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Urinary and Electrolytes Flashcards

1
Q

Example, Action and SE of loop diurectics

A

Furosemide
Inhibit Na/K/2Cl symporter in the tick ascending limb of the LoH
SE - hypokalaemic, hyponatramiea, low mg, met alkalosis, ototoxic, Hypovolaemia/ low BP, nausea

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2
Q

Example, Action, SE and CI of thiazide diurectics

A

Bendroflumethazide
Inhibit NaCl co-transporter in DCT

SE: ↓K,Na,Mg, hyperglycaemia, ↑ urate, postural hypotension, ↑ calcium, impotence

CI - addisons, ↓K, ↑ calcium, gout

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3
Q

Example, Action, SE and CI of K-Sparing Diuretics

A

Spironolactone - aldosterone antagonist
Amiloride - blocks DCT/CD luminal Na channel
 SE: ↑K, anti-androgenic (e.g. gynaecomastia, impotence, menstrual irregularities), ↓Na, lethargy, headache, confusion, hepatotoxic

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4
Q

Example, Action, SE and CI of Osmotic Diuretics

A

mannitol - freely filtered and poorly reabsorbed
 Effect: ↓ brain volume and ↓ ICP
 SE: ↓Na, pulmonary oedema, n/v

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5
Q

Causes of haematuria

A 
HSP and PKD
Antibiotics - cipro/ cephalosporin
Embolism/ infarct
Malignancy - renal, bladder, prostate, BPH, ureter
AI - GN, TIN
Trauma - renal/extrarenal - stone/catheter
Urethritis/ prostitis
Renal stone
Infection - pyelonephritis, cystitis 
Anticoagulants - NSAIDs
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6
Q

Causes of proteinuria

A

Common

  • DM
  • mimimal change
  • amyloidosis
  • SLE

Other
- HTN/ UTI/ Fever/ ATN/ TIN

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7
Q

what is eGFR modified for

A

sex, age, race

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8
Q

Causes of renal disease/ AKI

A

Pre-renal

  • shock/ hypovolaemia
  • renal vascular - RAS, NSAIDs, ACEi, thrombosis, hepatorenal syndrome

Renal

  • GN
  • ATN - ischaemia (shock) or nephrotoxins

Post-renal - SNIPIN

  • Stone
  • Neoplasm
  • Inflammation (stricture)
  • Prostatic hypertophy
  • Infection - TB/ Sarcoid
  • Neuro - post op/ neuropathy
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9
Q

Presentation of renal failure

A

UP-NAKAD
- Uraemia
- Protein loss and Na retention
poly/oli/an- uria, polydipsia, SOB; oedema, HTN, ↑ JVP
- Acidosis
SOB -+/- kussmaul, confused
- hyperKalaemia - palpitations, chest pain, weakness
- Anaemia - SOB, lethagy, faint, tiniitus, pallor, ↑HTR, Flow murmur
- vitamin D deficiency - bone pain/ # +/- osteomalacia

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10
Q

Symptoms and signs of uraemia

A 
Symptoms 
Pruritus
n/v, anorexia, wt. loss 
Lethargy
Confusion
Restless legs
Metallic taste 
Paraesthesia: neuropathy 
Bleeding
Chest pain: serositis 
Hiccoughs
Signs
Pale, sallow skin
Striae
Pericardial or plueral rub Fits
Coma
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11
Q

Presentation of UTI

A 
Pyelonephritis
 Fever, rigors
 Loin pain and tenderness
 Vomiting
 Oliguria if ARF
Cystitis
 Frequency and urgency
 Polyuria
 Haematuria
 Dysuria
 Suprapubic tenderness
 Foul smelling urine
Prostatitis
 Flu-like symptoms
 Low backache
 Dysuria
 Tender swollen prostate on PR
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12
Q

Risk Factors for UTIs

A 
 Female
 Sex
 Pregnancy
 Menopause
 DM
 Abnormal tract: stone, obstruction, catheter,
malformation
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13
Q

UTI - causative organisms

A

 E. coli
 Staphylococcus saprophyticus
 Proteus (alkaline urine → struvite renal stones)
 Klebsiella

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14
Q

Management of UTIs

A

Drink plenty, urinate often

Cystitis
 Trimethoprim/ Nitrofurantoin for 3d (F) and 7d (M)

Pyelonephritis
 Cefotaxime 1g IV BD for 10d

Prostatitis
 Ciproflxacin 4 weeks

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15
Q

Causes of glomerulonephritis

A 
 Idiopathic
 Immune: SLE, Goodpastures, vasculitis
 Infection: HBV, HCV, Strep, HIV
 Drugs: penicillamine, gold
 Amyloid
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16
Q

Complications of renal biopsy and when you should stop meds before

A
  • mild back pain
  • visible haematuria
  • bleeding
  • need for transfusion
  • have bed rest 4h

Stop aspirin 1 week and INR <1.2, LMWH stop 24h before

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17
Q

Features of IgA nephropathy and Mx

A 
 Young male  
- episodic macroscopic haematuria occurring a few days after URTI.
 Rapid recovery between attacks
 ↑IgA
 Can occasionally → nephritic syndrome

Biopsy - IgA deposition in mesangium

Mx: Steroids or cyclophosphamide if ↓renal function

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18
Q

Features of thin BM disease

A

AD
 Persistent, asymptomatic microscopic haematuria
 V. small risk of ESRF

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19
Q

Features of Alport’s syndrome

A 
 Haematuria, proteinuria → progressive renal failure
 Sensorineural deafness
 Lens dislocation and cataracts
 Retinal “flecks”
 Females: haematuria only
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20
Q

Nephritic v Nephrotic syndrome

A

Nephritic
 Haematuria (macro / micro) + red cell casts
 Proteinuria → oedema (esp. periorbital)
 Hypertension
 Oliguria and progressive renal impairment

Nephrotic
 Proteinuria: PCR >3.5g/24h
 Hypoalbuminaemia: <35g/L (Muehrcke’s nails)
 Oedema: periorbital, genital, ascites, peripheral
- Often intravascularly depleted = ↓ JVP (cf. CCF)

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21
Q

Features and Rx of post-streptococcal GN

A 
Young child develops malaise and nephritic syndrome  -  smoky urine 1-2wks after sore throat or skin infection.
 ↑ASOT (anti-strep Ab titre)
 ↓C3
 ↑ anti-DNAase
Biopsy: IgG and C3 deposition
Rx: Supportive
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22
Q

Features of RPGN/ Cresenteric

A 
Type 1: Anti-GBM (Goodpasture’s) 
 Ab to NC domain of collagen 4
 Haematuria and haemoptysis
 CXR shows infiltrates
 Rx: Plasmapheresis and immunosuppression

Type 2: Immune Complex Deposition – 45%
e.g SLE

Type 3: Pauci Immune – 50%
cANCA: Wegener’s
pANCA: microscopic polyangiitis, Churg-Strauss

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23
Q

Complications of nephrotic syndrome

A

Infection: ↓ Ig, ↓ complement activity
VTE: up to 40%
Hyperlipidaemia: ↑ cholesterol and triglycerides

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24
Q

Causes of nephrotic syndrome

A
  • Systemic - DM, SLE, amyloidosis

1) Minimal change GN - children
 Assoc. URTI
 Biopsy: normal light micro, fusion of podocytes on EM
 Rx: steroids

2) Membranous Nephropathy
 20-30% of adult
 Assoc: Ca: lung, colon, breast; AI: SLE, thyroid disease; HBV; Penicillamine, gold
 Biopsy: subepithelial immune complex deposits
 Rx: immunosuppression if GFR ↓
 40% spontaneous remission

3) FSGS
 Idiopathic or Secondary e.g. HIV
 Biopsy: focal scarring, IgM deposition
 Rx: steroids or cyclophosphamide/ciclosporin
 Prog: 30-50% → ESRF

4) Membranoproliferative GN
 Rare → nephrotic (60%) or nephritic (30%) syndrome
 Asooc. HBV, HCV, endocarditis
 Prog: 50% → ESRF

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25
Q

Mx of Nephrotic syndrome

A 
Monitor U+E, BP , fluid balance, wt.
 Treat underlying cause
 Symptomatic / Complication Rx:
 Oedema: salt and fluid restrict + frusemide 
 Proteinuria: ACEi / ARA ↓ proteinuria
 ↑ Lipids: Statin
 VTE: LMWH (as ↑ CF)
 Rx HTN
 pneumococcal and varicella vaccines
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26
Q

Definition of AKI

A

Significant decline in renal function over hrs or days manifesting as an abrupt and sustained ↑ in Se U and Cr

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27
Q

Presentation of AKI

A 
 Acidosis
 Hyperkalaemia
 Fluid overload
 Oedema, inc. pulmonary 
 ↑BP(or↓)
 S3 gallop
 ↑ JVP
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28
Q

Examples of nephrotoxins

A
  • ACEI
  • Aminoglycosides, Vancomycin, Aciclovir, Sulphonamides, Tetracyclines
  • NSAIDs
  • Lithium,
  • Hb
  • Bilirubin
  • Ig in Myeloma
  • Contrast
  • Ciclosporin and Tacrolimus
  • Urate
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29
Q

Things to observe in clinical assessment of suspected kidney disease

A
  1. Acute or chronic?
     Hx of comorbidity: DM, HTN
     Long duration of symptoms
     Previously abnormal bloods
2. Volume depleted?
 Postural hypotension
 ↓ JVP
 ↑ pulse
 Poor skin turgor, dry mucus membranes
3. GU tract obstruction?
 Suprapubic discomfort
 Palpable bladder
 Enlarged prostate
 Catheter
 Complete anuria (rare in ARF)
  1. Rare cause?
     proteinuria ± haematuria
     Vasculitis: rash, arthralgia, nosebleed
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30
Q

Stages of AKI

A 
Stage 1 - 
↑Cr x1.5 ↓GFR >25%
<0.5ml/kg/h x 6h 
Stage 2 - 
↑Cr x 2 ↓GFR >50%
<0.5ml/kg/h x 12h
Stage 3 - 
↑Cr x 3 ↓GFR >75%
<0.3ml/kg/h x 24h, or anuria x12h
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31
Q

Management of AKI

A

General
 Identify and Rx pre-renal or post-renal causes
 Urgent US
 Rx exacerbating factors: e.g. sepsis
 Give PPIs
 Stop nephrotoxins: NSAIDs, ACEi, gent, vanc  Stop metformin if Cr > 150mM

Monitor
 Catheterise and monitor UO
 Consider CVP
 Fluid balance 
 Wt.

Treat hyperkalaemia, pulmonary oedema and bleeding (FFP. transfuse)

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32
Q

Indications for Acute Dialysis

A

AEIOU
A”- acidosis;
“E”- electrolyte disarray ( K+, Na+, Ca++);
“I” - intoxicants (methanol ethylene glycol, Li, ASA);
“O”- intractable fluid overload;
“U”- uremic symptoms (nausea, seizure, pericarditis, bleeding)

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33
Q

Pathogenesis and clinical presentation of Rhabdomyolysis

A

 Skeletal muscle breakdown → release of K+, PO4, urate, Myoglobin, CK
 ↑K and AKI

 Muscle pain, swelling
 Red/brown urine
 AKI occurs 10-12h later

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34
Q

Causes of Rhabdomyolysis

A

 Ischaemia: embolism, surgery
 Trauma: immobilisation, crush, burns, seizures,
compartment syndrome
 Toxins: statins, fibrates, ecstasy, neuroleptics

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35
Q

Ix and Rx of rhabdomyolysis

A

Ix
 Dipstick: +ve Hb, -ve RBCs
 Blood: ↑CK, ↑K, ↑PO4, ↑urat

Rx
 Rx hyperkalaemia
 IV rehydration: 300ml/h
 CVP monitoring if oliguric
 IV NaHCO3 may be used to alkalinize urine and stabilise
a less toxic form of myoglobin.
36
Q

Features and classification of Chronic renal failure

A

Progressive and irreversible loss of the excretory and hormone functions of the kidney ≥3mo
Stage 1&2 require other evidence of kidney damage

Stage         GFR
1                  >90
2                60-89
3a              45-59
3b              30-44
4                16-29
5                <15
37
Q

Causes of CKD

A

 DM
 HTN

Other
 RAS
 GN
 Polycystic disease
 SLE
 Myeloma and amyloidosis
38
Q

Ix for CKD

A

Blood
 ↓Hb, U+E, ESR, glucose, ↓Ca/↑PO4, ↑ALP, ↑PTH
 Immune: ANA, dsDNA, ANCA, GBM, C3, C4, Ig, Hep
 Film: burr cells

Urine: dip, MCS, PCR, BJP

Imaging
 CXR: cardiomegaly, pleural/pericardial effusion, oedema
 AXR: calcification from stones
 Renal US - Usually small (<9cm); large: polycystic, amyloid
 Bone X-rays: renal osteodystrophy (pseudo#)
 CT KUB: e.g. cortical scarring from pyelonephritis

Renal biopsy: if cause unclear and size normal

39
Q

Complications of CKD

A

CRF HEALS
 Cardiovascular disease
 Renal osteodystrophy
 Fluid (oedema)

 HTN
 Electrolyte disturbances: K, H
 Anaemia
 Leg restlessness
 Sensory neuropathy
40
Q

Features of renal osteodystrophy

A

 Osteoporosis: ↓ bone density
 Osteomalacia: ↓ mineralisation of osteoid
 2°/3° HPT → osteitis fibrosa cystica
- Subperiosteal bone resorption
- Acral osteolysis: short stubby fingers
- Pepperpot skull
 May get spinal osteosclerosis → Rugger Jersey spine
- Sclerotic vertebral end-plate with lucent centre

41
Q

Mechanism of renal osteodystrophy

A

 ↓ 1α-hydroxylase → ↓ vit D activation → ↓ Ca → ↑ PTH
 Phosphate retention → ↓ Ca and ↑ PTH (directly)
 ↑ PTH → activation of osteoclasts ± osteoblasts
 Also acidosis → bone resorption

42
Q

Mx of CKD

A 
General
 Rx reversible causes
 Stop nephrotoxic drugs
Lifestyle
 Exercise  Healthy wt  Stop smoking  Na, fluid and PO4 restriction
CV Risk
 Statins (irrespective of lipids)
 Low-dose aspirin  RxDM
Hypertension
 Target <140/90 (<130/80 if DM - ACEi)
Oedema --> Frusemide
Bone Disease --> calcichew (P binder)
 Vit D analogues: alfacalcidol (1 OH-Vit D3)
 Ca supplements
 Cinacalcet: Ca mimetic
Anaemia
 EPO to raise Hb to 11g/dL (higher = thrombosis risk)

Restless Legs –>Clonazepam

43
Q

Positives and negatives of renal transplant

A

+ve

  • restores near normal renal function
  • cheaper than dialysis
  • allows mobility and rehab
  • improved survival
  • good long-term results
  • better QoL

Ive

  • not all suitable- limited donor supply
  • still left with progressive CKD
  • operation morbidity
  • life-long immunosuppression - malignancy and infection risk
44
Q

Complications of renal transplants

A

Post-op
 Bleeding  Graft thrombosis
 Infection  Urinary leaks

Hyperacute rejection (minutes)
 ABO incompatibility
 Thrombosis and SIRS

Acute Rejection (<6mo)
 ↑ing Cr (± fever and graft pain)
 Cell-mediated response
 Responsive to immunosuppression

Chronic Rejection (>6mo)
 Interstitial fibrosis + tubular atrophy
 Gradual ↑ in Cr and proteinuria
 Not responsive to immunosuppression

↓ Immune Function
 ↑ risk of infection: opportunists, fungi, warts
 ↑ risk of malignancy: BCC, SCC, lymphoma (EBV)

Cardiovascular Disease
 Hypertension and atherosclerosis

45
Q

Drugs CI in renal failure

A 
Many People Like to Nap Naked
Metformin
Potassium-sparing diuretics
Lithium
Tetracyclins
Nitrofurantoin
NSAIDs
46
Q

Drugs that accumulate in renal failure

A 
Aminoglycosides, penicillins, cephalosporins
LMWH
Digoxin
Atenolol
Methotrexate
Sulphonylureas
Opiods
47
Q

Causes of renovascular disease

A

 Atherosclerosis in 80%
 Fibromuscular dysplasia
 Thromboembolism
 External mass compression

48
Q

Features of RAS

A

 Refractory hypertension
 Worsening renal function after ACEi/ARB
 Flash pulmonary oedema (no LV impairment on echo)

–> Renal angiography: gold standard

49
Q

Features of Haemolytic Uraemic Syndrome

A

 E. coli O157:H7: verotoxin → endothelial dysfunction
Features
 Young children eating undercooked meat (burgers
Bloody diarrhoea and abdominal pain precedes:
- MAHA
- Thrombocytopenia
- Renal failure)

50
Q

Features of thrombotic thrombocytopenia purpura

A 
 Fever
 CNS signs: confusion, seizures 
 MAHA
 Thrombocytopenia
 Renal failure
51
Q

Presentation of PKD

A 
MISSHAPES
 Mass: abdo mass and flank pain
 Infected cyst
 Stones
 sBP↑
 Haematuria or haemorrhage into cyst
 Aneurysms: berry → SAH
 Polyuria + nocturia
 Extra-renal cysts: liver
 Systolic murmur: mitral valve prolapse
52
Q

Common type of renal stones

A

Calcium oxalate

53
Q

Ix and Mx of renal stones

A

Ix - Spiral non-contrast CT-KUB

Rx - Extracorporeal Shockwave Lithotripsy

54
Q

Features, +ve and -ve of haemodialysis

A

Blood is passed over a semi-permeable membrane against
dialysis fluid flowing in the opposite direction, diffusion of small solutes occurs down the concentration gradient.

+ve - 4 dialysis free days a week
-ve- Disequilibration syndrome, hypotension, time consuming, access problems (AV fistula: thrombosis, stenosis, infection, blockage), fluid restrictions

55
Q

Peritoneal dialysis features, +ve and -ves.

A

Uses the peritoneum as a semi-permeable membrane. Catheter is inserted into the peritoneal cavity and fluid infused, allowing solutes to diffuse slowly across. -

+ve – easily learned; allows mobility; CVS stability; less fluid/food restrictions
-ve – frequent exchanged (~ 4 x day); frequent failure; high revenue costs; EPO injection; body image, PD peritonitis, exit site infection, loss of membrane function over time

56
Q

Presentation of hyponatraemia

A
  • n&v, anorexia, malaise, lethargy, headache, confusion irritable
  • muscle cramps dn seizures
  • coma, death
57
Q

Mx of hyponatraemia

A
  • Rx cause
  • replace Na and water slowly (se central potine myelinosis)
    0 acute 1mM/h and chronic 10mM/d
  • if asymptomatic and chronic - fluid restrict
  • symoptomatic/ dehydrated - 0.9% NS
  • hypervolaemia - +/- furosemide
  • seizure/coma - hypertonic saline
58
Q

Causes of hyponatramia

A
  • hypovolaemia
    > renal loss - diuretics, addisons, renal failure, osmotic diuresis
    > extra-renal loss - d&v, fistula, SNO, burns
  • hypervolaemia
    > cardiac/ renal/ liver failure
    > nephrotic sun
  • Euvolaemia
    > increased osmolality urine - SIADH
    > decreased osmolality urine - water overload, severe hypothyroidism, gluco-corticoid insufficiency
59
Q

Presentation of hypernatraemia

A
  • thirst
  • lethargy
  • weakness
  • irritable
  • conufsion
  • fit/coma
  • dehydratino
60
Q

Causes of hypernatraemia

A
  • hypovolaemia - d&v, diuretics, osmotic diuresis, sweat, burns
  • euvolaemia - reduced fluid intakem DI, fever
  • hypervolaemia - ↑ Aldosterone (↑ BP and hypokaelaemia), hypertonic saline
61
Q

Mx of hypernatraemia

A
  • water
  • 5% dextrose IV/ 0.9% NS (hypovolaemic)
  • reduce na by 12mm/d (too fast - cerebral oedema)
62
Q

SIADH - features, causes and Rx

A
  • ↑ NA and ↑ osmolality of urine, (opp in blood), no oedema

causes
- resp - SCLC, pneumonia, TB
CNS - meningo-encephalitis, head injury, SAH
Hypothyroidism
Cyclophosphamide, SSRI, CBZ, Amitriptyline

Rx - treat cause and fluid restrict
- +/- vaptans

63
Q

Symptoms and causes of Diabetes insipidus

A
  • polyuria, polydipsia, dehydration

Causes

  • nephrogenic - inherited, high ca, Li, obstructive uropathy
  • cranial - idiopathic, tumour, trauma, haemorrhage, meningoencephalitis
64
Q

Ix and Rx of DI

A

Ix - ↑ Na, dilute urine
- water deprivation test

Rx - desmopressin if cranial

65
Q

Signs and symptoms of hyperkalaemia

A
  • fast, irregular pulse
  • chest pain
  • palpitations
  • weakness
  • light-headedness
66
Q

Treatment of hyperkalaemia

A
  • NON-URGENT - review meds and rx cause
  • calcium resonium PO

URGENT

  • ECG changes/ >6.5
  • SENIOR HELP
  • 10mL calcium chloride (10%) IV over 5 min
  • 50mL of 50% glucose and 10u actrapid over 5-15 min
  • salbutamol 5mg NEB
  • +/- haemofiltration
  • calcium resonium (+lactulose)
67
Q

Signs and symptoms of hypokalaemia

A
  • muscle weakness
  • hypotonia
  • hyporeflexia- constipated
  • cramps
  • tetany
  • palpitations
  • light-headed
68
Q

ECG changes in hypokalaemia

A
  • small/inverted T waves
  • prominent U waves
  • Long PR and QT
  • depressed ST
69
Q

Causes and treatment of hypokalaemia

A

causes -

  • increased excretion - diuretics, v&d, cushings, steroids, ACTH, Conn’s, pyloric stenosis, purgative abuse, renal tubular disorder, fistula
  • internal distribution - increase insulin; beta agonist; alkalosis
  • reduced input - inappropriate IV fluids

Treatment

  • replace magnesium
  • mild - oral K+ supplement - >80mmol/d
  • severe - IV KCl 10mmol/h - central if possible
70
Q

Causes of hyperkalaemia

A
  • artefact –> haemolysis; leucko/thrombocytosis; drip arm
  • Internal distribution –> acidosis; reduced insulin; B-b
  • Release from cell –> rhabdomyolysis; burns; tumour lysis syndrome
  • Increased intake –> massive blood transfusion; oral
  • decreased excretion –> - oliguric renal failure; addisons; K+ sparing diuretics; ACEi; NSAIDs
71
Q

Symptoms of hypocalcaemia

A 
Spasm(trousseaus)
Periorbital paraesthesia
Anxious/irritable
Seizure and tetany
Muscle tone ↑ (colic, dysphagia, wheeze)
Orientation impaied
Dermatitis
Impetigo herpetiformis
Chovsteks and cardiomyopathy (long QT)
72
Q

Causes of hypocalcaemia

A
  • ↑ PO4
    CKD; hypoparathyroid; acute rhabdomyolysis; ↓ Mg, Pseudohypoparathyroidism
  • ↓PO4
    Vit D def, Osteomalacia, (ALP ↑), Acute pancreatitis, over-hydration, resp alkalosis
73
Q

ECG changes and Mx hypocalcaemia

A

ECG - long QT

mild - Ca - 5mmol/6h PO (CKD - alfacalcidol)
severe - 10mL or 10% calcium gluconate IV over 30 min
- correct alkalosis

74
Q

Symptoms of hypercalcaemia

A 
Bones -pain, pathological #
Stones - renal
Moans - depression, confusion
Thrones - polyuria and dipsia
Groans - abdo pain, vom and constipaton, pancreatitis, PUD

+ HTN and pyrexia

75
Q

Causes of hypercalcaemia

A
  • ↑ albumin - cuffed specimen
  • ↑ urea - dehydrated

↓/- albumin
- ↑ PO4
and ALP ↑ - bone met, sarcoid, thyrotoxicosis, Li
Normal ALP - myeloma, raised vit d, sarcoid, ↑ HCO3 ↓PO4 - 1/3 hyperparathyroid

76
Q

ECG and Mx hypercalcaemia

A
  • short QT interval
  • Correct dehydration - IV fluids
  • Bisphosphonates infuse slowly (SE - flu, myalgia, n,v, low Mg, low Ca, low PO4, bone pain, seizures)
  • malignancy - chemo
77
Q

Signs and symptoms of anaemia

A

Symptoms

  • palpitation
  • fatigue
  • SOB
  • faintness
  • headache
  • tinnitus

Signs

  • angular stomatitis
  • conjunctival pallor
  • tachycardia
  • flow murmur
  • glossitis
  • koilonychia
78
Q

Causes of microcytic anaemia

A 
Thalaessmia
Anaemia of chronic disease
Iron def
Lead poisoning
Sideroblastic
79
Q

Causes of normocytic anaemia

A 
Anaemia of chronic disease
Haemolysis
Acute blood loss
BM failure
Renal failure
Hypothyroidism
Pregnancy
80
Q

Causes of macrocytic anaemia

A
  • B12 and folate def
  • Alcohol
  • retioculocytosis
  • cytotoxics
  • BM failure
  • Hypothyroidism
  • Pregnancy
81
Q

Causes of iron, b12 and folate deficiency

A
  • reduced intake diet, malabsorption (gastretomy/coeliacs (CD - folate and B12)),
  • increased utilisation - growth, pregnancy (tapeworm - b12)
  • pernicious anaemia (AI against intrinsic factor)
  • loss iron- GI bleed, menorrhagia
    DRUGS
    folate def - trimethoprim, methotrexate, sulphasalazine
    B12 def - metformin NO
    Iron def - cimetidine, rantidine
82
Q

Causes of anaemia of chronic disease

A

malignancy
infection - TB
Renal failure
Inflammation - RA, temporal arteritis

83
Q

Drugs that iron reduces absorption of

A 
tetracycline
Quinolones
bisphosphonates
levodopa
levothyroxine
84
Q

Causes and ix of haemolytic anaemia

A

Inherited - sickle cell, thalassaemia, spherocytosis, G6PD def, PK def

Acquired - AIHA, drug induce, DIC, TTP, physical damage/heart valves, lead, malaria

Ix - ↑ reticulocytes, ↑ unco bilirubin, ↑ LDH, ↑ urinary urobilinogen
- ↓ free haptoglobin (removed RBC intravascularly)

85
Q

Average daily requirements for an adult

A

25-30ml/kg/d water
1mmol/kg/d Na/K/Cl
50-100g glucose

IPE (9 decks)

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