restrict

27
Q

How is hyponatraemia treated if the patient is acutely unwell with seizures?

A

Hypertonic saline e.g. 3% sodium chloride

Be careful of risk of central pontine myelinosis

28
Q

How is hypervolaemic hyponatraemia managed?

A

Fluid restriction

Treat underlying cause

29
Q

How does central pontine myelinosis present?

A

Dysarthria, dysphagia, paraparesis or quadriparesis, seizures, confusion, and coma

Locked in syndrome

30
Q

What is renal tubular acidosis?

A

A cause of metabolic acidosis due to a pathology in the tubules of the kidney

31
Q

What is type 1 renal tubular acidosis? What electrolyte abnormality is seen? How is it treated?

A

Metabolic acidosis due to the distal tubule being unable to excrete hydrogen ions

Associated with renal stones

Causes a hypokalaemia and metabolic acidosis

Treatment = oral bicarbonate

32
Q

What is type 2 renal tubular acidosis? What is the main associated condition? how is it treated?

A

Metabolic acidosis due to the proximal tubule being unable to reabsorb bicarbonate

Associated with Fanconi syndrome and OSTEOMALACIA

Hypokalaemia

Treatment = oral bicarb

33
Q

What is type 4 renal tubular acidosis? What electrolyte abnormalities are seen? What is the treatment?

A

Metabolic acidosis due to reduced aldosterone (usually due to adrenal insufficiency)
Leads to hyperkalaemia

Treated with fludrocortisone and sodium bicarbonate
Treat the hyperkalaemia

34
Q

What is the most common type of renal tubular acidosis?

A

Type 4

35
Q

What is familial hypercholesterolaemia?

A

Autosomal dominant condition
High levels of LDL
Can lead to early cardiovascular disease

36
Q

When should you suspect familial hypercholesterolaemia?

A

Total cholesterol level >7.5
Personal/family history of CVD event before 60 years
Tendon xanthomata