Us and Es

Question 1

give three renal causes for hyponatraemia

Answer 1

diuretics, adrenal insufficiency, nephropathy

Question 2

Give three non-renal and non-endocrine causes of hyponatraemia

Answer 2

vomiting, ccf, cirrhosis

Question 3

Give three endocrine causes of hyponatraemia

Answer 3

SIADH , Addison’s, Hypothyroidism

Question 4

What is the commonest cause of hyPERnatraemia?

Answer 4

dehydration

Question 5

Name two endocrine causes for hyPERnatraemia

Answer 5

Conn’s Syndrome, Diabetes Insipidus

Question 6

Name three causes for hyPOkalaemia

Answer 6

Loop diuretics, diarrhoea, metabolic acidosis, Conn’s

Question 7

What ECG changes would be seen in hyPOkalaemia?

Answer 7

flat, broad T waves with ST depression, increased QT interval and ventricular dysrhythm

Question 8

What is the main cause of pseudohyPERkalaemia?

Answer 8

cell lyses (artefactual/rhabdomyolysis)

Question 9

Give four causes of true hyPERkalaemia

Answer 9

Renal Failure; K+ sparing diuretics, ACEI and diuretics, DKA and Addison’s

Question 10

What are the four steps for management of hyPERkalaemia?

Answer 10

1) calcium gluconate (protects cardiac myocytes)
2) dextrose and insulin (gets K+ into cells)
3) nebulised Salbutamol (drives K+ into cells)
4) calcium resonium (ultimate tx but takes a while to work)

Question 11

What ECG changes would be seen in hyPERkalaemis?

Answer 11

tented t waves, QRS broadening, loss of p waves - NB - cardiac arrest rhythm

Question 12

What are the main sx of hyponatraemia?

Answer 12

confusion, convulsions, fatigue

Question 13

What are the main sx of hypernatraemia?

Answer 13

those of dehydration + myoclonic jerks + techycardia + weakness

Question 14

Give four causes for low Urea

Answer 14

Malnourishment, ALD, AN

Question 15

What is the ultimate end product of protein metabolism?

Answer 15

Urea

Question 16

What is the end product of muscle metabolism?

Answer 16

Creatinine

Question 17

Give two actions of ADH

Answer 17

vasoconstriction + water reabsolrbtion

Question 18

Give two actions of Aldosterone

Answer 18

K+ Secretion and Na+ reabsorption

Question 19

What is the normal ratio between urea:creatinine?

Answer 19

1:10

Question 20

Increased urea with normal(ish) creatinine is indicative of what?

Answer 20

Dehydration

Question 21

What findings in Urea and Creatinine would you get in AKI?

Answer 21

Urea is normal(ish) but Creatinine is greatly increased

Question 22

What is the likely underlying cause of grossly elevated, urea, normalish creatining, decreased Hbg and increased platelets and WBC?

Answer 22

Upper GI bleed.

Question 23

What causes pre-renal AKI?

Answer 23

intravascular volume depletion - afferent vasoconstriction and/or efferent vasodilation: eg as a result of diuretics, dehydration, shock

Question 24

What causes renal AKI?

Answer 24

damage to the parenchyma. eg through Abx (vancomycin) Glomerulonephritis or NSAIDS

Question 25

What are the causes of post-renal AKI?

Answer 25

ureteric obstruction (inc prostate), retention

Question 26

What life threatening condition must be avoided in correction of hyponatraemia and how is this achieved?

Answer 26

Pontine Myelinolysis - avoided by not correcting too quickly