Metabolic medicine Flashcards
What is the criteria called used to diagnose Familial Hypercholesterolemia?
Simon-Broome
What is the mutation in that causes Familial Hypercholesterolemia?
LDL-receptor protein
How is familial hypercholesterolemia inherited?
Autosomal Dominant
How can Hypercalcemia be treated?
- Normal saline
- Bisphosphonates, calcitonin
What can hyponatremia cause?
Cerebral oedema
How is hyponatremia treated?
- Normal saline
- Hypertonic 3% saline if acute and severe
How is hypernatremia usually treated?
Normal saline
- diuretics possibly considered
How can hypomagnesium be treated?
- Oral Magnesium (MG citrate) or IV magnesium (sulfate)
How can hypermagnesium technically be treated?
- IV Calcium gluconate (works in opposite direction)
- Loop diuretic
- Haemodialysis
How can hypocalcemia be treated?
- IV calcium gluconate (10 ml 10% solution over 10 mins) (ECG monitoring required), often 50 mL/hour
- Asymptomatic: PO calcium gluconate
HYPOKALEMIA: iv PREPS
If both magneisum and potassium are low what is given first?
Magnesium
How can central diabetes insipidus be treated?
Desmopressin
How can nephrogenic DI be treated?
- Thiazides
- Low salt / protein diet
What can be used in the treated of SIADH? (3)
- Fluid restriction
- Demeclocycline (reduces responsiveness of CT to ADH)
- ADH (vasopressin) receptor antagonists
What can happen if SIADH is treated too quickly?
- Or any hyponatremia for that matter?
Osmotic demyelination syndrome (Central pontine myelinolysis)
How does ezetimibe work?
Inhibits cholesterol receptors on enterocytes, decreasing cholesterol absorption in the small intestine
SIADH causes what electrolyte abnormality?
Hyponatremia
Metformin in dehydration may cause what?
Lactic acidosis
Sodium bicarbonate is used in what?
Metabolic acidosis
what is a normal anion gap?
10 to 18
Acetazolamide ca cause what electrolyte abnormalities?
Hypomagnesemia
Hypokalemia
Max infusion rate of K+
10mmol per hour
Asymptomatically elevated uric acid is treated how?
With nothing
What is Chvostek sign and Trousseau sign associated with?
Hypocalcemia
Vasopressin receptor antagonist example
Tolvaptan (may be used in ADPKD, SIADH w. hyponatremia)
What are the electrolyte abnormalities in Refeeding syndrome?
- Low Mg
- Low K+
- Low Phosphate
- May cause low Ca2+
- Thiamine deficiency also
- ?Oedema
What are the electrolyte abnormalities in Tumour-lysis syndrome?
- High K+
- High Urate
- High Phosphate
- Low Ca2+
- Low LDH
Heparin and Beta blockers both cause what electrolyte abnormality?
Hyperkalemia
What type of RTA is associated with hyperkalemia?
Type 4 (decreased aldosterone)
What RTA is associated with bone conditions (osteomalacia, multiple myeloma)?
- Also hypokalemic
Type 2 RTA
What is the risk of giving too much 0.9% saline?
Hyperchloraemic metabolic acidosis
Maintenance electrolytes:
Approximately 1 mmol/kg/day of potassium, sodium and chloride
Sum up pediatric fluid prescribing in terms of how much water to give per kg for each weight?
- 1st 10kg of weight: 100ml/kg
- 2nd 10kgs (10 - 20 kg): 50ml/kg
- Over 20kgs: 20ml/kg
REMEMBER 100 -> 50 -> 20
Maintenance fluid/water per kg per day:
25-30 ml/kg/day of water
Maintenance glucose per day:
50-100 g/day
2 main potassium fluids (percentages) and mmol etc
- 0.3% potassium chloride in 0.9% NaCl = 40mmol / L (max rate is over 4 hrs)
- 0.15% potassium chloride in 0.9% NaCl = 20 mmol/L (max rate is over 2 hours)
Max rate at which 0.3% potassium chloride in 0.9% NaCl can be given? (1 litre)
4 hrs per Litre (as 40mmol per Litre)
Max rate at which 0.15% potassium chloride in 0.9% NaCl can be given? (1 litre)
2 hrs per Litre (as 20 mmol per Litre)
What RTA is associated with renalstones and the distal tubule also hpokalemic and fails to excrete H+
Type 1
