Urea and Electrolytes (U&Es)

Question 1

Sodium

Answer 1

Regulates extracellular volume
Where Sodium goes Water follows
Regulates fluid balance
Excreted in Urine, Faeces, Sweat

Moves opposite direction to K

Question 2

Potassium

Answer 2

Regulates intracellular volume
Levels monitored -Arrythmias
Excreted in Urine, Faeces, Sweat
Moves opposite direction to Na

Question 3

Sodium and Potassium maintain?

Answer 3

Transmembrane electrochemical gradients
Normal function of nerves/muscles/kidneys

Question 4

Calcium

Answer 4

Vasoconstriction/Dilation
Muscle Function
Nerve transmission
Intracellular Signalling
Stored in bone/teeth

Requested separately from U&E

Question 5

What can affect U&E results??

Answer 5

Patient difficult to bleed-High K
Prolonged tourniquet time-High Ca
Fluids running in same arm

Question 6

What is Hyperkalaemia.

Answer 6

Elevated levels in plasma

Question 7

Signs of Hyperkalaemia on ECG

Answer 7

Peaked T waves
Prolonged QRS
Slowed HR
Arrythmias

Question 8

Causes of Hyperkalaemia

Answer 8

• Acidosis-pushes K extracellular
• Hypoxia
• Potassium/Amiloride-K Sparing
• Tissue Damage/GI Bleed
• Adrenal Insufficiency= low Aldosterone

Question 9

Management of Hyperkalaemia

Answer 9

• Insulin shifts K intracellular
  50ml/50% Insulin Dextrose

-Protects myocytes Calcium gluconate 10ml/10%/10mins

• Dialysis to remove K

Question 10

Essentials for Hyperkalaemia management

Answer 10

ABCDE
ECG
Protect heart
Move K into cells
Remove excess
Senior Review + Fix Cause?

Question 11

What is Hypokalaemia?

Answer 11

Low levels of potassium in bloodstream

Question 12

Causes of Hypokalae?mia

Answer 12

• Metabolic Alkalosis
  Reduced intake +Increases loss
  Drugs Diuretics +Steroids
  Mineralocorticoid Excess
  Conn’s-High Na/Low K (overproduction of mineralocorticoids)
• Metabolic Acidosis
  Renal Tubular Acidosis
  Diarrhoea
• Redistribution
  Insulin & Glucose
  Catecholamine

Question 13

Signs of Hypokalaemia

Answer 13

Muscle cramps
Arrhythmia
Usually Asymptomatic

Question 14

Treatment of Hypokalaemia

Answer 14

Correct Potassium levels by IV/PO
Determine cause

Question 15

What is normal urine output?

Answer 15

0.5ml/kg/hr

Question 16

Causes of Uraemia

Answer 16

Pre-Renal- Increase protein breakdown

Renal- Glomerular Dysfunction

Post Renal- Obstruction

Question 17

Examples of:
1)Pre-Renal (MOST COMMON)
2)Renal
3)Post Renal

Answer 17

1) Major trauma, Infection, Large GI bleed, Fluid depletion, Shock

2) Infection, Autoimmune, Toxins, Genetic, Prolonged Pre-renal

3) Renal tract obstruction, CA bladder, BPH, Ureteric stricture