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GI > U&Es > Flashcards

U&Es Flashcards

1
Q

how is urea produced?

A
  • Waste product formed by liver and excreted by kidneys (amino acids are metabolised and converted to ammonia (by deamination of amino acids), CO2, water and energy)
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2
Q

what can ammonia do in the body?

A
  • Ammonia is toxic to cells (hepatic encephalopathy) and must be excreted
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3
Q

what is ammonia converted into?

A

urea - non toxic

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4
Q

what can cause raised urea?

A

kidney disease, upper GI bleed (increased cell turnover) and dehydration

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5
Q

what can cause decrease in urea?

A

malnutrition and liver disease

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6
Q

what is creatine useful for?

A

good for assessing eGFR
- Flow rate of filtered fluid through kidney

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7
Q

why is creatinine a good measure for eGFR?

A
  • Creatinine is made at fairly constant rate – production is non-acutely affected by other factors (infection, hypoxia)
  • Primarily excreted by kidneys
  • Minimal re-absorption after filtered renal tubules
  • Minimal metabolism by other organs
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8
Q

does creatinine levels vary between individuals?

A
  • Larger mass = higher creatinine (creatinine is affected by gender – higher in males, ethnicity – higher in black, age, muscle mass)
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9
Q

what would an increasing serum creatinine from baseline indicate?

A

worsening renal function

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10
Q

what can influence eGFR?

A

GFR declines naturally with age and it is influenced by muscle mass, high protein diet and exercise

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11
Q

when would eGFR not be useful?

A
  • In extreme cases: eg body builders, amputees, people with muscle wasting disorders  interpret eGFR with caution
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12
Q

what is normal potassium levels?

A

3.5-5.2mmol/L

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13
Q

what are normal sodium levels?

A

136-145mmol/L

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14
Q

what is renal tubule acidosis?

A

accumulation of acid due to failure to excrete acid in urine or fail to reabsorb bicarb from urine

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15
Q

what causes renal tubule acidosis?

A
  • Usually defect in renal tubule channels involved in acid balance
  • Usually otherwise normally functioning kidneys
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16
Q

what happens within type 1 renal tubule acidosis?

A

Type 1: severe acidaemia with hypokalaemia  failure to secrete H+ and reclaim K+

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17
Q

what occurs within type 2 renal tubule acidosis?

A

Type 2: acidaemia with hypokalaemia  failure of proximal tubular cells to reabsorb bicarb

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18
Q

what occurs within type 3 renal tubule acidosis?

A

mild acidaemia with hyperkalaemia  deficiency of aldosterone or resistance to aldosterone

19
Q

what would indicate mild hypophosphatemia?

A
  • Mild: 0.65-0.84 mmol/L
20
Q

what levels would show moderate hypophosphatemia?

A
  • Moderate: 0.32-0.64 mmol/L
21
Q

what levels would imply severe hypophosphatemia?

A
  • Severe <0.32 mmol/L
22
Q

what are the various symptom types of hypophosphatemia?

A

asymptomatic
neuromuscular
rhabdomyolysis
resp failure
bone deformities

23
Q

what neuromuscular dysfunctions can occur following hypophosphatemia?

A

dysfunction: muscle weakness and paraesthesia, convulsions

24
Q

what is rhabdomyolysis?

A

damaged muscles release their proteins and electrolytes into blood

25
Q

why can their be bone deformities within hypophosphatemia?

A
  • Prolonged reduction can cause rickets or osteomalacia (linked to calcium)
26
Q

how can hypophosphatemia arise?

A
  • Redistribution of phosphate to ECF into cells (resp alkalosis, re-feeding syndrome, recovery from DKA)
  • Decreased intestinal absorption of phosphate – metabolic/ resp acidosis, chronic diarrhoea/ prolonged poor oral intake
  • Increased urinary phosphate excretion – antacid abuse, vit D defiency, primary parathyroidism, medication
27
Q

what is refeeding syndrome?

A

: period of starvation and then eating again  mass retention

28
Q

name some medications that can reduce phosphate?

A
  • Proximally acting diuretics – acetazolamide, metolazone
  • Acute paracetamol overdose
  • Chemo therapy agents
  • Anti-epileptics
  • Antibioitcs
  • Antivirals
  • Phosphate binding drugs – calcium carbonate used in advanced renal failure
  • Antacids with magnesium/ aluminium binding agents reduce gut absorption of phosphate eg Gaviscon
  • Bisphosphonates
  • Theophylline, corticosteroids, bronchodilators
  • Insulin therapy
29
Q

what electrolyte must be carefully monitored alongside hypophosphatemia?

A

calcium

30
Q

as well as calcium, what else should be monitored following IV phosphate replacement?

A

Monitoring: every 6-12 hrs during IV phosphate replacement.
- Check phosphate, calcium, magnesium, potassium, sodium, renal function, ECG and blood pressure (can lead to arrythmias and hypotension)

31
Q

what levels are regarded as mild to moderate hypomagnesaemia?

A
  • Mild to moderate: 0.5-0.7mmol/L
32
Q

what is severe hypomagnesaemia?

A
  • Severe: <0.5mmol/L
33
Q

what are the various types of symptoms associated with hypomagnesaemia?

A

neuropsychiatric
neuromuscular
CVD
other electrolyte imbalance

34
Q

what neuropsychiatric symptoms are seen with hypomagnesaemia?

A
  • Neuropsychiatric symptoms: agitation, irritability, confusion, delirium, hallucinations, seizures
35
Q

what neuromuscular symptoms are associated with hypomagnesaemia?

A

tetany (involuntary muscle contractions), tremor, small muscle contractions, cramps, paraesthesia, weakness

36
Q

what Cardio signs are seen with hypomagnesaemia?

A

ECG changes, ventricular arrythmias

37
Q

name some medications that reduce magnesium?

A
  • Antifungals
  • Diuretics eg furosemide
  • Chemo
  • Ciclosporin, mycophenolate, tacrolimus
  • Bisphosphonates
  • PPI
  • Antibiotics eg gentamicin, tobramycin
  • Digoxin
38
Q

what magnesium replacements can be given?

A
  • Oral: 10mmol per sachet
  • IV: 20mmol in 100ml
39
Q

what needs to be monitored closely following magnesium replacement?

A
  • Monitoring: heart rate, BP, RR, Mg levels checked daily, renal function, ECG in critical care
40
Q

what tests should be ordered within a confusion screen?

A

FBC, CRP, U&Es, bone profile, B12 and folate, thyroid function, glucose, LFTs, coagulation/ INR

41
Q

what tests should be ordered within a sepsis screen?

A

: FBC, CRP, U&Es, lactate and blood cultures

42
Q

what tests should be ordered among a hyponatraemia screen?

A

U&Es, serum osmolarity+ urine osmolariy and urine sodium/potassium, thyroid function, serum cortisol

43
Q

what tests should be ordered among a hypocalcaemia screen?

A

: U&Es, bone profile, ionised calcium, PTH, vitD, LFTs

44
Q

what electrolyte derangement is seen within refeeding syndrome?

A

hypophostaemia
#hypomagnesia
hypokalaemia

GI (12 decks)

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