Metabolic medicine Flashcards
Where is CRP synthesised? When does this suggest evolving complications?
Levels of CRP are commonly measured in acutely unwell patients. CRP is a protein synthesised in the liver and binds to phosphocholine in bacterial cells and on those cells undergoing apoptosis. In binding to these cells it is then able to activate the complement system. CRP levels are known to rise in patients following surgery. However, levels of greater than 150 at 48 hours post operatively are suggestive of evolving complications.
What are the 6 divisions of BMI and their names?
< 18.5 Underweight Underweight
18.5 - 24.9 Normal Normal
25 - 29.9 Overweight Overweight
30 - 34.9 Obese Obese I
35 - 39.9 Clinically obese Obese II
> 40 Morbidly obese Obese III
What is a glycaemic index?
The glycaemic index (GI) describes the capacity of a food to raise blood glucose compared with glucose in normal glucose-tolerant individuals. Foods with a high GI may be associated with an increased risk of obesity and the post-prandial hyperglycaemia associated with such foods may also increase the risk of type 2 diabetes mellitus.
Give 3 high GI foods?
High GI White rice (87), baked potato (85), white bread (80)
Give 5 medium GI foods?
Couscous (65), boiled new potato (62), digestive biscuit (59), brown rice (58), Porridge (55)
Give 3 low gi foods?
Fruit and vegetables, peanuts
What is hyperkalaemia associated with - alkalosis or acidosis?
Potassium and hydrogen can be thought of as competitors. Hyperkalaemia tends to be associated with acidosis because as potassium levels rise fewer hydrogen ions can enter the cells
Which 4 conditions lead of hypokalaemia with alkalosis?
Hypokalaemia with alkalosis
vomiting thiazide and loop diuretics Cushing's syndrome Conn's syndrome (primary hyperaldosteronism)
Which 4 situations can lead to hypokalaemia with acidosis?
Hypokalaemia with acidosis
diarrhoea renal tubular acidosis acetazolamide partially treated diabetic ketoacidosis
How does magnesium affect potassium?
Magnesium deficiency may also cause hypokalaemia. In such cases, normalizing the potassium level may be difficult until the magnesium deficiency has been corrected
What are 6 causes of hyperkalaemia?
Causes of hyperkalaemia:
acute kidney injury drugs*: potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin** metabolic acidosis Addison's disease rhabdomyolysis massive blood transfusion
What are the ECG changes seen in hyperkalaemia?
ECG changes seen in hyperkalaemia include tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern and asystole
What foods are high in potassium?
Foods that are high in potassium:
salt substitutes (i.e. Contain potassium rather than sodium) bananas, oranges, kiwi fruit, avocado, spinach, tomatoes
Give 5 causes of hypokalaemia with hypertension?
Hypokalaemia with hypertension
Cushing's syndrome Conn's syndrome (primary hyperaldosteronism) Liddle's syndrome 11-beta hydroxylase deficiency*
Carbenoxolone, an anti-ulcer drug, and liquorice excess can potentially cause hypokalaemia associated with hypertension
Give 5 causes of hypokalaemia without hypertension?
Hypokalaemia without hypertension
diuretics GI loss (e.g. Diarrhoea, vomiting) renal tubular acidosis (type 1 and 2**) Bartter's syndrome Gitelman syndrome
Which 5 drugs increase potassium?
ACE inhibitors
Angiotensin-2 receptor blockers
Spironolactone
Potassium sparing diuretics (amiloride, triamterene)
Potassium supplements (Sando-K, Slow-K)
Which 3 drugs decrease potassium?
Thiazide diuretics
Loop diuretics
Acetazolamide
What are causes of pseudohyponatraemia?
Hyponatraemia may be caused by water excess or sodium depletion. Causes of pseudohyponatraemia include hyperlipidaemia (increase in serum volume) or a taking blood from a drip arm. Urinary sodium and osmolarity levels aid making a diagnosis
Hyponatraemia with urinary sodium >20mmol
-give 5 causes
Urinary sodium > 20 mmol/l
Sodium depletion, renal loss (patient often hypovolaemic)
diuretics: thiazides, loop diuretics Addison's disease diuretic stage of renal failure
Patient often euvolaemic
SIADH (urine osmolality > 500 mmol/kg) hypothyroidism
Hyponatraemia with urinary sodium <20
-Give 6 causes
Urinary sodium < 20 mmol/l
Sodium depletion, extra-renal loss
diarrhoea, vomiting, sweating burns, adenoma of rectum
Water excess (patient often hypervolaemic and oedematous)
secondary hyperaldosteronism: heart failure, liver cirrhosis nephrotic syndrome IV dextrose psychogenic polydipsia
What is acute hyponatraemia vs chronic? what is mild/mod/severe hyponatraemia?
Management of hyponatremia is complicated and primarily based on the following parameters:
duration of hyponatremia: is it acute or chronic?
acute: develops over a period of < 48 hours
chronic: develops over a period > 48 hours
the severity of hyponatremia: what is the sodium level?
mild: 130-134 mmol/L
moderate: 120-129 mmol/L
severe: < 120 mmol/L
How is chronic hyponatraemia managed if a hypovolaemic cause is suspected?
If a hypovolemic cause is suspected
normal, i.e. isotonic, saline (0.9% NaCl)
this may sometimes be given as a trial
if the serum sodium rises this supports a diagnosis of hypovolemic hyponatraemia
if the serum sodium falls an alternative diagnosis such as SIADH is likely
How is chronic hyponatraemia managed if a euvolaemic cause is suspected?
If a euvolemic cause is suspected
fluid restrict to 500–1000 mL/day
consider medications:
demeclocycline
vaptans (see below)
How is chronic hyponatraemia managed if a hypervolaemic cause is suspected?
If a hypervolemic cause is suspected
fluid restrict to 500–1000 mL/day consider loop diuretics consider vaptans
